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Dupixent
dupilumab
Adult Dosing .
Dosage forms: INJ (pen): 200 mg per 1.14 mL, 300 mg per 2 mL; INJ (pre-filled syringe): 200 mg per 1.14 mL, 300 mg per 2 mL
atopic dermatitis, moderate-severe
- [300 mg SC q2wk]
- Start: 600 mg SC x1
moderate-severe eosinophilic asthma, maintenance tx
- [200 mg SC q2wk]
- Start: 400 mg SC x1; Alt: start 600 mg SC x1, then 300 mg SC q2wk
moderate-severe PO corticosteroid-dependent asthma, maintenance tx
- [300 mg SC q2wk]
- Start: 600 mg SC x1
asthma w/ concurrent moderate-severe atopic dermatitis, maintenance tx
- [300 mg SC q2wk]
- Start: 600 mg SC x1
asthma w/ concurrent chronic rhinosinusitis w/ nasal polyps, maintenance tx
- [300 mg SC q2wk]
- Start: 600 mg SC x1
chronic rhinosinusitis w/ nasal polyps, maintenance tx
- [300 mg SC q2wk]
eosinophilic esophagitis
- [>40 kg]
- Dose: 300 mg SC qwk
prurigo nodularis
- [300 mg SC q2wk]
- Start: 600 mg SC x1
eosinophilic COPD, maintenance tx
- [300 mg SC q2wk]
- Info: search 'gold' for epocrates COPD GOLD decision tools
chronic spontaneous urticaria
- [300 mg SC q2wk]
- Start: 600 mg SC x1
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (pen): 200 mg per 1.14 mL, 300 mg per 2 mL; INJ (pre-filled syringe): 200 mg per 1.14 mL, 300 mg per 2 mL
Special Note
- [formulation clarification]
- Info: pen form for use in pts 2 yo and older; pre-filled syringe form for use in pts 6 mo and older
atopic dermatitis, moderate-severe
- [6 mo-5 yo, 5-14 kg]
- Dose: 200 mg SC q4wk
- [6 mo-5 yo, 15-29 kg]
- Dose: 300 mg SC q4wk
- [6-17 yo, 15-29 kg]
- Dose: 300 mg SC q4wk; Start: 600 mg SC x1
- [6-17 yo, 30-59 kg]
- Dose: 200 mg SC q2wk; Start: 400 mg SC x1
- [6-17 yo, >60 kg]
- Dose: 300 mg SC q2wk; Start: 600 mg SC x1
moderate-severe eosinophilic asthma, maintenance tx
- [6-11 yo, 15-29 kg]
- Dose: 300 mg SC q4wk
- [6-11 yo, >30 kg]
- Dose: 200 mg SC q2wk
- [12 yo and older]
- Dose: 200 mg SC q2wk; Start: 400 mg SC x1; Alt: start 600 mg SC x1, then 300 mg SC q2wk
moderate-severe PO corticosteroid-dependent asthma, maintenance tx
- [6-11 yo, 15-29 kg]
- Dose: 300 mg SC q4wk
- [6-11 yo, >30 kg]
- Dose: 200 mg SC q2wk
- [12 yo and older]
- Dose: 300 mg SC q2wk; Start: 600 mg SC x1
asthma w/ concurrent moderate-severe atopic dermatitis, maintenance tx
- [6-11 yo, 15-29 kg]
- Dose: 300 mg SC q4wk; Start: 600 mg SC x1
- [6-11 yo, 30-59 kg]
- Dose: 200 mg SC q2wk; Start: 400 mg SC x1
- [6-11 yo, >60 kg]
- Dose: 300 mg SC q2wk; Start: 600 mg SC x1
- [12 yo and older]
- Dose: 300 mg SC q2wk; Start: 600 mg SC x1
chronic rhinosinusitis w/ nasal polyps, maintenance tx
- [12 yo and older]
- Dose: 300 mg SC q2wk
eosinophilic esophagitis
- [1 yo and older, 15-29 kg]
- Dose: 200 mg SC q2wk
- [1 yo and older, 30-39 kg]
- Dose: 300 mg SC q2wk
- [1 yo and older, >40 kg]
- Dose: 300 mg SC qwk
chronic spontaneous urticaria
- [12 yo and older, 30-59 kg]
- Dose: 200 mg SC q2wk; Start: 400 mg SC x1
- [12 yo and older, >60 kg]
- Dose: 300 mg SC q2wk; Start: 600 mg SC x1
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pts <2 yo (pen form)
- helminth infection
- status asthmaticus
- asthma, acute
- bronchospasm, acute
- COPD, acute
- avoid: abrupt corticosteroid D/C
Drug Interactions .
Overview
dupilumab
IL-4 antagonist
- immunosuppressive effects
Contraindicated
- adenovirus vaccine, live
- chikungunya vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
Avoid/Use Alternative
- abrocitinib
- cladribine oral
- infliximab
- pimecrolimus topical
- rabies vaccine
- ruxolitinib topical
Monitor/Modify Tx
- anthrax vaccine
- chikungunya vaccine
- COVID-19 vaccine
- diphtheria/tetanus/pertussis vaccine
- ebola vaccine, live
- Haemophilus b vaccine
- hepatitis A vaccine
- human papillomavirus vaccine
- influenza H5N1 vaccine
- influenza vaccine
- Japanese encephalitis vaccine
- pneumococcal vaccine
- respiratory syncytial virus vaccine
- smallpox/mpox vaccine, live
- temsirolimus
- typhoid vaccine
Caution Advised
- abatacept
- abemaciclib
- acalabrutinib
- adalimumab
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anakinra
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- baricitinib
- 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
- canakinumab
- carboplatin
- carmustine
- certolizumab pegol
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- copanlisib
- corticotropin
- cortisone
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- deflazacort
- deucravacitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- epirubicin
- eribulin
- etanercept
- etoposide
- fingolimod
- floxuridine
- fludarabine
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemcitabine
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inotuzumab ozogamicin
- iptacopan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- leflunomide
- lenalidomide
- lifileucel
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methylprednisolone
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- nelarabine
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- oxaliplatin
- ozanimod
- paclitaxel
- panobinostat
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- rilonacept
- risankizumab
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- sarilumab
- satralizumab
- selinexor
- siltuximab
- siponimod
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vamorolone
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn
- anaphylaxis
- angioedema
- serum sickness
- serum sickness-like rxn
- keratitis
- helminth infection (peds pts)
- arthralgia, severe
- psoriatic arthritis
- pneumonia, eosinophilic
- granulomatosis w/ polyangiitis, eosinophilic
- cholecystitis
Common Reactions
- injection site rxn
- conjunctivitis
- URI
- eosinophilia
- nasopharyngitis
- headache
- hand-foot-mouth dz (atopic dermatitis use in pts <6 yo)
- back pain
- keratitis
- herpes viral infection
- diarrhea
- arthralgia
- myalgia
- dizziness
- UTI
- helminth infection (peds pts)
- oropharyngeal pain
- gastritis
- ocular pruritus
- dry eyes
- skin papilloma (atopic dermatitis use in pts <6 yo)
- psoriasis
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available, though likely to cross placenta based on human data w/ other monoclonal antibodies; no known risk of teratogenicity or embryo-fetal toxicity based on animal data at up to 10x recommended human dose
Pregnancy Registry
enroll pts or encourage pts to enroll in MotherToBaby Pregnancy Study at 1-877-311-8972 or www.mothertobaby.org/ongoing-study/dupixent/
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: catabolism; CYP450: unknown
Excretion: unknown; Half-life: unknown
Subclass: Atopic Dermatitis, Systemic Nonsteroidal Agents ; Interleukin-4/13 (IL-4/13) Antagonists ; Pruritus/Urticaria, Systemic Nonsteroidal Agents
Mechanism of Action
binds to interleukin-4 receptor alpha subunit and inhibits interleukin-4 and interleukin-13 cytokine-induced responses incl. release of pro-inflammatory cytokines, chemokines, nitric oxide, and IgE (monoclonal antibody)
Formulary .
No Formulary Selected
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