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Interactions
Drug-Drug: May decrease the antibody response to andqadverse reactions from
1
rilonacept (ri-lon-a-sept)
live vaccines; vaccination should take place prior to initiation of treatment. Concurrrent use with TNF inhibitorsqrisk of serious infections and is not recommended.
Medications that are substrates of the CYP450 enzyme system, especially
those with narrow therapeutic indices such as warfarin should be monitored carefully as enzyme activity may increase (normalize) as a result of treatment.
Arcalyst
Classification
Therapeutic: orphan drugs
Pharmacologic: fusion proteins, interleukin antagonists
Pregnancy Category C
Route/Dosage
Indications
Treatment of Cryopyrin-Associated Periodic Syndromes (CAPS), including Familial
Cold Autoinflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS).
Action
Modulates cryopyrin by blocking interleukin-1 beta (IL-1␤) preventing its interaction with surface receptors. Therapeutic Effects: Decreased inflammatory manifestations of CAPS including fever, rash, arthralgia, myalgia, fatigue and conjunctivitis.
Pharmacokinetics
Absorption: Absorbed following subcutaneous administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.
● Assess for signs of infections. Discontinue therapy if serious infection occurs. Do
not administer to patients with active or chronic infections.
● Assess for signs of hypersensitivity reactions; institute symptomatic therapy.
● Lab Test Considerations: Monitor lipid profiles every 2– 3 mo during therapy.
Risk for infection (Adverse Reactions)
ONSET
PEAK
DURATION
Subcut
within several days
unknown
unknown
Contraindications/Precautions
Contraindicated in: Active or chronic infections; OB: May cause fetal harm.
Use Cautiously in: Patients at risk of infections; Lactation: Use cautiously;
Pedi: Safety and effectiveness have not been established in children ⬍12 yr.
Adverse Reactions/Side Effects
Resp: upper respiratory tract infections, cough. Local: injection site reactions.
Metab: changes in lipid profile. Neuro: hypoesthesia. Misc: SERIOUS LIFE-THREAT⫽ Genetic Implication.
NURSING IMPLICATIONS
Assessment
Potential Nursing Diagnoses
ROUTE
ENING INFECTIONS, hypersensitivity reactions.
Subcut (Adults ⱖ18 yr): 320 mginitially, followed by 160 mg weekly.
Subcut (Children and adolescents 12– 17 yr): 4.4 mg/kg (not to exceed 320
mg) initially, followed by 2.2 mg/kg (not to exceed 160 mg) weekly.
May causeqtotal cholesterol, HDL, LDL, and triglycerides. Consider lipid lowering
therapies as needed.
TIME/ACTION PROFILE (improvement in symptoms)
⫽ Canadian drug name.
Plate # 0-Composite
Implementation
● Administer all recommended adult and pediatric vaccinations, including pneumo-
coccal vaccine and inactivated influenza vaccine, prior to starting rilonacept therapy.
● Administer first dose under supervision of health care professional.
● Loading dose in adults is given as two 2 mL injections on the same day in 2 different
injection sites. In pediatric patients 1 or 2 injections may be used. Do not administer more than once weekly or more then 2 mL/injection site.
● Reconstitute with 2.3 mL of Sterile water for injection using a 27-gauge 1/2 inch
needle for a concentration of 80 mg/mL. Discard needle and syringe after reconstitution. Shake vial for 1 min and allow to sit for 1 min. Solution is viscous, clear,
colorless to pale yellow. Do not administer solutions that are discolored, contain
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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particulate matter, or are passed the expiration date. Withdraw recommended
dose up to 2 mL with new 27-gauge 1/2 inch needle. Vials are single use; discard
unused solution. Rilonacept must be refrigerated and protected from light. Reconstituted solution is stable for 3 hrs at room temperature.
● Subcut: Inject subcut into abdomen (avoid area within 2 inches of navel), thigh
or upper arm by pinching skin and injecting at a 90⬚ (45⬚ angle for small children
or persons with little fat). May require 30 seconds to inject entire dose. Pull needle
out of skin and hold gauze over site for several seconds. Rotate sites and avoid sites
that are bruised, red, tender or hard.
Patient/Family Teaching
● Instruct patient or family on correct technique for preparing and administering in-
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jection, and disposing of equipment. If a dose is missed, administer up to the day
before next scheduled dose. Take next dose at regularly scheduled time. Advise
patient to read Patient Information prior to starting therapy and with each Rx refill in case of new information.
Advise patient to notify health care professional immediately if signs of infection
(fever, cough, flu-like symptoms, open sores) occur during therapy.
Instruct patient to notify health care professional or seek emergency care if signs
of allergic reaction (rash, swollen face, difficulty breathing) occur.
Advise patient that injection site reactions (erythema, swelling pruritus, bruising,
inflammation, pain, edema, dermatitis, urticaria, vesicles, warmth, and hemorrhage) may occur; usually resolve in 1– 2 days. Notify health care professional if
reaction is persistent.
Instruct patient to consult health care professional prior to taking other Rx, OTC,
or herbal products.
Advise female patients to notify health care professional if pregnancy is planned or
suspected or if breast feeding.
Evaluation/Desired Outcomes
● Decrease in symptoms (rash, joint pain, fever, tiredness), decrease in and nor-
malization of serum Amyloid A (SAA) and C-Reactive Protein (CRP) levels.
Why was this drug prescribed for your patient?
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