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Nucala 100mg Injection
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Indications & Clinical Uses
- Nucala 100 mg (mepolizumab) is a monoclonal antibody that blocks interleukin-5 (IL-5), a protein that drives production of eosinophils, a type of white blood cell involved in several inflammatory conditions.
- It is used as an add-on maintenance treatment for severe eosinophilic asthma in adults and children aged 6 and older; for chronic rhinosinusitis with nasal polyps in adults whose symptoms are not controlled by nasal corticosteroids; for eosinophilic granulomatosis with polyangiitis (EGPA), a rare form of vasculitis, in adults; for hypereosinophilic syndrome (HES) lasting six months or more without another identifiable cause, in patients aged 12 and older; and for chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype that remains inadequately controlled, in adults.
- Nucala is not a rescue treatment and must not be used to relieve a sudden asthma attack or acute bronchospasm.
- This presentation is given as a subcutaneous injection, usually once every four weeks.
Side Effects
- There is no boxed warning for Nucala.
- The most common side effects in asthma trials include headache, injection-site reactions such as pain, redness or swelling, back pain and fatigue.
- Hypersensitivity reactions, including rash, itching, hives, swelling of the face or throat (angioedema), low blood pressure and, rarely, anaphylaxis, have occurred in up to about 1 in 25 people, usually within hours of the injection but sometimes with a delayed onset; treatment should be stopped if a serious reaction occurs.
- Shingles (herpes zoster) has been reported more often than with placebo, so vaccination should be considered before starting if medically appropriate.
- Because Nucala reduces eosinophils, which help fight parasites, existing worm (helminth) infections should be treated before starting.
- Seek urgent help for facial or throat swelling, difficulty breathing, or a widespread rash with dizziness or fainting.
Precautions & Warnings
- Do not use Nucala if you have had a hypersensitivity reaction to mepolizumab or any of its ingredients.
- Do not stop or reduce oral or inhaled corticosteroids abruptly when starting Nucala; any reduction must be gradual and supervised, as sudden withdrawal can cause adrenal insufficiency symptoms.
- Tell your healthcare provider if you have a current parasitic (helminth) infection, as this should be treated first; if an infection develops during treatment and does not respond to standard anti-parasite therapy, Nucala should be paused until it resolves.
- Nucala is not a substitute for other asthma or COPD medicines and must not be used to treat a sudden flare-up or acute bronchospasm.
- This prefilled-syringe or autoinjector presentation is refrigerated at 2°C to 8°C, protected from light, and should reach room temperature for about 30 minutes before injecting; the separate lyophilised-powder vial presentation is instead stored below 25°C and reconstituted before use, so check which presentation you were dispensed.
- Safety in pregnancy is not fully established, so it is used only if clearly needed.
Avoid Interactions
- Formal drug-interaction studies have not been carried out with Nucala, and it has not been shown to interact significantly with other medicines through the liver enzyme or transporter systems that cause most classic drug interactions, because it is a large protein antibody rather than a small-molecule drug.
- Nucala can safely be used alongside standard asthma treatments such as inhaled corticosteroids, long-acting bronchodilators and leukotriene modifiers, and alongside nasal corticosteroids for nasal polyps, and is typically added on top of these rather than replacing them; oral corticosteroids should be reduced gradually, not stopped abruptly, once Nucala starts working.
- Live or live-attenuated vaccines have not been specifically studied with Nucala, so discuss vaccination timing with your healthcare provider before receiving one.
- Always tell your healthcare provider and pharmacist about every other medicine, biologic therapy or supplement you are using before starting Nucala, particularly any other treatment for asthma, vasculitis or eosinophilic disease, to avoid unnecessary duplication of therapy.
References
Frequently Asked Questions
Nucala (mepolizumab) is an add-on biologic for severe eosinophilic asthma (age 6+), chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome (age 12+) and eosinophilic COPD. It reduces eosinophils, a white blood cell that drives inflammation. It's not for treating sudden asthma attacks.
Nucala is injected under the skin (subcutaneous), usually once every 4 weeks, into the thigh, abdomen or upper arm. It can be given by a healthcare provider or, for some presentations, self-injected at home with a prefilled syringe or autoinjector after proper training.
Common side effects include headache, injection-site reactions, back pain and fatigue. Allergic reactions, including facial swelling or, rarely, anaphylaxis, can occur, usually within hours. Shingles has been reported more often than with placebo. Seek urgent help for swelling of the face or throat, or breathing difficulty.
Don't stop or lower your corticosteroid dose suddenly when starting Nucala; any reduction must be gradual and supervised. Existing parasitic (worm) infections should be treated before starting, since Nucala lowers eosinophils that help fight them. Don't use Nucala to treat a sudden asthma attack.
Prefilled syringes and autoinjectors are kept refrigerated at 2°C to 8°C, away from light, and should sit at room temperature for about 30 minutes before injecting. Don't freeze or shake them. If you were dispensed the vial (powder) form instead, storage and preparation are different, so check with your pharmacist.
Nucala is approved for severe eosinophilic asthma in children aged 6 and older, and for hypereosinophilic syndrome from age 12. It is not approved for nasal polyps, EGPA or COPD in children. Dosing may differ by age and weight, so it's prescribed by a specialist.
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