ecallantide

Therapeutic Classification: antiangioedema agents

Pharmacologic Classification: kallikrein inhibitors

Indications ⬆ ⬇

REMS

Treatment of acute attacks of hereditary angioedema (HAE).

Action ⬆ ⬇

Acts as a selective, reversible inhibitor of kallikrein, thereby inhibiting its action in initiating bradykinin production, part of the cascade of events in hereditary angioedema (HAE).

Therapeutic effects:

Decreased severity of attack of HAE.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Renally eliminated.

Half-Life: 2 hr.

Time/Action Profile ⬆ ⬇

(symptom improvement)

ROUTE	ONSET	PEAK	DURATION
SC	unknown	2–4 hr	up to 24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

OB: Other agents preferred for treatment of hereditary angioedema during pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <12 yr (safety and effectiveness not established);
Geri: Consider age-related ↓ in hepatic, renal, or cardiac function, concomitant diseases or other drug therapy in older adults; lower initial dose may be considered.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus, rash , urticaria

EENT: nasopharyngitis

GI: nausea, abdominal pain, diarrhea

Local: injection site reactions

Neuro: headache, fatigue

Misc: ANAPHYLAXIS, HYPERSENSITIVITY REACTIONS INCLUDING , fever

Interactions ⬆ ⬇

Drug-drug:

None noted.

Route/Dosage ⬆ ⬇

SC (Adults and Children ≥12 yr): 30 mg given as three 10 mg injections; an additional dose of 30 mg may be given within 24 hr.

Availability ⬆ ⬇

Solution for injection: 10 mg/mL

Assessment ⬆ ⬇

Assess for symptoms of hereditary angioedema (submucosal or SUBQ swelling) before and following treatment.
Assess for signs and symptoms of anaphylaxis (chest discomfort, flushing, pharyngeal edema, pruritus, rhinorrhea, sneezing, nasal congestion, throat irritation, urticaria, wheezing, hypotension); usually occur within 1 hr of administration.

Implementation ⬆ ⬇

Ecallantide should only be administered by a health care professional with medical support to manage anaphylaxis and hereditary angioedema.
SC: Use a large bore needle to withdraw ecallantide from vial. Change needles. Solution is clear and colorless; do not administer solutions that are discolored or contain a precipitate. Administer three 1 mL (10 mg/mL) injections using a 27 gauge needle into abdomen, thigh, or upper arm for a total dose of 30 mg. Injection site for each of the 3 injections may be in the same or different locations; no need for rotation. Separate injection sites by as least 2 inches from site of angioedema attack. If attack persists, may repeat dose, using same instructions, within 24 hrs.

Patient/Family Teaching ⬆ ⬇

Explain purpose for ecallantide and the need for administration by health care professional to patient. Advise patient to read Medication Guide prior to administration.
Caution patient of the risk for anaphylactic reaction usually within 1 hr of injection. Advise patient to notify health care professional immediately if signs and symptoms of anaphylactic reactions occur.
Inform patient that injection site reactions (local pruritus, erythema, pain, irritation, uriticaria, bruising) may occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇