Formulary
Canakinumab: Indications, Dosing, Side Effects and Interactions
Canakinumab is a recombinant human monoclonal antibody that selectively inhibits interleukin-1 beta receptor binding.
MedNext Academy | 5 min read
Canakinumab: Indications, Dosing, Side Effects and Interactions
Canakinumab is a recombinant human monoclonal antibody that selectively inhibits interleukin-1 beta receptor binding.
Drug action
Canakinumab is a recombinant human monoclonal antibody that selectively inhibits interleukin-1 beta receptor binding.
Indications and dose
**Gouty arthritis [in patients whose condition has not responded adequately to treatment with NSAIDs or colchicine, or in those with contra-indications or intolerances to them, and in whom repeated courses of corticosteroids are inappropriate]**
- **Adult** (By Subcutaneous Injection): 150 mg for 1 dose, in patients who respond, dose may be repeated after at least 12 weeks if symptoms recur, to be administered to the upper thigh, abdomen, upper arm or buttocks.
**Cryopyrin-associated periodic syndromes (specialist use only)**
- **Adult** (By Subcutaneous Injection): (body-weight 41 kg and above) 150 mg every 8 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, additional doses may be considered if clinical response not achieved within 7 days-consult product literature.
**Tumour necrosis factor receptor associated periodic syndrome (specialist use only),Hyperimmunoglobulin D syndrome (specialist use only),Familial Mediterranean fever (specialist use only)**
- **Adult** (By Subcutaneous Injection): (body-weight 41 kg and above) 150 mg every 4 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, a second dose may be considered if clinical response not achieved within 7 days-consult product literature.
**Still's disease (specialist use only)**
- **Adult** (By Subcutaneous Injection): 4 mg/kg every 4 weeks (max. per dose 300 mg), to be administered to the upper thigh, abdomen, upper arm or buttocks.
**Cryopyrin-associated periodic syndromes (specialist use only) for canakinumab**
- **Child 2-3 years (body-weight 7.5-14 kg)** (By subcutaneous injection): 4 mg/kg every 8 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, additional doses may be considered if clinical response not achieved within 7 days-consult product literature.
- **Child 4-17 years (body-weight 7.5-14 kg)** (By subcutaneous injection): 4 mg/kg every 8 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, additional doses may be considered if clinical response not achieved within 7 days-consult product literature.
- **Child 4-17 years (body-weight 15-40 kg)** (By subcutaneous injection): 2 mg/kg every 8 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, additional doses may be considered if clinical response not achieved within 7 days-consult product literature.
- **Child 4-17 years (body-weight 41 kg and above)** (By subcutaneous injection): 150 mg every 8 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, additional doses may be considered if clinical response not achieved within 7 days-consult product literature.
**Tumour necrosis factor receptor associated periodic syndrome (specialist use only), Hyperimmunoglobulin D syndrome (specialist use only), Familial Mediterranean fever (specialist use only) for canakinumab**
- **Child 2-17 years (body-weight 7.5-40 kg)** (By subcutaneous injection): 2 mg/kg every 4 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, a second dose may be considered if clinical response not achieved within 7 days-consult product literature.
- **Child 2-17 years (body-weight 41 kg and above)** (By subcutaneous injection): 150 mg every 4 weeks, to be administered to the upper thigh, abdomen, upper arm or buttocks, a second dose may be considered if clinical response not achieved within 7 days-consult product literature.
**Still's disease (specialist use only) for canakinumab**
- **Child 2-17 years (body-weight 7.5 kg and above)** (By subcutaneous injection): 4 mg/kg every 4 weeks (max. per dose 300 mg), to be administered to the upper thigh, abdomen, upper arm or buttocks.
Cautions
History of recurrent infection; latent and active tuberculosis; predisposition to infection Cautions, further information Vaccinations Patients should receive all recommended vaccinations (including pneumococcal and inactivated influenza vaccine) before starting treatment; avoid live vaccines unless potential benefit outweighs risk-consult product literature for further information. M
Contraindications
Gouty arthritis [in patients whose condition has not responded adequately to treatment with NSAIDs or colchicine, or in those with contra-indications or intolerances to them, and in whom repeated courses of corticosteroids are inappropriate] for canakinumab By subcutaneous injection Adult 150 mg for 1 dose, in patients who respond, dose may be repeated after at least 12 weeks if symptoms recur, to be administered to the upper thigh, abdomen, upper arm or buttocks.
Side effects
Common or very common Abdominal pain upper; arthralgia; asthenia; dizziness; increased risk of infection; leucopenia; neutropenia; pain; proteinuria; vertigo Uncommon Gastrooesophageal reflux disease
Interactions
**Severe interactions:**
- Use of canakinumab with TNF inhibitors is not recommended because this may increase the risk of serious infections.
**Other interactions (6):**
- Interactions between canakinumab and other medicinal products have not been investigated in formal studies.
- Thus, CYP450 expression may be reversed when potent cytokine inhibitory therapy, such as canakinumab, is introduced.
- On initiation of canakinumab in patients being treated with this type of medicinal product, it is recommended that therapeutic monitoring of the effect or of the active substance concentration is...
- No data are available on either the effects of live vaccination or the secondary transmission of infection by live vaccines in patients receiving canakinumab.
- In case vaccination with live vaccines is indicated after initiation of canakinumab treatment, the recommendation is to wait for at least 3 months after the last canakinumab injection and before the...
- The results of a study in healthy adult subjects demonstrated that a single dose of canakinumab 300 mg did not affect the induction and persistence of antibody responses after vaccination with...
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs risk.
Breast feeding
Consider if benefit outweighs risk-not known if present in human milk.
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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