Home Drug Guide Anakinra

Drug Guide

Generic Name

Anakinra

Brand Names Kineret

Classification

Therapeutic: Anti-inflammatory, Immunomodulator

Pharmacological: Interleukin-1 receptor antagonist

FDA Approved Indications

Rheumatoid arthritis (moderate to severe, in adults)
Cryopyrin-associated periodic syndromes (CAPS)
Neonatal-onset multisystem inflammatory disease (NOMID)
Ferritin levels in Still's disease

Mechanism of Action

Anakinra competitively inhibits interleukin-1 (IL-1) by binding to IL-1 receptors, thereby blocking IL-1 mediated inflammatory responses.

Dosage and Administration

Adult: Typically 100 mg injected subcutaneously once daily; dosage may be adjusted based on response and tolerability.

Pediatric: Dosing varies; for NOMID and other indications, typically 2 mg/kg/day subcutaneously, not to exceed the adult dose.

Geriatric: No specific dose adjustment, but monitor for increased risk of infection.

Renal Impairment: No specific adjustment for mild impairment; use caution in severe impairment.

Hepatic Impairment: No specific data; caution advised.

Pharmacokinetics

Absorption: Approximately 95% bioavailable after subcutaneous injection.

Distribution: Distributed mainly in plasma and interstitial fluid.

Metabolism: Metabolized via proteolytic enzymes; not reliant on cytochrome P450 system.

Excretion: Eliminated via renal and non-renal pathways.

Half Life: Approximately 4 to 6 hours.

Contraindications

Known hypersensitivity to Anakinra or its components.

Precautions

Increased risk of infections, including tuberculosis. Use cautiously in patients with active infections.
Monitor for signs of infection during therapy.
Use with caution in patients with neutropenia or other blood dyscrasias.

Adverse Reactions - Common

Injection site reactions (redness, swelling, pain) (Common)
Infections (upper respiratory, skin infections) (Common)

Adverse Reactions - Serious

Serious infections (sepsis, pneumonia) (Less common)
Anaphylaxis or hypersensitivity reactions (Rare)

Drug-Drug Interactions

Other immunosuppressants, biologic agents increasing infection risk.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, neutropenia, and hypersensitivity reactions.

Diagnoses:

Impaired skin integrity related to injection site reactions.
Risk for infection related to immunosuppression.

Implementation: Administer subcutaneously as prescribed, patient education on injection technique.

Evaluation: Assess for reduction in symptoms, monitor blood counts, and signs of adverse effects.

Patient/Family Teaching

Instruct on proper injection technique and site rotation.
Warn about signs of infection and when to seek medical attention.
Emphasize adherence to scheduled doses and follow-up visits.

Special Considerations

Black Box Warnings:

Serious infections, including invasive bacterial and potentially fatal infections.
Malignancies and/or lymphoma observed in clinical trials, although causality is not established.

Genetic Factors: No specific genetic markers recommended before therapy.

Lab Test Interference: May increase risk of neutropenia; regular complete blood count (CBC) monitoring required.

Overdose Management

Signs/Symptoms: Increased risk of infections, injection site reactions.

Treatment: Supportive care, discontinue drug, monitor blood counts and vital signs.

Storage and Handling

Storage: Store refrigerated at 2-8°C (36-46°F). Protect from light. Do not freeze.

Stability: Stable until the expiration date when refrigerated.