Home Drug Guide Ocrelizumab

Drug Guide

Generic Name

Ocrelizumab

Brand Names Ocrevus

Classification

Therapeutic: Immunosuppressant, Monoclonal Antibody

Pharmacological: Anti-CD20 Monoclonal Antibody

FDA Approved Indications

Relapsing Multiple Sclerosis (RMS)
Primary Progressive Multiple Sclerosis (PPMS)

Mechanism of Action

Ocrelizumab selectively targets CD20-positive B cells, leading to their depletion, which reduces inflammation and central nervous system damage in multiple sclerosis.

Dosage and Administration

Adult: For RMS and PPMS, 600 mg IV every 6 months, administered as two 300 mg infusions separated by 2 weeks.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment, but monitor renal function and signs of infection.

Renal Impairment: No specific adjustment recommended; monitor closely.

Hepatic Impairment: No specific data; use caution and monitor.

Pharmacokinetics

Absorption: Administered intravenously, so absorption is immediate.

Distribution: Widely distributed; volume of distribution approximately 4.8 L.

Metabolism: Metabolized through protein catabolism pathways.

Excretion: Not eliminated via urine; cleared via cellular mechanisms.

Half Life: Approximately 26 days.

Contraindications

Hypersensitivity to ocrelizumab or any of its components.

Precautions

Increased risk of infections, including serious and opportunistic infections.
Reactivation of hepatitis B virus.
Vaccinations should be given prior to initiation; live vaccines should be avoided during treatment.

Adverse Reactions - Common

Infusion reactions (fever, chills, rash, SOB) (Common)
Upper respiratory tract infections (Common)
Headache (Common)

Adverse Reactions - Serious

Infections (pneumonia, herpes zoster) (Uncommon)
Progressive Multifocal Leukoencephalopathy (PML) (Rare)
Hypersensitivity and anaphylactic reactions (Rare)

Drug-Drug Interactions

Other immunosuppressants, live vaccines, vaccines that may be affected by immunosuppression

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, infusion reactions, and PML.

Diagnoses:

Risk for infection
Risk for delayed infusion reactions

Implementation: Pre-medicate with corticosteroids, antihistamines, and antipyretics prior to infusion; monitor vital signs during and after infusion.

Evaluation: Assess for adverse reactions, efficacy of MS symptom control, and monitor for infections.

Patient/Family Teaching

Report any signs of infection or allergic reactions immediately.
Avoid live vaccines during treatment and for 6 months following the last infusion.
Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

Risk of PML

Genetic Factors: N/A

Lab Test Interference: May affect immunoglobulin levels and lymphocyte counts, which should be monitored.

Overdose Management

Signs/Symptoms: N/A for specific overdose; monitor for infusion reactions and signs of infection.

Treatment: Supportive care; corticosteroids or antihistamines for infusion reactions; no specific antidote.

Storage and Handling

Storage: Store in a refrigerator between 2°C and 8°C. Do not freeze.

Stability: Stable until the expiration date printed on the vial when stored properly.