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Mepolizumab

mepolizumab (me-poe-liz-ue-mab) Nucala Classification Therapeutic: antiasthmatics Pharmacologic: monoclonal antibodies, interleukin antagonists

Pharmacologic Profile

Indications

Add-on maintenance treatment of severe asthma that is of an eosinophilic phenotype.

Action

Interleukin-5 (IL-5) antagonist that inhibits binding of IL-5 to the surface of the eosinophil, which reduces the production and survival of eosinophils. Therapeutic Effects: Decreased incidence of asthma exacerbations. Reduction in use of maintenance oral corticosteroid therapy.

Pharmacokinetics

Absorption: 80% absorbed following subcut administration. Distribution: Minimally distributed to tissues. Metabolism and Excretion: Degraded by proteolytic enzymes located throughout the body. Half-life: 16–22 days.

Time-Action Profile

ROUTE	ONSET	PEAK	DURATION
Subcut	unknown	unknown	unknown
(blood levels)

Contraindications and Precautions

Contraindicated in: Hypersensitivity; Acute bronchospasm or status asthmaticus. Use Cautiously in: Obstetric: Pregnancy; expected to cross the placenta (potential effects likely to be greater during 2nd and 3rd trimesters); Lactation: No information regarding presence of drug in human breast milk; benefits of breast feeding need to be evaluated against any potential risks to infant.

Adverse Reactions and Side Effects

CNS: headache. Derm: flushing, rash. MS: back pain, myalgia. Misc: hypersensitivity reactions, fatigue, herpes zoster infection, injection site reactions.

Interactions

Drug-Drug: None known.

Route and Dosage

Subcutaneous (Adults and Children ≥12 yr): 100 mg every 4 wks.

Availability

Powder for injection (requires reconstitution): 100 mg/vialRx

Nursing Implications

Assessment

• Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) periodically during therapy. • Monitor for signs and symptoms of hypersensitivity reactions (anaphylaxis, angioedema, bronchospasm, urticaria, rash) following injection. Reactions usually occur within hrs, but may have a delayed onset (days). Discontinue mepolizumab if hypersensitivity reaction occurs. • Assess for and treat parasitic infections prior to therapy. If infected during therapy and unresponsive to anti-helminth treatment, discontinue mepolizumab until infection resolves.

Potential Nursing Diagnoses

Ineffective breathing pattern (Indications)

Implementation

• Only administer in a health care setting by a health care professional able to manage anaphylaxis. Mepolizumab is for prevention; do no use to treat acute bronchospasm or status asthmaticus. • Consider administration of varicella vaccination prior to starting therapy. • Do not abruptly stop systemic or inhaled corticosteroids when starting therapy. May ↓ corticosteroids doses gradually under direct supervision of health care professional. Corticosteroid ↓ may lead to systemic withdrawal symptoms and/or unmask conditions previously suppressed. • Reconstitute in vial with 1.2 mL of sterile water for injection using a 2– or 3–mL syringe and a 21–gauge needle for a concentration of 100 mg/mL. Direct stream into center of cake. Swirl gently for 10 sec until powder is dissolved; do not shake. Reconstitution takes 5 min or more. Solution is clear to opalescent and colorless to pale yellow or pale brown; do not administer if solution is discolored, cloudy, or contains particles. Stable for 8 hr if refrigerated. • Subcutaneous: Administer 1 mL once every 4 wks into upper arm, thigh, or abdomen.

Patient/Family Teaching

• Instruct patient to read Patient Information before starting therapy. • Inform patient of risk and signs and symptoms of anaphylaxis. Instruct patient to notify health care professional immediately if signs and symptoms of hypersensitivity reactions (swelling of face, mouth, tongue, fainting, dizziness, feeling lightheaded, hives, breathing problems, rash) occur. • Advise patient to notify health care professional if asthma remains uncontrolled or worsens after starting therapy. • Caution patient not to reduce corticosteroid dose unless instructed by health care professional. • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications. • http://www.mothertobaby.org/asthma

Evaluation/Desired Outcomes

• Decreased incidence of asthma exacerbations and reduction in use of maintenance oral corticosteroid therapy.

= Canadian Drug Name. *CAPITALS indicate life threatening; Dashed indicates most frequent.

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