Casirivimab and imdevimab parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulations of casirivimab and imdevimab.
These products have been produced by recombinant technology using Chinese Hamster Ovary (CHO) cell lines.
Drugs List
Therapeutic Indications
Uses
Coronavirus disease 2019 (COVID-19) - treatment
Coronavirus disease 2019 (COVID-19): Prophylaxis
Dosage
Adults
Treatment
600mg of casirivimab and 600mg imdevimab to be given as soon as a positive viral test for SARS-CoV-2 is confirmed.
Prevention- single dose
600mg of casirivimab and 600mg imdevimab to be given as soon as possible after exposure to SARS-CoV-2.
Prevention- repeat dose
Intended for those who require ongoing prevention e.g. those unlikely to be protected by vaccination due to a medical condition.
Initial dose is 600mg of casirivimab and 600mg imdevimab. Subsequent doses are 300mg of casirivimab and 300mg imdevimab once every four weeks.
Additional Dosage Information
Missed Dose
If a dose is missed, it should be administered as soon as possible, adjusting the schedule to ensure adequate time between doses.
Administration
Repeat dosing regimens for prevention of COVID-19 allow for switching from intravenous infusion to subcutaneous injection or vice versa over the course of treatment.
Intravenous infusion
Casirivimab and imdevimab both must be diluted and administered together as a single intravenous infusion.
Subcutaneous injection
Casirivimab and imdevimab must be administered consecutively by subcutaneous injection at a different injection site: the upper thighs, the upper outer arms, or the abdomen, except for 5cm around the navel. The waistline should be avoided.
It is also recommended to use different quadrants of the abdomen or upper thighs or upper outer arms to space apart each 2.5ml subcutaneous injection of casirivimab and imdevimab.
Contraindications
Children under 12 years
Weight below 40kg
Severe hepatic impairment
Precautions and Warnings
Females of childbearing potential
Breastfeeding
Moderate hepatic impairment
Pregnancy
Severe renal impairment
Monitor patient throughout infusion and for at least 1 hour afterwards
Treatment to be initiated and supervised by a specialist
Contains polysorbate
Aseptic technique should be used throughout
Avoid injection into broken or bruised skin
Avoid injection into scar tissue
Do not use if solution is discoloured or particulates are apparent
Record name and batch number of administered product
Resuscitation facilities must be immediately available
Suspend treatment or reduce rate until infusion reactions resolve
Warm to room temperature prior to use
Interrupt therapy/reduce infusion rate if infusion-related reactions occur
Discontinue if severe hypersensitivity reactions occur
Pregnancy and Lactation
Pregnancy
Use casirivimab and imdevimab with caution during pregnancy.
The manufacturer does not recommend using casirivimab and imdevimab during pregnancy. At the time of writing there is limited published information regarding the use of casirivimab and imdevimab during pregnancy. However, human immunoglobulin G1 antibodies are known to cross the placenta and therefore transfer of casirivimab and imdevimab across the placenta can be expected.
Potential risks are unknown, therefore the manufacturer states that casirivimab and imdevimab should only be used where the potential benefit of casirivimab and imdevimab outweighs the potential risk to the foetus.
Lactation
Use casirivimab and imdevimab with caution during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking casirivimab and imdevimab. The presence of casirivimab and imdevimab in human breast milk is unknown but due to their large molecular weight, transfer expected to be low.
Effects on exposed infants are unknown, therefore the manufacturer states that casirivimab and imdevimab should only be used where the potential benefit of casirivimab and imdevimab outweighs the potential risk to the child or infant.
Side Effects
Anaphylaxis
Chills
Dizziness
Ecchymosis
Erythema
Flushing
Hypersensitivity reactions
Infusion related reaction
Local reaction at injection site
Lymphadenopathy
Nausea
Oedema
Pain
Pruritus
Rash
Syncope
Tenderness (non-specified)
Urticaria
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: November 2021
Reference Sources
Summary of Product Characteristics: Ronapreve 120 mg/ml solution for injection or infusion. Roche Products Limited. Revised August 2021.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Casirivimab. Last revised: 21 June 2021
Last accessed: 23 November 2021
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Imdevimab. Last revised: 21 June 2021
Last accessed: 23 November 2021
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