Nurses Compass
Drug Guide
Tildrakizumab-asmn
Classification
Therapeutic: Immunosuppressant, Monoclonal antibody
Pharmacological: Anti-IL-23 monoclonal antibody
FDA Approved Indications
- Plaque psoriasis in adult patients
Mechanism of Action
Tildrakizumab is a humanized monoclonal antibody that binds specifically to the p19 subunit of interleukin-23 (IL-23), inhibiting its interaction with the IL-23 receptor, thereby reducing inflammation associated with psoriasis.
Dosage and Administration
Adult: My first dose is 100 mg subcutaneously at week 0, then every 12 weeks thereafter.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustment necessary, but monitor closely due to potential comorbidities.
Renal Impairment: No specific dosage adjustment recommended.
Hepatic Impairment: No specific dosage adjustment recommended.
Pharmacokinetics
Absorption: Subcutaneous administration with peak concentrations reached in approximately 7 days.
Distribution: Limited distribution, primarily within the vascular and interstitial spaces.
Metabolism: Metabolized via proteolytic pathways.
Excretion: Excreted as peptides via catabolic pathways.
Half Life: Approximately 20 days.
Contraindications
- Hypersensitivity to tildrakizumab or excipients.
Precautions
- Risk of infection; monitor for signs of infection, including TB prior to initiation.
- Use with caution in patients with a history of demyelinating diseases, as immune modulation could exacerbate such conditions.
- Pregnancy Category B: No adequate data; weigh benefits vs. risks.
Adverse Reactions - Common
- Upper respiratory infections (Likely)
- Headache (Likely)
- Injection site reactions (Likely)
Adverse Reactions - Serious
- Serious infections (Uncommon)
- Hypersensitivity reactions including anaphylaxis (Rare)
- Potential increase in malignancy risk (Unknown)
Drug-Drug Interactions
- Other immunosuppressants, live vaccines (avoid)
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- Limited data, but caution with immune-modulating herbs
Nursing Implications
Assessment: Monitor for signs of infection, injection site reactions, and general immune status.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Administer by subcutaneous injection as per schedule, educate patient on signs of infection, and ensure monitoring during therapy.
Evaluation: Assess efficacy by reduction in psoriasis plaques, monitor for adverse effects, and patient compliance.
Patient/Family Teaching
- Report any signs of infection or adverse reactions immediately.
- Do not receive live vaccines during therapy.
- Follow the injection schedule carefully.
- Maintain good skin and hygiene practices.
Special Considerations
Black Box Warnings:
- Risk of serious infections; report any signs or symptoms of infection.
Genetic Factors: Not specifically indicated for genetic factors.
Lab Test Interference: May affect immune response-related lab tests.
Overdose Management
Signs/Symptoms: Potential increased risk of infection or immune response abnormalities.
Treatment: Supportive care; no specific antidote. Dispose of unused medication properly.
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 when refrigerated. Do not freeze.