Ansuvimab
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From MedlinePlus, U.S. National Library of Medicine
Zaire Ebolavirus Glycoprotein-directed Antibody
Dosing in kidney impairment
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Preparation and administration
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2 DOSAGE AND ADMINISTRATION The recommended dose of EBANGA for adult and pediatric patients is 50 mg/kg reconstituted, further diluted, and administered as a single intravenous infusion over 60 minutes. ( 2.1 , 2.2 ) See Full Prescribing Information for instructions on preparation, dilution and administration of EBANGA injection. 2.1 Recommended Dosage for Adult and Pediatric Patients The recommended dosage of EBANGA is 50 mg/kg administered as a single intravenous (IV) infusion over 60 minutes.
EBANGA must be reconstituted with Sterile Water for Injection, USP then further diluted in 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP prior to IV infusion [see Dosage and Administration ] . 2.2. Preparation, Administration, and Storage Instructions EBANGA must be prepared and administered under the supervision of a health care professional.
Reconstitution Instructions Aseptically reconstitute and further dilute EBANGA prior to IV infusion. Do not administer as an IV push or bolus. More than one vial may be needed for a full dose. Calculate the dose (mg) based on the patient’s actual weight in kg and the number of EBANGA vials required [see Dosage and Administration ] .
Prior to reconstitution, allow EBANGA vial(s) to reach ambient temperature (15°C to 27°C [59°F to 81°F]) for approximately 20 minutes. If for any reason reconstitution cannot proceed immediately upon reaching ambient temperature, vials that have NOT been reconstituted may be kept at ambient temperature, protected from light, for no more than 24 hours.
Slowly inject the diluent along the wall of the vial and without any air to avoid foaming and bubbles. Gently swirl (do NOT shake) for approximately 10 seconds; then set the vial down to rest for at least 10 seconds. Repeat until the cake is dissolved. This may take up to 20 minutes. Upon reconstitution, one vial delivers 8 mL of solution that is clear to slightly opalescent and colorless to slightly yellow containing 50 mg/mL of ansuvimab-zykl.
Do NOT administer and discard the vial if the reconstituted solution is discolored or contains visible particles. Dilute the EBANGA solution immediately upon reconstitution. If needed, the reconstituted solution may be stored refrigerated at 2°C to 8°C (36°F to 46°F), protected from light, for up to 4 hours. This 4-hour window includes time required for further dilution and EBANGA solution should be infused immediately upon further dilution.
Dilution Instructions Following reconstitution, EBANGA must be further diluted prior to IV infusion. Use an 18-20 gauge, 1-1.5” needle with an appropriately sized syringe up to 60 mL to perform the dilution steps. Prepare the EBANGA IV dosing solution using an appropriately sized syringe up to 60 mL. For patients weighing ≥ 2 kg, prepare the diluent using either a latex-free, di-ethylhexylphthalate (DEHP)-free 0.9% Sodium Chloride Injection USP infusion bag, or latex-free, DEHP-free 5% Dextrose Injection USP infusion bag.
For patients weighing 0.5 to < 2 kg use a pump-compatible syringe ( Table 1 ). For adult and pediatric patients, either 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP can be used as the diluent. The total volume of the infusion solution to be administered is based on the patient’s body weight and is specified in Table 1 .
For patients weighing 0.5 to < 2 kg: Use a 10 mL syringe compatible with the IV infusion pump. Fill the 10 mL syringe with the appropriate amount of diluent ( Table 1 ). Add the calculated volume of EBANGA to the 10 mL syringe ( Table 1 ). Mix the diluted solution by gentle inversion (3 to 5 times) until admixed. Do not shake.
For patients weighing ≥ 2 kg: Select a diluent solution infusion bag size of appropriate fill volume based on the patient’s body weight (see Table 1 ). Withdraw and discard from the bag a volume of diluent solution that will leave remaining in the bag the appropriate volume based on the patient’s weight (see Table 1 ). Then add the calculated volume of EBANGA to the bag based on the patient's weight (see Table 1 ).
For example, for a 55 kg patient, withdraw and discard 150 mL of diluent from a 250 mL infusion bag. Then add 55 mL of EBANGA to obtain a total infusion volume of 155 mL. Gently invert the IV bag 5 to 10 times until the diluted solution is admixed. Do NOT shake. Infuse the EBANGA solution immediately upon dilution. If needed, the diluted infusion solution may be stored refrigerated at 2°C to 8°C (36°F to 46°F), for up to 4 hours.
Do not freeze the diluted solution. If refrigerated, allow approximately 20 minutes for the diluted solution to come to ambient temperature prior to use. These time limits include reconstitution time. Prepare a medical label including patient weight in kg, date, and time of reconstitution. Discard vial(s) and all unused contents. [See table below.] Administration Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
Do not administer if discolored or if the vial contains visible particles. Do not mix with or administer as an infusion with other medicinal products. Prepare the IV infusion line with 1.2 micron in-line filter extension set. Administer the IV infusion solution over 60 minutes. The diluted EBANGA IV solution can be infused via a central line or peripheral catheter.
Do not administer EBANGA as an IV push or bolus. Do not co-administer other drugs simultaneously through the same infusion line. Infusions may be slowed or stopped if necessary, to alleviate any side effects. At the end of the infusion, if a syringe pump was used, then remove the syringe and flush the line with 2 to 5 mL of diluent, but not to exceed the total infusion volume.
If an infusion bag was used, replace the empty bag and flush the line by infusing at least 25 mL of the diluent, to ensure complete product administration.
| Weight in kg | Volume of EBANGA | Diluent Volume (mL) a,b | Final Infusion Volume (mL) | Syringe or Infusion Bag Volume for IV Administration |
|---|---|---|---|---|
| a The recommended diluent volume ensures the final concentration of the diluted solution is approximately 8-30 mg/mL. b For IV bag administration, the diluent volume column includes the volume of diluent needed to remain in the infusion bag. | ||||
| 0.5 kg | 1 mL/kg | 2.5 mL | 3 mL | 10 mL syringe compatible with IV infusion pump |
| 1 kg | 5 mL | 6 mL | ||
| 2 to 10 kg | 10 mL | 12 to 20 mL | 25 mL IV bag | |
| 11 to 25 kg | 25 mL | 36 to 50 mL | 50 mL IV bag | |
| 26 to 50 kg | 50 mL | 76 to 100 mL | 100 mL IV bag | |
| 51 to 100 kg | 100 mL | 151 to 200 mL | 250 mL IV bag | |
| 101 kg and above | 150 mL | 251 mL and above | 500 mL IV bag | |
Drug interactions
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Interaction with live vaccine indicated for prevention of Orthoebolavirus zairense infection: No vaccine interaction studies have been performed. EBANGA may reduce the efficacy of the live vaccine. The interval between administration of EBANGA therapy and live vaccination should be in accordance with current vaccination guidelines. ( 7.1 )
7.1 Vaccine Interactions No vaccine-therapeutic interaction studies have been performed in human participants using EBANGA. However, because of the potential for EBANGA to inhibit replication of a live vaccine virus indicated for prevention of Orthoebolavirus zairense infection and possibly reduce the efficacy of the vaccine, avoid the concurrent administration of a live vaccine during treatment with EBANGA. The interval between administration of EBANGA therapy and live vaccination should be in accordance with current vaccination guidelines.
The efficacy of EBANGA among participants who reported receipt of a recombinant live vaccine prior to their enrollment in the PALM trial was similar to participants who did not report receiving a vaccine prior to enrollment.
Contraindications
None . None.
Pregnancy and lactation
Pregnancy
8.1 Pregnancy Risk Summary Orthoebolavirus zairense infection is life-threatening for both the mother and fetus and treatment should not be withheld due to pregnancy (see Clinical Considerations ) . Available data from the PALM trial in which pregnant women with Orthoebolavirus zairense infection were treated with EBANGA demonstrate the high rate of maternal and fetal/neonatal morbidity consistent with published literature regarding the risk associated with underlying maternal Orthoebolavirus zairense infection. These data are insufficient to evaluate for a drug associated risk of major birth defects, miscarriage, or adverse maternal/fetal outcome.
Animal reproduction studies with ansuvimab-zykl have not been conducted. Monoclonal antibodies, such as EBANGA, are transported across the placenta; therefore, EBANGA has the potential to be transferred from the mother to the developing fetus. Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Maternal, fetal and neonatal outcomes are poor among pregnant women infected with Orthoebolavirus zairense . The majority of such pregnancies result in maternal death with miscarriage, stillbirth, or neonatal death. Treatment should not be withheld due to pregnancy.
For breastfeeding, also see LactMed (National Library of Medicine), which summarizes milk levels and infant effects.
Supply and cost
Drug shortage status
Recalls (last 24 months)
Therapeutic equivalence (Orange Book)
Price ladder
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