Pharmacologic class: Immunomodulator
Therapeutic class: Multiple sclerosis agent
Pregnancy risk category B
Unknown. Thought to alter immune processes believed to be responsible for pathogenesis of multiple sclerosis.
Injection: 20 mg lyophilized glatiramer acetate and 40 mg mannitol in single-use 2-ml vial (1-ml vial of sterile water for injection included for reconstitution)
⊘Indications and dosages
➣ To reduce frequency of relapses in relapsing-remitting multiple sclerosis
Adults: 20 mg/day subcutaneously
• Hypersensitivity to drug
Use cautiously in:
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Give only by subcutaneous injection into arms, abdomen, hips, or thighs.
• Administer immediately after preparing. Discard unused portion.
CNS: abnormal dreams, agitation, anxiety, confusion, emotional lability, migraine, nervousness, speech disorder, stupor, tremor, weakness, vertigo
CV: chest pain, hypertension, palpitations, tachycardia, peripheral edema
EENT: eye disorder, nystagmus, ear pain, rhinitis
GI: nausea, vomiting, diarrhea, anorexia, gastroenteritis, other GI disorder, oral candidiasis, salivary gland enlargement, ulcerative stomatitis
GU: urinary urgency, hematuria, erectile dysfunction, amenorrhea, dysmenorrhea, menorrhagia, abnormal Papanicolaou smear, vaginal candidiasis, vaginal hemorrhage
Hematologic: ecchymosis, lymphadenopathy
Musculoskeletal: joint, back, or neck pain; foot drop; hypertonia
Respiratory: bronchitis, dyspnea, hyperventilation
Skin: eczema, erythema, diaphoresis, pruritus, rash, skin atrophy, skin nodules, urticaria, warts
Other: dental caries, facial edema, weight gain, herpes simplex, herpes zoster, cysts, chills, flulike symptoms, pain at injection site
☞ Assess for immediate postinjection reaction, including flushing, chest pain, anxiety, breathing problems, and hives.
• Watch for transient chest pain, but be aware that this problem doesn't seem to be clinically significant.
• Check for vaginal bleeding.
• Watch for signs and symptoms of infection.
• Teach patient how to prepare and self-administer drug. Supervise him the first time he does so.
☞ Teach patient to recognize and immediately report signs and symptoms of postinjection reaction. Tell him this reaction may occur right away or up to several months after first dose.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
☞ Instruct patient to report signs or symptoms of infection or vaginal hemorrhage.
• Provide dietary counseling. Refer patient to dietitian if adverse GI effects significantly affect food intake.
• As appropriate, review all other significant and life-threatening adverse reactions.
ClassificationTherapeutic: anti multiple sclerosis agents
Pharmacologic: immune response modifiers
Adverse Reactions/Side Effects
Central nervous system
- anxiety (most frequent)
- weakness (most frequent)
- chest pain (most frequent)
- palpitations (most frequent)
- pruritis (most frequent)
- rashes (most frequent)
- sweating (most frequent)
Ear, Eye, Nose, Throat
- rhinitis (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- urgency (most frequent)
- injection site reactions (most frequent)
- arthralgia (most frequent)
- back pain (most frequent)
- hypertonia (most frequent)
- dyspnea (most frequent)
- flu-like symptoms (most frequent)
- lymphadenopathy (most frequent)
- immediate postinjection reaction
- weight gain
- Assess patient for side effects immediately after injection. Symptoms may include flushing, chest pain, palpitations, anxiety, dyspnea, constriction of throat, and urticaria. Symptoms are usually transient and self-limited without requiring treatment. May occur at the beginning of or following several months of therapy, and patients may experience one or several episodes of symptoms.
Potential Nursing DiagnosesImpaired physical mobility (Indications)
Deficient knowledge (Patient/Family Teaching)
- Subcutaneous: Allow prefilled syringes to warm to room temperature for 20 min before injection. Solution is clear, colorless to slightly yellow; do not administer solutions that are discolored or contain particulate matter. Sites for injection include arms, abdomen, hips, or thighs. Pinch skin and inject at a 90° angle. Discard unused solution. Unused syringes should be stored in refrigerator. Rotate injection sites to minimize risk of lipoatrophy.
- First injection should be performed under the supervision of a health care professional.
- Instruct patient to administer medication exactly as directed. Missed doses should be taken as soon as remembered but omitted if not remembered until next day; do not double doses.
- Advise patient not to discontinue medication or change dose or dosing schedule without consulting health care professional.
- Inform patient of potential post-injection reactions. Advise patient to contact health care professional if chest pain is unusally severe.
- Home Care Issues: Instruct patient in the correct technique for self-injection, storage, and proper disposal of equipment. Provide and discuss patient package insert. Caution patient not to reuse syringe. Provide patient with a puncture-proof container for needle and syringe disposal.
- Decreased incidence of relapses in relapsing-remitting MS.