Home Drug Guide Eculizumab

Drug Guide

Generic Name

Eculizumab

Brand Names Soliris

Classification

Therapeutic: Immunosuppressant; Complement inhibitor

Pharmacological: Monoclonal antibody

FDA Approved Indications

  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Atypical hemolytic uremic syndrome (aHUS)
  • Generalized myasthenia gravis (gMG) in adults with anti-acetylcholine receptor antibodies
  • Complement-mediated complement inhibitor in pediatric patients with aHUS

Mechanism of Action

Eculizumab is a monoclonal antibody that binds to the complement protein C5, preventing its cleavage into C5a and C5b, thereby inhibiting the formation of the membrane attack complex (MAC) and reducing complement-mediated cell destruction.

Dosage and Administration

Adult: Initial dose of 900 mg IV weekly for 4 weeks, followed by 1200 mg at week 5, then 1200 mg every 2 weeks.

Pediatric: Dosing varies based on weight and condition; specific protocols are provided in FDA labeling.

Geriatric: No specific adjustments required; use caution and monitor therapy.

Renal Impairment: No dosage adjustment needed.

Hepatic Impairment: No specific dosage adjustments established.

Pharmacokinetics

Absorption: Administered via intravenous infusion; bioavailability unknown.

Distribution: Widely distributed in body tissues and fluids.

Metabolism: Metabolized via proteolytic degradation into small peptides and amino acids.

Excretion: Excreted primarily through proteolytic catabolism.

Half Life: Approximately 11 days.

Contraindications

  • Hypersensitivity to eculizumab or excipients.

Precautions

  • Increased risk of meningococcal infections; vaccination against Neisseria meningitidis required prior to treatment. Risk of infections, especially meningococcal, should be carefully managed. Monitor for signs of infection; consider prophylactic antibiotics in some cases.

Adverse Reactions - Common

  • Headache (Common)
  • Hair thinning or alopecia (Uncommon)
  • Nausea (Common)
  • Back pain (Uncommon)
  • Infusion reactions (Uncommon)

Adverse Reactions - Serious

  • Meningococcal meningitis (Serious and potentially life-threatening, very rare without vaccination)
  • Severe allergic reactions including anaphylaxis (Rare)
  • Serious infections from encapsulated bacteria (Serious, depends on vaccination status.)

Drug-Drug Interactions

  • No significant interactions identified with other drugs.

Drug-Food Interactions

  • No specific interactions reported.

Drug-Herb Interactions

  • Limited data; standard precautions advised.

Nursing Implications

Assessment: Monitor for signs of infection, especially meningococcal infection. Assess for allergic reactions during and post-infusion. Ensure vaccination status is current.

Diagnoses:

  • Risk for infection related to immunosuppression.
  • Potential allergic reaction related to infusion.

Implementation: Administer via infusion with appropriate premedication if necessary. Confirm meningococcal vaccination at least 2 weeks prior to first dose. Observe during and after infusion for adverse reactions.

Evaluation: Monitor patient's response, infection signs, and adherence to vaccination protocol.

Patient/Family Teaching

  • Ensure meningococcal vaccination prior to therapy.
  • Report any signs of infection such as fever, headache, or neck stiffness.
  • Understand infusion schedule and importance of adherence.
  • Be aware of potential allergic reactions during infusions.

Special Considerations

Black Box Warnings:

  • Serious infections, including meningococcal infections, which can be fatal. Vaccination is mandatory before initiation of therapy.
  • Increased risk of infections due to complement inhibition.

Genetic Factors: Eculizumab may be less effective in individuals with certain complement gene variants but generally used across populations without genetic screening.

Lab Test Interference: Potential for suppressed complement activity; may affect diagnostic tests involving complement.

Overdose Management

Signs/Symptoms: Potential infusion-related reactions, increased risk of infection.

Treatment: Supportive care; no specific antidote. Discontinue infusion and provide supportive treatment as needed.

Storage and Handling

Storage: Store refrigerated at 2-8°C. Do not freeze.

Stability: Stable until the expiration date on the label when stored properly. Protect from light.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.