Formulary
Emicizumab: Indications, Dosing, Side Effects and Interactions
Emicizumab is a monoclonal antibody that bridges activated factor IX and factor X to restore function of missing activated factor VIII, which is needed for...
MedNext Academy | 3 min read
Emicizumab: Indications, Dosing, Side Effects and Interactions
Emicizumab is a monoclonal antibody that bridges activated factor IX and factor X to restore function of missing activated factor VIII, which is needed for...
Drug action
Emicizumab is a monoclonal antibody that bridges activated factor IX and factor X to restore function of missing activated factor VIII, which is needed for haemostasis.
Indications and dose
**Prophylaxis of haemorrhage in haemophilia A (initiated by a specialist)**
- **Adult** (By Subcutaneous Injection): Initially 3 mg/kg once weekly for 4 weeks, then maintenance 1.5 mg/kg once weekly, alternatively maintenance 3 mg/kg every 2 weeks, alternatively maintenance 6 mg/kg every 4 weeks.
**Prophylaxis of haemorrhage in haemophilia A (initiated by a specialist) for emicizumab**
- **Child** (By subcutaneous injection): Initially 3 mg/kg once weekly for 4 weeks, then maintenance 1.5 mg/kg once weekly, alternatively maintenance 3 mg/kg every 2 weeks, alternatively maintenance 6 mg/kg every 4 weeks.
Cautions
Concomitant bypassing agent; risk factors for thrombotic microangiopathy Cautions, further information Concomitant bypassing agent Manufacturer advises discontinue bypassing agents the day before starting emicizumab; if a bypassing agent is required-consult product literature.
Side effects
Common or very common Arthralgia; diarrhoea; fever; headache; myalgia Uncommon Cavernous sinus thrombosis; embolism and thrombosis; skin necrosis; thrombotic microangiopathy
Interactions
**Other interactions (6):**
- No adequate or well-controlled interaction studies have been conducted with emicizumab.
- Clinical experience indicates a medicinal product interaction exists with emicizumab and aPCC (see sections 4.4 and 4.8).
- There is a possibility for hypercoagulability with rFVIIa or FVIII with emicizumab based on preclinical experiments.
- Emicizumab increases coagulation potential, therefore the rFVIIa or FVIII dose required to achieve haemostasis may be lower than when used without Hemlibra prophylaxis.
- Further management should be tailored to the individual clinical circumstances.
- However, the possibility of thrombotic events should be considered when systemic anti-fibrinolytics are used in combination with aPCC or rFVIIa in patients receiving emicizumab.
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk-no information available.
Breast feeding
Manufacturer advises avoid-no information available.
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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