Formulary
Ravulizumab: Indications, Dosing, Side Effects and Interactions
Ravulizumab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis and thrombotic...
MedNext Academy | 4 min read
Ravulizumab: Indications, Dosing, Side Effects and Interactions
Ravulizumab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis and thrombotic...
Drug action
Ravulizumab is a recombinant monoclonal antibody that inhibits terminal complement activation at the C5 protein, thereby reducing haemolysis and thrombotic microangiopathy.
Indications and dose
**Atypical haemolytic uraemic syndrome (under expert supervision),Paroxysmal nocturnal haemoglobinuria (under expert supervision)**
- **Adult** (By Intravenous Infusion): (body-weight 100 kg and above) Loading dose 3 g for 1 dose, then maintenance 3.6 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
**Atypical haemolytic uraemic syndrome (under expert supervision), Paroxysmal nocturnal haemoglobinuria (under expert supervision) for ravulizumab**
- **Child (body-weight 10-19 kg)** (By intravenous infusion): Loading dose 0.6 g for 1 dose, then maintenance 0.6 g every 4 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
- **Child (body-weight 20-29 kg)** (By intravenous infusion): Loading dose 0.9 g for 1 dose, then maintenance 2.1 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
- **Child (body-weight 30-39 kg)** (By intravenous infusion): Loading dose 1.2 g for 1 dose, then maintenance 2.7 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
- **Child (body-weight 40-59 kg)** (By intravenous infusion): Loading dose 2.4 g for 1 dose, then maintenance 3 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
- **Child (body-weight 60-99 kg)** (By intravenous infusion): Loading dose 2.7 g for 1 dose, then maintenance 3.3 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
- **Child (body-weight 100 kg and above)** (By intravenous infusion): Loading dose 3 g for 1 dose, then maintenance 3.6 g every 8 weeks, start maintenance dosing 2 weeks after the loading dose, a maintenance dose (except for the first maintenance dose) may be given up to 7 days before or after the scheduled date; the subsequent dose should be given according to the original schedule, for duration of infusion-consult product literature.
Cautions
Active systemic infection Cautions, further information Meningococcal infection Vaccinate against Neisseria meningitidis at least 2 weeks before treatment (vaccines against serotypes A, C, Y, W135 and B where available, are recommended); revaccinate according to current medical guidelines. Patients receiving ravulizumab less than 2 weeks after receiving meningococcal vaccine must be given prophylactic antibiotics until 2 weeks after vaccination. Other immunisations should also be up to date for all age groups. M
Contraindications
Patients unvaccinated against Neisseria meningitidis ; unresolved Neisseria meningitidis infection
Side effects
Common or very common Arthralgia; asthenia; back pain; diarrhoea; dizziness; fever; gastrointestinal discomfort; headache; increased risk of infection; influenza like illness; infusion related reaction; muscle complaints; nausea; skin reactions; vomiting Uncommon Chills; hypersensitivity; meningococcal sepsis
Interactions
**Other interactions (2):**
- Based on the potential inhibitory effect of ravulizumab on complement-dependent cytotoxicity of rituximab, ravulizumab may reduce the expected pharmacodynamic effects of rituximab.
- Chronic intravenous human immunoglobulin (IVIg) treatment may interfere with the endosomal neonatal Fc receptor (FcRn) recycling mechanism of monoclonal antibodies such as ravulizumab and thereby...
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk-no information available. Ravulizumab is an immunoglobulin G (IgG) monoclonal antibody; human IgG antibodies are known to cross the placenta.
Breast feeding
Manufacturer advises avoid breast-feeding during and for up to 8 months after treatment-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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