siltuximab

Contraindicated in:

Hypersensitivity;
Severe infections
OB: Pregnancy (↑ risk of infection in infants);
Lactation: Lactation.

Use Cautiously in:

End stage renal disease or severe hepatic impairment;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may be more sensitive to drug effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, hypotension

Derm: pruritus, rash, dry skin, eczema, psoriasis, skin hyperpigmentation

F and E: dehydration

GI: abdominal pain/distention, diarrhea, ↓appetite, GI PERFORATION, constipation, oropharyngeal pain

GU: renal impairment

Hemat: thrombocytopenia

Metab: hyperuricemia, weight gain, ↑lipids

MS: musculoskeletal pain

Neuro: fatigue, headache

Misc: ↑risk of infection, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), infusion reactions

Interactions ⬆ ⬇

Drug-drug:

May ↓ immune response to live vaccines (avoid administration)
May restore function of CYP450 enzyme and ↑ metabolism of CYP450 substrates (including CYP3A4) especially those with narrow therapeutic indices, including atorvastatin, cyclosporine, hormonal contraceptives, lovastatin, theophylline and warfarin; careful monitoring is recommended during and for several wk after treatment with siltuximab.

Availability ⬆ ⬇

Lyophilized powder for injection : 100 mg/vial; 400 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults ): 11 mg/kg every 3 wks.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to interleukin-6 (IL-6) preventing binding to IL-6 receptors. MCD is associated with overproduction of IL-6.

Therapeutic effects:

Decreased tumor load and manifestations of MCD including infections, fevers, weight loss, fatigue and night sweats.

Classifications ⬆ ⬇

Therapeutic Classification: orphan drugs

Pharmacologic Classification: interleukin antagonists

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Used up in the binding process.

Half-Life: 20.6 days (range 14.2–29.7 days)

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose of siltuximab to patient. Advise patient to read Patient Information prior to starting therapy and before each infusion in case of changes.
Advise patient to notify health care professional at risk for GI perforation (have or have had any stomach or bowel (intestine) problems, such as diverticulitis or ulcers) or if pain in stomach area occurs.
Advise patient to notify health care professional if signs and symptoms of infection or allergic reactions (difficulty breathing, chest tightness, wheezing, severe dizziness or light-headedness, swelling of the lips or skin rash) occur.
Advise patient to avoid receiving live vaccines during therapy.
Advise patient to consult health care professional before taking other Rx or OTC medications, vitamins, or herbal products
Rep: Caution females of reproductive potential to use effective contraception and to avoid breastfeeding during and for at least 3 mo following therapy.

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Indications ⬇

Contraind./Precautions ⬆ ⬇