Nurses Compass
Drug Guide
Daclizumab
Classification
Therapeutic: Immunosuppressant / Monoclonal antibody
Pharmacological: Il-2 receptor antagonist
FDA Approved Indications
- Multiple sclerosis, relapsing forms
Mechanism of Action
Daclizumab is a humanized monoclonal antibody that binds to the alpha subunit (CD25) of the IL-2 receptor on activated T-lymphocytes, blocking IL-2 mediated activation and proliferation of T-cells, thereby modulating immune responses in multiple sclerosis.
Dosage and Administration
Adult: 150 mg subcutaneously once every four weeks, starting with a loading dose of 150 mg at week 0 and week 4.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustments; use with caution in elderly patients.
Renal Impairment: No specific adjustments required.
Hepatic Impairment: No specific adjustments documented.
Pharmacokinetics
Absorption: Rapidly absorbed after subcutaneous administration.
Distribution: Distributed primarily in plasma and extracellular fluid.
Metabolism: Metabolized via proteolytic degradation to peptides and amino acids.
Excretion: Excreted mainly through proteolytic pathways.
Half Life: Approximately 21 days.
Contraindications
- Hypersensitivity to daclizumab or any component of the formulation.
Precautions
- Risk of serious infections due to immunosuppression, including serious infections like herpes zoster, herpes simplex, and respiratory infections.
- Potential for immune-mediated disorders, including autoimmune hepatitis and encephalitis.
- Monitoring for signs of infections or immune dysregulation is essential.
Adverse Reactions - Common
- Nasopharyngitis (Common)
- Elevated liver enzymes (Common)
- Headache (Common)
Adverse Reactions - Serious
- Immune-mediated encephalitis (Rare)
- Hepatotoxicity, including autoimmune hepatitis (Rare)
- Serious infections, including herpes zoster (Serious, less than 1%)
Drug-Drug Interactions
- Other immunosuppressants, risk of increased immunosuppression.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- Limited data; caution advised with herbal supplements affecting immune function.
Nursing Implications
Assessment: Monitor for signs of infection, liver function tests, neurologic status.
Diagnoses:
- Risk for infection, risk for hepatotoxicity, impaired immune response.
Implementation: Administer subcutaneously as directed, monitor for adverse effects, educate patient on infection prevention.
Evaluation: Assess for adverse reactions, effectiveness of MS symptom control.
Patient/Family Teaching
- Report signs of infection promptly.
- Avoid live vaccines during treatment.
- Use proper injection technique and site rotation.
- Understand potential side effects and when to seek medical attention.
Special Considerations
Black Box Warnings:
- Serious infections and immune-mediated neurological disorders.
Genetic Factors: No specific genetic testing required.
Lab Test Interference: Can elevate liver enzymes, monitor regularly.
Overdose Management
Signs/Symptoms: No specific overdose symptoms identified.
Treatment: Supportive care, monitor vital signs, and manage complications as they arise.
Storage and Handling
Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F).
Stability: Stable until the expiration date on the package when refrigerated.