Formulary
Siltuximab: Indications, Dosing, Side Effects and Interactions
Siltuximab is a monoclonal antibody that inhibits interleukin-6 receptor binding.
MedNext Academy | 3 min read
Siltuximab: Indications, Dosing, Side Effects and Interactions
Siltuximab is a monoclonal antibody that inhibits interleukin-6 receptor binding.
Drug action
Siltuximab is a monoclonal antibody that inhibits interleukin-6 receptor binding.
Indications and dose
**Treatment of multicentric Castleman's disease (MCD) in patients who are human immunodeficiency virus (HIV) negative and human herpesvirus-8 (HHV-8) negative**
- **Adult** (By Intravenous Infusion): 11 mg/kg every 3 weeks.
Cautions
Patients at increased risk of gastrointestinal perforation-promptly investigate those presenting with symptoms suggestive of gastrointestinal perforation; severe infection-withhold treatment until resolved; treat infection prior to treatment Cautions, further information Hypersensitivity reactions Infusion-related side-effects are reported commonly with siltuximab; resuscitation facilities should be available during treatment. Consult product literature for further information about siltuximab cautions.
Side effects
Common or very common Abdominal pain; arthralgia; constipation; diarrhoea; dizziness; dyslipidaemia; gastrooesophageal reflux disease; headache; hypersensitivity; hypertension; hyperuricaemia; increased risk of infection; infusion related reaction; localised oedema; nausea; neutropenia; oral ulceration; oropharyngeal pain; pain in extremity; renal impairment; skin reactions; thrombocytopenia; vomiting; weight increased Side-effects, further information Siltuximab therapy should be discontinued permanently in the event of a severe infusion-related reaction, anaphylaxis, a severe allergic reaction, or the occurrence of cytokine-release syndrome. Mild to moderate infusion-related reactions may improve by temporarily reducing the rate or stopping the infusion. When restarting treatment, a reduced infusion rate and the administration of antihistamines, paracetamol, and corticosteroids may be considered . Consider discontinuation of siltuximab if more than 2 doses are delayed due to treatment-related toxicities during the first 48 weeks-for full details consult product literature.
Interactions
**Other interactions (5):**
- Binding bioactive IL-6 by siltuximab may result in increased metabolism of CYP450 substrates, because CYP450 enzyme activity will normalise.
- Therefore, administering siltuximab with CYP450 substrates that have a narrow therapeutic index has the potential to change therapeutic effects and toxicity of these medicinal products due to...
- Upon initation or discontinuation of siltuximab in patients being treated with concomitant medicinal products that are CYP450 substrates and have a narrow therapeutic index, monitoring of the effect...
- The effect of siltuximab on CYP450 enzyme activity can persist for several weeks after stopping therapy.
- Prescribers should also exercise caution when siltuximab is co-administered with medicinal products that are CYP3A4 substrates where a decrease in effectiveness would be undesirable (e.g., oral...
Pregnancy
Manufacturer advises avoid unless potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Manufacturer advises caution (no information).
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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