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Gamifant (emapalumab-lzsg)
emapalumab
Adult Dosing .
Dosage forms: INJ
Special Note
- [drug name clarification]
- Info: nonproprietary name = emapalumab-lzsg
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, concomitant meds, prophylactic antimicrobials, and dosing
primary hemophagocytic lymphohistiocytosis
- [1-10 mg/kg/dose IV q3-4 days]
- Start: 1 mg/kg/dose IV q3-4 days; Info: for pts w/ refractory, recurrent, progressive dz or intolerance to conventional tx; use w/ dexamethasone 5-10 mg/m^2/day; adjust dose based on clinical response (see pkg insert)
macrophage activation syndrome, Still dz-associated
- [3 mg/kg/dose IV q3-4 days starting day 19]
- Start: 6 mg/kg/dose IV on day 1, then 3 mg/kg/dose IV q3 days x5 doses on days 4-16; Info: for pts w/ hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS) w/ recurrent MAS or inadequate response or intolerance to glucocorticoids; may adjust dose to max cumulative dose of 10 mg/kg over 3 days and frequency to q1-2 days, based on clinical response
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [drug name clarification]
- Info: nonproprietary name = emapalumab-lzsg
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, concomitant meds, prophylactic antimicrobials, and dosing
primary hemophagocytic lymphohistiocytosis
- [1-10 mg/kg/dose IV q3-4 days]
- Start: 1 mg/kg/dose IV q3-4 days; Info: for pts w/ refractory, recurrent, progressive dz or intolerance to conventional tx; use w/ dexamethasone 5-10 mg/m^2/day; adjust dose based on clinical response (see pkg insert)
macrophage activation syndrome, Still dz-associated
- [3 mg/kg/dose IV q3-4 days starting day 19]
- Start: 6 mg/kg/dose IV on day 1, then 3 mg/kg/dose IV q3 days x5 doses on days 4-16; Info: for pts w/ hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS) w/ recurrent MAS or inadequate response or intolerance to glucocorticoids; may adjust dose to max cumulative dose of 10 mg/kg over 3 days and frequency to q1-2 days, based on clinical response
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- mycobacterial infection, untreated
- herpes zoster, untreated
- Histoplasma Capsulatum infection, untreated
- caution: TB infection risk
- caution: TB infection, latent
Drug Interactions .
Overview
emapalumab
IFN-gamma blocker
- hypokalemia
- immunosuppressive effects
- caution advised w/ narrow therapeutic index drugs; chronic inflammatory conditions may alter metabolic enzyme formation; tx w/ immune modulators may reverse this effect, resulting in altered levels of concomitant drugs
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
- abrocitinib
- anifrolumab
- arsenic trioxide
- cladribine oral
- deuruxolitinib
- etrasimod
- natalizumab
- pimecrolimus topical
- rabies vaccine
- ritlecitinib
- ruxolitinib topical
- upadacitinib
Monitor/Modify Tx
- abiraterone acetate
- acetazolamide
- albuterol
- albuterol inhaled
- aloe
- amphotericin
- anthrax vaccine
- arformoterol inhaled
- asparaginase
- betamethasone
- budesonide
- bumetanide
- carboplatin
- carfilzomib
- cetuximab
- chikungunya vaccine
- chlorothiazide
- chlorthalidone
- cisplatin
- corticotropin
- cortisone
- COVID-19 vaccine
- crizotinib
- decitabine
- deflazacort
- dexamethasone
- dichlorphenamide
- digoxin
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- ebola vaccine, live
- epinephrine
- ethacrynic acid
- everolimus
- fludrocortisone
- formoterol inhaled
- foscarnet
- furosemide
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- hydrochlorothiazide
- hydrocortisone
- indapamide
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- isoproterenol
- Japanese encephalitis vaccine
- lenalidomide
- levalbuterol inhaled
- licorice
- magnesium citrate
- mannitol
- meningococcal vaccine
- methazolamide
- methylprednisolone
- metolazone
- mifepristone
- motixafortide
- necitumumab
- nilotinib
- olodaterol inhaled
- osilodrostat
- pamidronate
- panitumumab
- pneumococcal vaccine
- poliovirus vaccine
- polyethylene glycol
- polyethylene glycol/electrolytes
- posaconazole
- prednisolone
- prednisone
- respiratory syncytial virus vaccine
- sacituzumab govitecan
- salmeterol inhaled
- selinexor
- sipuleucel-T
- sirolimus albumin-bound
- smallpox/mpox vaccine, live
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- sulfate bowel prep
- tafasitamab
- temsirolimus
- terbutaline
- tick-borne encephalitis vaccine
- topiramate
- torsemide
- trastuzumab
- triamcinolone
- typhoid vaccine
- vamorolone
- vilanterol inhaled
- zonisamide
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
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- canakinumab
- carmustine
- certolizumab pegol
- chlorambucil
- ciltacabtagene autoleucel
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- copanlisib
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- delgocitinib topical
- deucravacitinib
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- epcoritamab
- epirubicin
- eribulin
- etanercept
- etoposide
- fingolimod
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- leflunomide
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methotrexate
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- nelarabine
- nipocalimab
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- oxaliplatin
- ozanimod
- paclitaxel
- panobinostat
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- pozelimab
- prednisolone ophthalmic
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- rilonacept
- risankizumab
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- sarilumab
- satralizumab
- secukinumab
- siltuximab
- siponimod
- sirolimus
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- tralokinumab
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- infection, severe
- sepsis
- necrotizing fasciitis
- appendicitis
- infusion rxn, severe
- GI hemorrhage
- multiple organ failure
Common Reactions
- infection
- HTN
- infusion rxn
- fever
- hypokalemia
- constipation
- rash
- abdominal pain
- CMV infection
- diarrhea
- lymphocytosis
- cough
- irritability
- tachycardia
- tachypnea
- vomiting
- acute kidney injury
- asthenia
- bradycardia
- dyspnea
- GI hemorrhage
- peripheral edema
- epistaxis
- anemia
- leukopenia
- thrombosis
- headache
- hyperglycemia
- thrombocytopenia
Safety/Monitoring .
Monitoring Parameters
TB test at baseline; s/sx herpes zoster, adenovirus, EBV, CMV infection as clinically indicated during tx; s/sx infusion rxn
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; no known risk of fetal harm based on animal data
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: unknown; CYP450: unknown
Excretion: unknown; Half-life: 22 days
Subclass: Interferon Antagonists
Mechanism of Action
binds and neutralizes interferon gamma
Formulary .
No Formulary Selected
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