erenumab

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: calcitonin gene-related peptide receptor antagonists, monoclonal antibodies

Indications ⬆ ⬇

REMS

Migraine prevention.

Action ⬆ ⬇

Monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor, which reduces the neuroinflammatory and vasodilatory effects of CGRP.

Therapeutic effects:

Reduction in frequency of migraines.

Pharmacokinetics ⬆ ⬇

Absorption: 82% absorbed following SUBQ administration.

Distribution: Some tissue distribution.

Metabolism/Excretion: Low concentrations: Eliminated through saturable binding to CGRP receptor; High concentrations: Eliminated through nonspecific, nonsaturable proteolytic pathway.

Half-Life: 28 days.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
SUBQ	unknown	6 days	1 mo

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Hypertension;
Raynaud phenomenon;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Choose dose carefully in older adults, considering concurrent disease states, drug therapy, and age-related ↓ in hepatic and renal function.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, Raynaud phenomenon

GI: constipation

Local: injection site reactions

MS: muscle spasm

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

Medications that GI motility may ↑ risk of more severe constipation.

Route/Dosage ⬆ ⬇

SC (Adults ): 70 mg once monthly; may ↑ dose, if needed, to 140 mg once monthly.

Availability ⬆ ⬇

Solution for injection (prefilled syringes and autoinjectors): 70 mg/mL; 140 mg/mL

Assessment ⬆ ⬇

Assess frequency and intensity of migraines. Evaluate efficacy after a minimum of 3 consecutive months of treatment and continue as long as needed. May consider trial off of treatment on case-by-case basis after 12–18 mo.
Assess for latex allergy. Needle shield within white or orange cap of prefilled autoinjector and gray needle cap of prefilled syringe contain dry natural rubber (a derivative of latex); may cause allergic reactions in individuals sensitive to latex.
Monitor for new-onset hypertension or worsening of pre-existing hypertension. May require discontinuation.
Monitor for signs and symptoms of hypersensitivity reactions (rash, urticaria, pruritus, flushing, dizziness, vomiting, abdominal pain) and angioedema (swelling of throat, lips, tongue, or face; dyspnea; wheezing; hoarseness); usually occur within hours of injection but can occur >1 wk after injection. If reaction is severe, discontinue erenumab and treat as needed.
Monitor for signs and symptoms of severe constipation, especially if on concurrent medications that ↓ GI mobility; manage as needed.
Monitor for Raynaud phenomenon and recurrence or worsening of pre-existing Raynaud phenomenon. May require discontinuation.

Implementation ⬆ ⬇

SC: Prior to use, allow vial to sit at room temperature for ≥30 min; protect from direct sunlight. Do not use other methods to warm solution (hot water or microwave). Do not shake. Solution is clear to opalescent, colorless to light yellow; do not administer solutions that are discolored, cloudy, or contain particulates. Store in refrigerator in original carton to protect from light; do not freeze. May be stored up to 7 days at room temperature.
- Inject entire contents into abdomen, thigh, or upper arm. Do not inject into areas where the skin is tender, bruised, red, or hard.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of erenumab. Instruct patient to take as directed. Administer missed doses as soon as possible and schedule next dose 1 mo from last dose administered. Educate patient and/or caregiver on correct technique for injection and disposal of equipment. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
Instruct patient to notify health care provider immediately or call 911 if signs and symptoms of hypersensitivity reaction (swelling of face, mouth, tongue, or throat; trouble breathing; rash) occur.
Advise patient to notify health care provider if severe constipation occurs; may cause serious complications.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Inform patient of pregnancy registry that monitors outcomes in women exposed to erenumab. Encourage patients to enroll by calling 1-833-244-4083 or visiting www.genesispregnancyregistry.com.

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Pronunciation ⬇

Classifications ⬆ ⬇