Home Drug Guide Siltuximab

Drug Guide

Generic Name

Siltuximab

Brand Names Sylvant

Classification

Therapeutic: Antineoplastic, Immunosuppressant

Pharmacological: Chimeric Monoclonal Antibody

FDA Approved Indications

  • Castleman's Disease (multicentric, HIV-negative, HHV-8-negative)

Mechanism of Action

Siltuximab binds to interleukin-6 (IL-6), preventing IL-6 from interacting with its receptor, thereby reducing inflammatory responses and tumor growth associated with cytokine-driven diseases.

Dosage and Administration

Adult: At presentation, 11 mg/kg IV every 3 weeks. Dose adjustments are not typically required. Pre-medication with antihistamines and corticosteroids is recommended to reduce infusion-related reactions.

Pediatric: Not approved for pediatric use; safety and efficacy not established.

Geriatric: No specific dosage adjustments required based on age.

Renal Impairment: No specific data; use with caution and monitor closely.

Hepatic Impairment: No specific data; use with caution, considering liver function tests.

Pharmacokinetics

Absorption: Administered IV; absorption not applicable.

Distribution: Distributed mainly in the vascular and extravascular compartments.

Metabolism: Metabolized via proteolytic pathways like other monoclonal antibodies.

Excretion: Primarily degraded into peptides and amino acids; not excreted renally.

Half Life: Approximately 16-18 days.

Contraindications

  • Hypersensitivity to siltuximab or other components.

Precautions

  • Monitor for infusion reactions, cytopenias, infections, and gastrointestinal perforation. Use caution in patients with active infections or immunosuppression.

Adverse Reactions - Common

  • Infections (e.g., upper respiratory, urinary tract) (Common)
  • Infusion reactions (fever, chills, rash) (Common)
  • Fatigue, nausea, headache (Common)

Adverse Reactions - Serious

  • Serious infections including sepsis (Less common)
  • Gastrointestinal perforation (Rare)
  • Hypersensitivity reactions (Rare)

Drug-Drug Interactions

  • No significant direct interactions reported; caution when used with other immunosuppressants.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for infusion reactions, signs of infection, blood counts, liver function tests.

Diagnoses:

  • Risk for infection
  • Knowledge deficit related to drug therapy

Implementation: Administer infusion over 60 minutes; premedicate to reduce reactions. Regularly monitor blood counts and vital signs.

Evaluation: Assess patient for adverse effects and effectiveness of symptom control.

Patient/Family Teaching

  • Report any signs of infection immediately.
  • Inform about possible infusion reactions.
  • Discuss importance of adhering to scheduled treatments and monitoring.
  • Advise on warning signs such as fever, rash, or difficulty breathing.

Special Considerations

Black Box Warnings:

  • Serious infections, including sepsis, can be life-threatening.
  • Gastrointestinal perforation has been reported.

Genetic Factors: No specific genetic testing required.

Lab Test Interference: None documented.

Overdose Management

Signs/Symptoms: Potential for immune-related adverse effects, severe infusion reactions, or infections.

Treatment: Supportive care, discontinuation of drug, and symptomatic treatment as needed.

Storage and Handling

Storage: Store refrigerated at 2-8°C (36-46°F). Protect from light.

Stability: Product stability and expiry date provided on the packaging.

🛡️ 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.