anakinra

anakinra,

an antirheumatic agent and immunomodulator used to reduce the signs and symptoms of moderate to severe active rheumatoid arthritis in adults.

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anakinra

Kineret

Pharmacologic class: Interleukin-1 (IL-1) blocker

Therapeutic class: Immunomodulator, antirheumatic

Pregnancy risk category B

Action

Inhibits binding of IL-1 with IL type I receptors, thereby mediating immunologic, inflammatory, and other physiologic responses

Availability

Prefilled glass syringes: 100 mg/0.67 ml

⊘Indications and dosages

➣ Moderately to severely active rheumatoid arthritis in patients ages 18 and older who don't respond to disease-modifying antirheumatics alone

Adults: 100 mg/day subcutaneously, given at same time each day

Contraindications

• Hypersensitivity to drug or Escherichia coli-derived protein
• Serious infections

Precautions

Use cautiously in:
• immunosuppression, active infection, chronic illness, renal impairment
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

☞ Withhold drug and notify prescriber if patient shows signs or symptoms of active infection.
☞ Use extreme caution if patient is concurrently receiving drugs that block tumor necrosis factor (TNF), because of increased risk of serious infection.
• Give entire dose from prefilled syringe.
• Don't freeze or shake syringe.

Route	Onset	Peak	Duration
Subcut.	Slow	3-7 hr	Unknown

Adverse reactions

CNS: headache

EENT: sinusitis

GI: nausea, diarrhea, abdominal pain

Hematologic: thrombocytopenia, neutropenia

Respiratory: upper respiratory tract infection

Skin: rash, pruritus, injection site reaction or bruising, rash, erythema, inflammation

Other: flulike symptoms, infections

Interactions

Drug-drug. Etanercept, infliximab, other drugs that block TNF: increased risk of serious infection

Live-virus vaccines: vaccine inefficacy

Drug-diagnostic tests. Neutrophils: decreased count

Patient monitoring

• Monitor CBC with white cell differential.
• Assess injection site for reactions.

Patient teaching

☞ Tell patient to immediately report signs or symptoms of infection.
• Advise patient to report signs and symptoms of allergic response.
• Instruct patient to take drug at same time each day for best response.
• Teach patient about proper drug disposal (in puncture-resistant container). Also caution him against reusing needles, syringes, and drug product.
• Tell patient not to freeze or shake drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.