anakinra

Action

Inhibits binding of IL-1 with IL type I receptors, thereby mediating immunologic, inflammatory, and other physiologic responses

Availability

Prefilled glass syringes: 100 mg/0.67 ml

Indications and dosages

➣ Moderately to severely active rheumatoid arthritis in patients ages 18 and older who don't respond to disease-modifying antirheumatics alone

Adults: 100 mg/day subcutaneously, given at same time each day

Contraindications

• Hypersensitivity to drug or Escherichia coli-derived protein

• Serious infections

Precautions

Use cautiously in:

• immunosuppression, active infection, chronic illness, renal impairment

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

See Withhold drug and notify prescriber if patient shows signs or symptoms of active infection.

See Use extreme caution if patient is concurrently receiving drugs that block tumor necrosis factor (TNF), because of increased risk of serious infection.

• Give entire dose from prefilled syringe.

• Don't freeze or shake syringe.

Adverse reactions

CNS: headache

EENT: sinusitis

GI: nausea, diarrhea, abdominal pain

Hematologic: thrombocytopenia, neutropenia

Respiratory: upper respiratory tract infection

Skin: rash, pruritus, injection site reaction or bruising, rash, erythema, inflammation

Other: flulike symptoms, infections

Interactions

Drug-drug. Etanercept, infliximab, other drugs that block TNF: increased risk of serious infection

Live-virus vaccines: vaccine inefficacy

Drug-diagnostic tests. Neutrophils: decreased count

Patient monitoring

• Monitor CBC with white cell differential.

• Assess injection site for reactions.

Patient teaching

See Tell patient to immediately report signs or symptoms of infection.

• Advise patient to report signs and symptoms of allergic response.

• Instruct patient to take drug at same time each day for best response.

• Teach patient about proper drug disposal (in puncture-resistant container). Also caution him against reusing needles, syringes, and drug product.

• Tell patient not to freeze or shake drug.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.