Drug Guide
Fremanezumab-vfrm
Classification
Therapeutic: Migraine prophylaxis
Pharmacological: Calcitonin gene-related peptide (CGRP) monoclonal antibody
FDA Approved Indications
- Prevention of migraine in adults
Mechanism of Action
Fremanezumab is a monoclonal antibody that binds to CGRP, a neuropeptide involved in migraine pathophysiology, thereby inhibiting its activity and reducing migraine frequency.
Dosage and Administration
Adult: Administer 225 mg subcutaneously once every month. It can be given as a single 675 mg dose (three injections of 225 mg each) once quarterly.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustments; monitor elderly patients closely.
Renal Impairment: No specific dose adjustment required.
Hepatic Impairment: No specific dose adjustment required.
Pharmacokinetics
Absorption: Subcutaneous administration with a bioavailability of approximately 52%.
Distribution: Limited data suggests widespread distribution.
Metabolism: Metabolized via proteolytic degradation into small peptides and amino acids.
Excretion: Renal elimination of the degraded peptides and amino acids.
Half Life: Approximate half-life of 28 days.
Contraindications
- Hypersensitivity to fremanezumab or any component of the formulation.
Precautions
- Use with caution in patients with a history of cardiopulmonary or cerebrovascular disease. Consider potential immunogenic responses. Watch for allergic reactions.
Adverse Reactions - Common
- Injection site reactions (pain, swelling, redness) (Common)
- Hypersensitivity reactions (Uncommon)
Adverse Reactions - Serious
- Anaphylaxis (Rare)
- Serious allergic reactions including angioedema and urticaria (Rare)
Drug-Drug Interactions
- No known significant interactions as of now.
Drug-Food Interactions
- No known interactions.
Drug-Herb Interactions
- No known interactions.
Nursing Implications
Assessment: Monitor for allergic reactions, injection site reactions, and efficacy in migraine frequency reduction.
Diagnoses:
- Impaired comfort related to migraine symptoms.
- Risk for allergic reaction.
Implementation: Administer subcutaneously as prescribed. Educate patient on proper technique or ensure appropriate administration training.
Evaluation: Assess reduction in migraine frequency and severity, monitor for adverse effects.
Patient/Family Teaching
- Instruct on proper self-injection technique.
- Report any signs of allergic reactions such as rash, swelling, difficulty breathing.
- Avoid abrupt discontinuation unless advised by healthcare provider.
- Maintain regular follow-up appointments.
Special Considerations
Black Box Warnings:
- None currently issued.
Genetic Factors: Not applicable.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Possible allergic reactions or injection site reactions.
Treatment: Supportive care, antihistamines, or epinephrine in case of anaphylaxis; symptomatic treatment.
Storage and Handling
Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze.
Stability: Stable for up to 24 hours at room temperature (up to 25°C) if necessary, but preferred to store refrigerated.