erenumab

General

Pronunciation:
e-ren-ue-mab

Trade Name(s)

  • Aimovig

Ther. Class.
vascular headache suppressants

Pharm. Class.
monoclonal antibodies
temporary class calcitonin gene-related peptide receptor antagonists

Indications

Migraine prevention.

Action

Binds to the calcitonin gene-related peptide (CGRP) receptor, which reduces the neuroinflammatory and vasodilatory effects of CGRP.

Therapeutic Effect(s):

Reduction in frequency of migraines.

Pharmacokinetics

Absorption: Well absorbed (82%) following subcutaneous administration.

Distribution: Some tissue distribution.

Metabolism and Excretion: Low concentrations–Eliminated through saturable binding to CGRP receptor; High concentrations–Eliminated through non-specific, non-saturable proteolytic pathway.

Half-life: 28 days.

TIME/ACTION PROFILE (plasma concentrations)

ROUTEONSETPEAKDURATION
Subcutunknown6 days1 mo

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity

Use Cautiously in:

  • Geri: Choose dose carefully, considering concurrent disease states, drug therapy, and age-related ↓ in hepatic and renal function;
  • OB: Safety and effectiveness not established
  • Lactation: Use only if potential maternal benefit justifies potential risk to infant
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

GI: constipation

Local: injection site reactions

MS: muscle spasm

Misc: HYPERSENSITIVITY REACTIONS (ANAPHYLAXIS AND ANGIOEDEMA)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None known.

Route/Dosage

SC (Adults) 70 mg once monthly; may ↑ dose, if needed, to 140 mg once monthly.

Availability

Solution for subcutaneous injection (in prefilled syringes and autoinjectors): 70 mg/mL, 140 mg/mL

Assessment

  • Assess frequency and intensity of migraines.
  • Assess for latex allergy. Needle shield within white or orange cap of prefilled autoinjector and gray needle cap of prefilled syringe contain dry natural rubber (a derivative of latex), may cause allergic reactions in individuals sensitive to latex.
  • Monitor for signs and symptoms of hypersensitivity reactions (rash, angioedema, anaphylaxis); usually occur within hours of injection but >1 wk after injection. If reaction is severe, discontinue erenumab and treat as needed.

Potential Diagnoses

Implementation

  • SC Prior to use allow vial to sit at room temperature for at least 30 min, protect from direct sunlight. Do no use other methods to warm solution (hot water or microwave). Do not shake. Solution is clear to opalescent, colorless to light yellow; do not administer solutions that are discolored, cloudy, or contain particulate matter. Store in refrigerator in original carton to protect from light; do not freeze. May be stored up to 7 days at room temperature.
    • Inject entire contents into abdomen, thigh, or upper arm. Do not inject into areas where the skin is tender, bruised, red, or hard.

Patient/Family Teaching

  • Instruct patient to take as directed. Administer missed doses as soon as possible and schedule next dose 1 mo from last dose administered. Educate patient and/or caregiver on correct technique for injection and disposal of equipment. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
  • Instruct patient to notify health care professional immediately if signs and symptoms of hypersensitivity reaction (swelling of face, mouth, tongue or throat, trouble breathing, rash) occur.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decrease in frequency and intensity of migraines.

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