Nurses Compass
Drug Guide
Alemtuzumab
Classification
Therapeutic: Antineoplastic and Immunomodulator
Pharmacological: Monoclonal antibody (anti-CD52)
FDA Approved Indications
- Treatment of B-cell chronic lymphocytic leukemia (CLL)
- Relapsing multiple sclerosis (Lemtrada)
Mechanism of Action
Alemtuzumab is a monoclonal antibody that targets CD52, a protein conducted on the surface of mature lymphocytes, leading to antibody-dependent cell-mediated cytolysis and significant lymphocyte depletion, modulating immune responses.
Dosage and Administration
Adult: For CLL: 30 mg intravenously 3 times a week for 3 weeks, with prophylactic corticosteroids and antimicrobials. For MS: 12 mg IV daily for 5 consecutive days, repeated after 12 months.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution; monitor renal and hepatic function.
Renal Impairment: Adjust dosage based on renal function; close monitoring recommended.
Hepatic Impairment: No specific adjustment; monitor liver function during therapy.
Pharmacokinetics
Absorption: Administered intravenously; rapid distribution.
Distribution: Widely distributed; crosses blood-brain barrier in limited amounts.
Metabolism: Metabolized to peptides and amino acids by proteolytic degradation.
Excretion: Primarily via cellular catabolism; not renal elimination.
Half Life: Approximately 3 weeks.
Contraindications
- Hypersensitivity to alemtuzumab or its components.
- Active infections.
Precautions
- Monitor for infusion reactions, infections, autoimmune conditions, and secondary malignancies. Use with caution in patients with pre-existing autoimmune diseases or active infections.
Adverse Reactions - Common
- Infusion reactions (fever, chills, rash) (Common)
- Infections, including opportunistic infections (Common)
- Lymphopenia (Common)
Adverse Reactions - Serious
- Autoimmune disorders (e.g., immune thrombocytopenic purpura, thyroid disorders) (Serious but less common)
- Secondary malignancies, including melanoma and other skin cancers (Less common)
Drug-Drug Interactions
- Immunosuppressants, vaccines, other biologics
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor complete blood counts, liver and renal function, signs of infusion reactions, and infections.
Diagnoses:
- Risk for infection
- Impaired immune response
- Risk for autoimmune response
Implementation: Pre-medicate with antihistamines, corticosteroids, and acetaminophen to reduce infusion reactions. Ensure strict aseptic technique during administration.
Evaluation: Assess for infusion reactions, infection signs, autoimmune symptoms, and laboratory abnormalities regularly.
Patient/Family Teaching
- Report signs of infection, autoimmune symptoms, or unusual bleeding.
- Follow infection prevention measures.
- Attend regular blood tests and follow-up visits.
Special Considerations
Black Box Warnings:
- Risk of serious autoimmune conditions, including immune thrombocytopenic purpura and thyroid disorders.
- Risk of malignancies.
Genetic Factors: No specific genetic testing recommended.
Lab Test Interference: May alter lymphocyte counts; interpret with caution during and after therapy.
Overdose Management
Signs/Symptoms: Severe immunosuppression, infections, infusion reactions.
Treatment: Supportive care; corticosteroids or antihistamines for infusion reactions; antimicrobial therapy as needed; no specific antidote.
Storage and Handling
Storage: Store vials refrigerated at 2°C to 8°C.
Stability: Stable until the expiration date stated on package.