Formulary
Crovalimab: Indications, Dosing, Side Effects and Interactions
Crovalimab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis.
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Crovalimab: Indications, Dosing, Side Effects and Interactions
Crovalimab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis.
Drug action
Crovalimab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis.
Indications and dose
**Paroxysmal nocturnal haemoglobinuria (initiated under specialist supervision) for crovalimab**
- **Child 12-17 years (body-weight 40-99 kg)** (Initially by intravenous infusion): Loading dose 1000 mg for 1 dose, to be given on day 1, then (by subcutaneous injection) 340 mg for 4 doses, to be given on days 2, 8, 15, and 22, followed by (by subcutaneous injection) maintenance 680 mg every 4 weeks, to be given from day 29 onwards.
- **Child 12-17 years (body-weight 100 kg and above)** (Initially by intravenous infusion): Loading dose 1500 mg for 1 dose, to be given on day 1, then (by subcutaneous injection) 340 mg for 4 doses, to be given on days 2, 8, 15, and 22, followed by (by subcutaneous injection) maintenance 1020 mg every 4 weeks, to be given from day 29 onwards.
Cautions
Active systemic infections (monitor for signs and symptoms of worsening infection) Cautions, further information Vaccination against serious infection To reduce the risk of serious infection, it is advised that patients are vaccinated against Neisseria meningitidis (vaccines against serotypes A, C, Y, W135, and B, where available, are recommended), Streptococcus pneumoniae , and Haemophilus influenzae type b according to local guidelines, at least 2 weeks before starting treatment. If immediate treatment is needed, administer the required vaccines as soon as possible; treat with prophylactic antibiotics until 2 weeks after vaccination. M
Contraindications
Patients unvaccinated against Neisseria meningitidis ; unresolved infection caused by Neisseria meningitidis
Side effects
Common or very common Abdominal pain; arthralgia; asthenia; diarrhoea; fever; headache; hypersensitivity; increased risk of infection; infusion related reaction; injection related reaction; rash; type III hypersensitivity reaction (complex-mediated) (when switching from another C5 inhibitor) Uncommon Sepsis Side-effects, further information Monitor patients for symptoms of type III hypersensitivity reactions (such as arthralgia, rash, fever, fatigue, abdominal distress, headache and axonal neuropathy) for the first 30 days after switching between C5 inhibitors.
Interactions
**Other interactions (4):**
- Crovalimab and other C5 inhibitors bind different epitopes on C5 such that immune complexes comprised of the antibodies bridged by C5 may form when both are present in the circulation.
- These immune complexes, also referred to as drug-target-drug complexes (DTDCs), can comprise one or more units of C5 bound to both crovalimab and to another C5 inhibitor and are expected to be...
- The immune complexes may be cleared after a longer duration in the case of switch from C5 inhibitors with an extended half-life such as ravulizumab.
- In patients switching from another C5 inhibitor therapy, a transient increase in clearance is observed due to the formation of the immune complexes, leading to a faster elimination of crovalimab.
Pregnancy
Use only if potential benefit outweighs risk (limited information available). M Crovalimab is an immunoglobulin G (IgG) monoclonal antibody; human IgG antibodies are known to cross the placenta.
Breast feeding
Avoid (limited information available). M
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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