Formulary
Alemtuzumab: Indications, Dosing, Side Effects and Interactions
For all anti-lymphocyte monoclonal antibodies The anti-lymphocyte monoclonal antibodies cause lysis of B lymphocytes.
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Alemtuzumab: Indications, Dosing, Side Effects and Interactions
For all anti-lymphocyte monoclonal antibodies The anti-lymphocyte monoclonal antibodies cause lysis of B lymphocytes.
Drug action
For all anti-lymphocyte monoclonal antibodies The anti-lymphocyte monoclonal antibodies cause lysis of B lymphocytes.
Indications and dose
**Treatment of adults with relapsing-remitting multiple sclerosis with active disease defined by clinical or imaging features**
- **Adult** (By Intravenous Infusion): (consult product literature).
Cautions
B carriers; hepatitis C carriers; not recommended for inactive disease; not recommended for stable disease; patients should receive oral prophylaxis for herpes infection starting on the first day of treatment and continuing for at least a month following each treatment course; pretreatment before administration is required (consult product literature) Cautions, further information For full details of cautions, consult product literature. Autoimmune mediated conditions The risk of autoimmune mediated conditions may increase during treatment, including immune thrombocytopenic purpura, thyroid disorders, nephropathies, cytopenias, autoimmune hepatitis, and acquired haemophilia A. Manufacturer advises monitoring for autoimmune mediated conditions throughout the course of treatment (consult product literature).
Contraindications
Angina (past history); autoimmune diseases (excluding multiple sclerosis); cervicocephalic arterial dissection (past history); clotting abnormalities (including patients on anticoagulant therapy); human immunodeficiency virus; hypertension (uncontrolled); myocardial infarction (past history); severe active infection (until complete resolution); stroke (past history)
Side effects
For all anti-lymphocyte monoclonal antibodies Common or very common Anaemia; anaphylactic reaction; arthralgia; conjunctivitis; cough; hypersensitivity (discontinue permanently); increased risk of infection; infusion related reaction; neutropenia; pain in extremity; thrombocytopenia; vomiting Uncommon Haemolytic anaemia Side-effects, further information Infusion-related side-effects In rare cases infusion reactions may be fatal. Infusion-related side-effects occur predominantly during the first infusion. Patients should receive premedication before administration of anti-lymphocyte monoclonal antibodies to reduce these effects-consult product literature for details of individual regimens. The infusion may have to be stopped temporarily and the infusion-related effects treated-consult product literature for appropriate management. Cytokine release syndrome Fatalities following severe cytokine release syndrome (characterised by severe dyspnoea) and associated with features of tumour lysis syndrome have occurred after infusions of anti-lymphocyte monoclonal antibodies. Patients with a high tumour burden as well as those with pulmonary insufficiency or infiltration are at increased risk and should be monitored very closely (and a slower rate of infusion considered). Progressive Multifocal Leukoencephalopathy (PML) If suspected, treatment should be suspended until PML has been excluded. If a patient develops an opportunistic infection or PML, anti-lymphocyte monoclonal antibodies should be permanently discontinued. Side-effects For alemtuzumab Common or very common Abdominal pain; alopecia; anxiety; asthenia; asthma; cytokine release syndrome; decreased leucocytes; depression; diarrhoea; endocrine ophthalmopathy; goitre; haemorrhage; hiccups; hyperthyroidism; hypothyroidism; influenza like illness; leucocytosis; lymphadenopathy; malaise; meningitis; menstrual cycle irregularities; multiple sclerosis exacerbated; muscle complaints; muscle weakness; neoplasms; nephropathy; oropharyngeal pain; pain; peripheral oedema; sensation abnormal; skin reactions; stomatitis; sweat changes; thyroiditis; tremor; urine abnormalities; vertigo; vision disorders Uncommon Acquired haemophilia; appetite decreased; cervical dysplasia; constipation; dry mouth; dysphagia; ear pain; facial swelling; gallbladder disorders; gastrointestinal disorders; Goodpasture's syndrome; limb discomfort; musculoskeletal stiffness; nephrolithiasis; pancytopenia; pneumonitis; tension headache; throat irritation; weight changes Rare or very rare Haemophagocytic lymphohistiocytosis Frequency not known Artery dissection; cerebrovascular insufficiency; hepatitis autoimmune (including fatal cases); liver injury; myocardial infarction; myocardial ischaemia; reactivation of infections; thyroid disorder autoimmune
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs risk-toxicity in animal studies. Autoimmune thyroid disease during treatment may affect fetus (consult product literature).
Breast feeding
Manufacturer advises avoid during and for 4 months after each treatment course unless potential benefit outweighs risk.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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