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Kineret
anakinra
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 100 mg per 0.67 mL
Special Note
- [FDA emergency use authorization (EUA)]
- Info: for hospitalized patients with confirmed COVID-19, requiring supplemental oxygen, at risk for progression to severe respiratory failure, and likely to have an elevated plasma soluble urokinase plasminogen activator receptor (suPAR); not FDA approved for COVID-19; available from Swedish Orphan Biovitrum or authorized distributors at https://kineretrxhcp.com/EUA.php; for clinical trial eligibility and enrollment info, check www.clinicaltrials.gov
- [mandatory reporting for EUA]
- Info: serious medication errors and adverse events must be reported to FDA MedWatch (www.fda.gov/medwatch/report.htm or 1-800-FDA-1088) and Swedish Orphan Biovitrum (1-866-773-5274)
rheumatoid arthritis, moderate-severe
- [100 mg SC q24h]
- Info: for monotherapy or in combination with other anti-rheumatics except TNF blocking agents
neonatal-onset multisystem inflammatory disease
- [3-4 mg/kg/dose SC q24h]
- Start: 1-2 mg/kg/dose SC q24h, may incr. by 0.5-1 mg/kg/day; Max: 8 mg/kg/day; Info: may divide dose bid
interleukin-1 receptor antagonist deficiency
- [1-8 mg/kg/dose SC q24h]
- Start: 1-2 mg/kg/dose SC q24h, may incr. by 0.5-1 mg/kg/day; Max: 8 mg/kg/dose
COVID-19
- [100 mg SC q24h x10 days]
- Info: for hospitalized, SARS-CoV-2-positive patients requiring supplemental oxygen, at risk for progression to severe respiratory failure, and likely to have an elevated plasma suPAR, per FDA EUA
renal dosing
- [see below]
- CrCl <30: give usual dose q48h
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 100 mg per 0.67 mL
neonatal-onset multisystem inflammatory disease
- [3-4 mg/kg/dose SC q24h]
- Start: 1-2 mg/kg/dose SC q24h, may incr. by 0.5-1 mg/kg/day; Max: 8 mg/kg/day; Info: may divide dose bid
interleukin-1 receptor antagonist deficiency
- [1-8 mg/kg/dose SC q24h]
- Start: 1-2 mg/kg/dose SC q24h, may incr. by 0.5-1 mg/kg/day; Max: 8 mg/kg/dose
renal dosing
- [see below]
- CrCl <30: give usual dose q48h
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to E. coli protein
- infection, active
- caution: CrCl <30
- caution: immunosuppressed patients
- caution: infection, chronic
- caution: infection, recurrent
- caution: asthma
Drug Interactions .
Overview
anakinra
IL-1 antagonist
- immunomodulatory effects
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- abatacept
- abrocitinib
- adalimumab
- anifrolumab
- baricitinib
- canakinumab
- certolizumab pegol
- cladribine oral
- deuruxolitinib
- etanercept
- etrasimod
- golimumab
- infliximab
- natalizumab
- pimecrolimus topical
- rabies vaccine
- rilonacept
- ritlecitinib
- ruxolitinib topical
- sarilumab
- tocilizumab
- tofacitinib
- upadacitinib
Monitor/Modify Tx
- anthrax vaccine
- carfilzomib
- chikungunya vaccine
- COVID-19 vaccine
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- ebola vaccine, live
- everolimus
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- influenza H5N1 vaccine
- influenza vaccine
- Japanese encephalitis vaccine
- meningococcal vaccine
- mitomycin
- pneumococcal vaccine
- poliovirus vaccine
- respiratory syncytial virus vaccine
- sipuleucel-T
- smallpox/mpox vaccine, live
- tick-borne encephalitis vaccine
- typhoid vaccine
Caution Advised
- abemaciclib
- acalabrutinib
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- betamethasone
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- carboplatin
- carmustine
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- coccidioides immitis skin test antigen
- copanlisib
- corticotropin
- cortisone
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- deflazacort
- delgocitinib topical
- deucravacitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- epirubicin
- eribulin
- etoposide
- etuvetidigene autotemcel
- fingolimod
- floxuridine
- fludarabine
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemtuzumab ozogamicin
- glofitamab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- icotrokinra
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- leflunomide
- lenalidomide
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methotrexate
- methylprednisolone
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- narsoplimab
- nelarabine
- nipocalimab
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- oxaliplatin
- ozanimod
- paclitaxel
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- rilzabrutinib
- risankizumab
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- satralizumab
- secukinumab
- selinexor
- sibeprenlimab
- siltuximab
- siponimod
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- temsirolimus
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- topotecan
- trabectedin
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vamorolone
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- angioedema
- drug reaction with eosinophilia and systemic symptoms
- infection, serious
- neutropenia
- thrombocytopenia
- malignancy risk
- amyloidosis
Common Reactions
- injection site reaction
- URI
- headache
- nausea
- diarrhea
- arthralgia
- vomiting
- fever
- rash
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; ANC at baseline, qmo x3mo, then q3mo for up to 1y
Look/Sound-Alike Drug Names
Kineret confused with: Amikin
anakinra confused with: amikacin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of teratogenicity based on animal data at 25x MRHD
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for anakinra: other; CYP450: unknown
Excretion: for anakinra: urine; Half-life: 4-6h
Subclass: DMARDs, Interleukin (IL) Antagonists ; Interleukin-1 (IL-1) Antagonists
Mechanism of Action
for anakinra: inhibits interleukin-1 type I receptors; modulates various inflammatory and immunological responses (anticytokine)
Formulary .
No Formulary Selected
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