Formulary
Ocrelizumab: 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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Ocrelizumab: 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
**Multiple sclerosis (specialist use only)**
- **Adult** (By Intravenous Infusion): Initially 300 mg, then 300 mg after 2 weeks; maintenance 600 mg every 6 months, the first maintenance dose should be given 6 months after the first initial dose; a minimum interval of 5 months should be maintained between each maintenance dose, for dose interruption, adjustment of infusion rate or discontinuation of treatment due to infusion-related reactions or side-effects-consult product literature.
Cautions
Complete required vaccinations at least 6 weeks before treatment initiation; hepatitis B reactivation
Contraindications
Active infection; active malignancies; severely immunocompromised patients
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 ocrelizumab Common or very common Catarrh Frequency not known Malignancy
Interactions
**Other interactions (3):**
- Vaccinations The safety of immunisation with live or live-attenuated vaccines, following ocrelizumab therapy has not been studied.
- Data are available on the effects of tetanus toxoid, 23-valent pneumococcal polysaccharide, keyhole limpet haemocyanin neoantigen, and seasonal influenza vaccines in patients receiving ocrelizumab...
- Immunosuppressants It is not recommended to use other immunosuppressive therapies concomitantly with ocrelizumab except corticosteroids for symptomatic treatment of relapses (see section 4.4).
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs risk-limited information available; monitor infants for B-cell depletion.
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
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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