raxibacumab


raxibacumab

(rax-ee-bak-ue-mab) raxibacumab,

ABthrax

(trade name)

Classification

Therapeutic: antidotes
Pharmacologic: temporary class
Pregnancy Category: B

Indications

Treatment of inhalational anthrax in combination with anti-infective agents.Prevention of inhalational anthrax when other agents cannot be used or are unavailable.

Action

A monoclonal anti-toxin, blocks the activity of toxin produced by Bacillus anthracisThe toxin is a primary cause of disease progression.

Therapeutic effects

Decreased morbidity and mortality associated with inhalational anthrax exposure and disease.

Pharmacokinetics

Absorption: IV administration results in complete bioavailabilityDistribution: Some tissue distributionMetabolism and Excretion: No renal clearanceHalf-life:

Time/action profile (levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusionunknown

Contraindications/Precautions

Contraindicated in: No contraindications noted.Use Cautiously in: Infusion reactions (premedication with diphenhyramine is recommended) Obstetric: Effects in pregnant women are not know Lactation: Use cautiously Pediatric: Safe and effective use in children >16 yr has not been studied

Adverse Reactions/Side Effects

Central nervous system

  • drowsiness

Dermatologic

  • pruritus
  • rash

Musculoskeletal

  • extremity pain

Miscellaneous

  • infusion reactions (rash/urticaria/pruritus)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Pretreatment with diphenhydramine is recommended.Intravenous (Adults and Children > 50 kg) 40 mg/kg single doseIntravenous (Children >15 kg-50 kg) 60 mg/kg single doseIntravenous (Children ≤15 kg) 80 mg/kg single dose

Availability

Solution for IV infusion (requires further dilution): 1700 mg/34 mL (50 mg/mL) vial

Nursing implications

Nursing assessment

  • Monitor for infusion-related reactions (rash, urticaria, pruritus). Slow or interrupt infusion if these occur.

Potential Nursing Diagnoses

Risk for infection (Indications)
Deficient knowledge, related to disease process and medication regimen (Patient/Family Teaching)

Implementation

  • Premedicate within 1 hr of infusion with 25 to 50 mg PO or IV depending on proximity of raxibacumab infusion.
  • Intermittent Infusion: Diluent: Dilute in 0.9% NaCl or 0.45% NaCl for patients up to 15 kg and 0.9% NaCl for patients >15 kg to a final volume of 250 mL or to a volume based on child's weight for either syringe or infusion bag preparation. For syringe preparation, use volume of 7 mL for patients ≤1 kg, 15 mL for patients 1.1–2 kg, 20 mL for patients 2.1–3 kg, 25 mL for patients 3.1–4.9 kg, 50 kg for patients 5–10 kg. Gently mix solution; do not shake. For infusion bag preparation, use volume of 100 mL for patients 16–30 kg, 250 mL for patients 31–40 kg, 250 mL for patients 41 to 50 kg or greater. Gently invert infusion bag; do not shake. Solution is clear to opalescent, colorless to pale yellow; do not administer solutions that are discolored or contain particulate matter. Stable for 8 hr at room temperature.
  • Rate: Infuse over up to 2 hr and 15 min based on patient weight. For patients ≤1 kg, first 20 min infuse at 0.5 mL/hr and remaining infusion over 3.5 mL/hr, patients 1.1–2 kg, first 20 min infuse at 1 mL/hr and remaining infusion over 7 mL/hr, patients 2.1–3 kg, first 20 min infuse at 1.2 mL/hr and remaining infusion over 10 mL/hr, patients 3.1–4.9 kg, first 20 min infuse at 1.5 mL/hr and remaining infusion over 12 mL/hr, patients 5–10 kg, first 20 min infuse at 3 mL/hr and remaining infusion over 25 mL/hr, patients 11–30 kg, first 20 min infuse at 6 mL/hr and remaining infusion over 50 mL/hr, patients 31–50 kg or more, first 20 min infuse at 15 mL/hr and remaining infusion over 125 mL/hr. Rate may be slowed or discontinued if symptoms of adverse reactions or infusion-related reactions occur.

Patient/Family Teaching

  • Explain purpose of raxibacumab to patient or parents.
  • Advise patient to notify health care professional immediately if rash, hives, or itching occur during infusion.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decreased morbidity and mortality associated with inhalational anthrax exposure and disease.