Home Drug Guide Ocrelizumab

Drug Guide

Generic Name

Ocrelizumab

Brand Names Ocrevus

Classification

Therapeutic: Immunosuppressant, Monoclonal Antibody

Pharmacological: Anti-CD20 Monoclonal Antibody

FDA Approved Indications

  • Relapsing Multiple Sclerosis (RMS)
  • Primary Progressive Multiple Sclerosis (PPMS)

Mechanism of Action

Ocrelizumab selectively targets CD20-positive B cells, leading to their depletion, which reduces inflammation and central nervous system damage in multiple sclerosis.

Dosage and Administration

Adult: For RMS and PPMS, 600 mg IV every 6 months, administered as two 300 mg infusions separated by 2 weeks.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment, but monitor renal function and signs of infection.

Renal Impairment: No specific adjustment recommended; monitor closely.

Hepatic Impairment: No specific data; use caution and monitor.

Pharmacokinetics

Absorption: Administered intravenously, so absorption is immediate.

Distribution: Widely distributed; volume of distribution approximately 4.8 L.

Metabolism: Metabolized through protein catabolism pathways.

Excretion: Not eliminated via urine; cleared via cellular mechanisms.

Half Life: Approximately 26 days.

Contraindications

  • Hypersensitivity to ocrelizumab or any of its components.

Precautions

  • Increased risk of infections, including serious and opportunistic infections.
  • Reactivation of hepatitis B virus.
  • Vaccinations should be given prior to initiation; live vaccines should be avoided during treatment.

Adverse Reactions - Common

  • Infusion reactions (fever, chills, rash, SOB) (Common)
  • Upper respiratory tract infections (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Infections (pneumonia, herpes zoster) (Uncommon)
  • Progressive Multifocal Leukoencephalopathy (PML) (Rare)
  • Hypersensitivity and anaphylactic reactions (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines, vaccines that may be affected by immunosuppression

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, infusion reactions, and PML.

Diagnoses:

  • Risk for infection
  • Risk for delayed infusion reactions

Implementation: Pre-medicate with corticosteroids, antihistamines, and antipyretics prior to infusion; monitor vital signs during and after infusion.

Evaluation: Assess for adverse reactions, efficacy of MS symptom control, and monitor for infections.

Patient/Family Teaching

  • Report any signs of infection or allergic reactions immediately.
  • Avoid live vaccines during treatment and for 6 months following the last infusion.
  • Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

  • Risk of PML

Genetic Factors: N/A

Lab Test Interference: May affect immunoglobulin levels and lymphocyte counts, which should be monitored.

Overdose Management

Signs/Symptoms: N/A for specific overdose; monitor for infusion reactions and signs of infection.

Treatment: Supportive care; corticosteroids or antihistamines for infusion reactions; no specific antidote.

Storage and Handling

Storage: Store in a refrigerator between 2°C and 8°C. Do not freeze.

Stability: Stable until the expiration date printed on the vial when stored properly.

🛡️ 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.