Adult Dosing

Relapsing forms of multiple sclerosis

Avonex

• Week 1: 7.5 mcg IM qwk
• Week 2: 15 mcg IM qwk
• Week 3: 22.5 mcg IM qwk
• Week 4+: 30 mcg IM qwk
• Max: 30 mcg qwk

Rebif

• Target dose of 22 mcg SC 3 times/wk:
• Start: 4.4 mcg SC 3x/wk x2wks, then increase to 11 mcg SC 3x/wk x2wks, then increase to maintenance dose of 22 mcg SC 3x/wk

• Target dose of 44 mcg SC 3 times/wk:
• Start: 8.8 mcg SC 3x/wk x2wks, then increase to 22 mcg SC 3x/wk x2wks, then increase to maintenance dose of 44 mcg SC 3x/wk

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of patients with relapsing forms of multiple sclerosis to decrease the frequency of clinical exacerbations and delay the accumulation of physical disability

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined, caution advised

• Cautiously administer in conditions common with multiple sclerosis such as depression or other mood disorders. Depression and suicide have been reported with the use of therapy
• Therapy may cause anaphylactic reactions or allergic reactions including dyspnea, orolingual edema, skin rash and urticaria
• Decreased peripheral blood counts along with pancytopenia and thrombocytopenia have also been reported. Therefore closely monitor for signs of these disorders
• Hepatic injury, hepatic failure and symptomatic elevation of hepatic transaminases have also been reported
• Carefully prescribe in patients with history of seizures, and cardiac disease such as angina, congestive heart failure, or arrhythmia

Cautions: Use cautiously in

• Hx of seizure disorders
• Hepatic impairment
• Cardiomyopathy
• Congestive Heart Failure
• Autoimmune Disorders

Pregnancy Category:C

Breastfeeding: Safety unknown. The amount of the drug excreted in milk is very low. Any interferon in breastmilk is probably destroyed in the infant's gastrointestinal tract and not absorbed, except perhaps in neonates. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 May 2011). Maternal medication usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 12 May 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.

• CNS: Seizures, dizziness, fatigue, headache, drowsiness, rigors
• PSYCHIATRIC: Psychiatric disorder, suicidal ideation
• NEURO: Paresthesias, myasthenia
• EENT: Sinusitis, vision abnormalities
• RESP: Upper respiratory tract infection
• CV: Chest pain, CHF, cardiomyopathy, vasodilation
• GI: Abdominal pain, nausea, autoimmune hepatitis, dry mouth, elevated liver function studies
• HEPA: Hepatotoxicity, hepatic failure, elevated liver transaminases
• GU: Urinary tract infection, urinary incontinence, polyuria
• DERM: Alopecia, rash
• ENDO: Hyperthyroidism, hypothyroidism, spontaneous abortion
• IMMU: Autoimmune disorders, autoimmune hepatitis
• HEMA: Neutropenia, anemia, thrombocytopenia, pancytopenia
• LOCAL: Injection-site reactions, injection site necrosis
• MUSC: Myalgia, arthralgia, back pain, muscle spasm, hypertonia
• MISC: Allergic reactions including anaphylaxis, chills, fever, flu-like symptoms, pain, viral transmission risk

• Interferon; exact mechanism of action unknown. In response to viral infection and other biological inducers, it mediates antiviral, antiproliferative and immunomodulatory activities
• 50% absorbed following SC administration
• Metabolism: Unknown
• Excretion: Unknown
• Half-life:
• IM: 10 hrs
• SC: 69 hrs

US Trade Name(s)

• Avonex
• Rebif

US Availability

Avonex

• PWDR for INJ (kit): 30 mcg/vial

Rebif

• INJ (prefilled syringes): 22 mcg/0.5 mL
• INJ (prefilled syringes): 44 mcg/0.5 mL

Canadian Trade Name(s)

• Avonex
• Rebif

Canadian Availability

Avonex PS

• INJ (prefilled syringes): 30 mcg/0.5 mL

Avonex PEN

• INJ (prefilled syringes): 30 mcg/0.5 mL (autoinjector)

Rebif

• INJ (prefilled syringes): 8.8 mcg/0.2 mL
• INJ (prefilled syringes): 22 mcg/0.5 mL
• INJ (prefilled syringes): 44 mcg/0.5 mL
• INJ (prefilled syringes): 132 mcg/1.5 mL

UK Trade Name(s)

• Avonex
• Rebif

UK Availability

Avonex

• PWDR for INJ: 30 mcg/vial

Rebif

• INJ (prefilled syringes): 8.8 mcg/0.1 mL
• INJ (prefilled syringes): 22 mcg/0.2 mL
• INJ (prefilled syringes): 22 mcg/0.5 mL
• INJ (prefilled syringes): 44 mcg/0.5 mL

Australian Trade Name(s)

• Avonex
• Rebif

Australian Availability

Avonex

• PWDR for INJ: 30 mcg/vial

Rebif

• INJ (prefilled syringes): 22 mcg/0.5 mL
• INJ (prefilled syringes): 44 mcg/0.5 mL

[Outline]

Allergy & Immunology

Interferons

Neurologic

Multiple Sclerosis Agent

Immune Response Modifiers

Pricing data from www.DrugStore.com in U.S.A.

• Rebif Titration Pack 6X8.8 & 6X22 MCG SOLN [Box] (SERONO)
  4.2 mcg = $2872.13
  12.6 mcg = $8568.2
• Avonex 30 MCG/VIAL KIT [Box] (BIOGEN IDEC)
  4 vial = $3638.02
  12 vial = $10755.34
• Rebif 22 MCG/0.5ML SOLN [Box] (SERONO)
  6 0.5ml = $3063.93
  18 0.5ml = $9112.81
• Avonex Prefilled 30 MCG/0.5ML KIT [Box] (BIOGEN IDEC)
  4 0.5ml = $3447.99
  12 0.5ml = $10242.97
• Rebif 44 MCG/0.5ML SOLN [Box] (SERONO)
  6 0.5ml = $3204.01
  18 0.5ml = $9570.85

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.