Home Drug Guide Guselkumab

Drug Guide

Generic Name

Guselkumab

Brand Names Tremfya

Classification

Therapeutic: Immunomodulator, Antirheumatic, Biologic

Pharmacological: Interleukin-23 (IL-23) inhibitor

FDA Approved Indications

  • Plaque psoriasis in adults
  • Active psoriatic arthritis in adults

Mechanism of Action

Guselkumab is a human monoclonal antibody that binds selectively to the p19 subunit of interleukin-23 (IL-23), inhibiting its interaction with the IL-23 receptor, thereby reducing inflammation associated with psoriasis and psoriatic arthritis.

Dosage and Administration

Adult: Initial dose of 100 mg by subcutaneous injection at week 0, week 4, then every 8 weeks.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment; monitor for increased risk of infections.

Renal Impairment: No specific adjustment needed.

Hepatic Impairment: No specific adjustment needed.

Pharmacokinetics

Absorption: Subcutaneous absorption; maximum concentration achieved in about 4-7 days.

Distribution: Limited to vascular and interstitial spaces.

Metabolism: Catabolized into small peptides and amino acids.

Excretion: Via normal protein degradation pathways.

Half Life: Approximately 15-18 days.

Contraindications

  • Hypersensitivity to guselkumab or any excipients.

Precautions

  • Risk of infections, including tuberculosis, cancer, hypersensitivity reactions. Use with caution in patients with active infections or a history of recurrent infections. Not recommended during pregnancy unless benefits outweigh risks. Immunogenicity may develop.

Adverse Reactions - Common

  • Upper respiratory infections (Occasional)
  • Headache (Common)
  • CMR (cell-mediated immune response) reactions (Less common)

Adverse Reactions - Serious

  • Serious infections such as tuberculosis, sepsis (Rare)
  • Hypersensitivity reactions including anaphylaxis (Rare)
  • Malignancies (Infrequent, long-term safety data ongoing)

Drug-Drug Interactions

  • No clinically significant interactions identified.
  • Monitor when used with immunosuppressants or live vaccines.

Drug-Food Interactions

  • No known food interactions.

Drug-Herb Interactions

  • No known herbal interactions.

Nursing Implications

Assessment: Monitor for signs of infection, TB screening recommended before initiation.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity

Implementation: Administer subcutaneously as prescribed, monitor injection sites, educate patients on infection signs.

Evaluation: Monitor for effectiveness in skin clearance or symptom reduction, assess adverse reactions.

Patient/Family Teaching

  • Report signs of infection or unusual symptoms immediately.
  • Adherence to injection schedule.
  • Avoid live vaccines during therapy.
  • Discuss pregnancy planning with healthcare provider.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis, and malignancy

Genetic Factors: Limited data, no specific genetic considerations.

Lab Test Interference: Possibly false-positive tuberculosis tests; screening recommended prior to therapy.

Overdose Management

Signs/Symptoms: Potential immunosuppression leading to severe infections.

Treatment: Supportive care, infection management, no specific antidote.

Storage and Handling

Storage: Store in the refrigerator (36°F to 46°F / 2°C to 8°C). Protect from light.

Stability: Stable until expiration date when stored as recommended.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.