Formulary
Nemolizumab: Indications, Dosing, Side Effects and Interactions
Nemolizumab is a humanised monoclonal antibody that inhibits interleukin-31 signalling.
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Nemolizumab: Indications, Dosing, Side Effects and Interactions
Nemolizumab is a humanised monoclonal antibody that inhibits interleukin-31 signalling.
Drug action
Nemolizumab is a humanised monoclonal antibody that inhibits interleukin-31 signalling.
Indications and dose
**Moderate-to-severe atopic eczema**
- **Adult** (By Subcutaneous Injection): (body-weight 30 kg and above) Initially 60 mg for 1 dose, to be administered as two consecutive 30 mg injections at different injection sites, followed by maintenance 30 mg every 4 weeks, patients who achieve clinical response after 16 weeks of treatment should be given maintenance dosing of 30 mg every 8 weeks, consider discontinuation of treatment if no response after 16 weeks.
**Moderate-to-severe prurigo nodularis**
- **Adult** (By Subcutaneous Injection): (body-weight 90 kg and above) Initially 60 mg for 1 dose, to be administered as two consecutive 30 mg injections at different injection sites, followed by maintenance 60 mg every 4 weeks, to be administered as two consecutive 30 mg injections at different injection sites, consider discontinuation of treatment if no response after 16 weeks.
**Moderate-to-severe atopic eczema for nemolizumab**
- **Child 12-17 years (body-weight 30 kg and above)** (By subcutaneous injection): Initially 60 mg for 1 dose, to be administered as two consecutive 30 mg injections at different injection sites, followed by maintenance 30 mg every 4 weeks, patients who achieve clinical response after 16 weeks of treatment should be given maintenance dosing of 30 mg every 8 weeks, consider discontinuation of treatment if no response after 16 weeks.
Cautions
Cautions, further information Immunisation Consider completion of immunisations according to current guidelines before initiating treatment-immunisation during treatment has not been studied. M
Side effects
Common or very common Headaches; skin reactions Uncommon Angioedema Frequency not known Hypersensitivity
Interactions
**Severe interactions:**
- Interactions with cytochrome P450 The effects of nemolizumab on the pharmacokinetics of midazolam (CYP3A4/5 substrate), warfarin (CYP2C9 substrate), omeprazole (CYP2C19 substrate), metoprolol...
- No clinically significant changes in the exposure of CYP450 substrates before and after multiple nemolizumab injections were observed, with Cmax and AUC ratios ranging from 88.24 to 107.81%.
Pregnancy
Avoid (limited information available). M
Breast feeding
Specialist sources indicate use with caution, especially if breast-feeding a neonate or pre-term infant (no information available). Large molecular weight suggests limited excretion into milk and drug molecule likely to be partially destroyed in the infant's gastro-intestinal tract; waiting for at least 2 weeks postpartum to resume treatment may minimise transfer to infant.
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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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