Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Antirheumatic, Disease Modifying; Interleukin-1 Receptor Antagonist
Original Date: 
November 2008
Revised Date: 
February 2017
  • Active rheumatoid arthritis (moderate-severe) who have failed disease-modifying antirheumatic drugs (DMARDs);  may be used alone or in combination with DMARDs  (other than tumor necrosis factor-blocking agents)
  • Macrophage activation syndrome (MAS) without a known homozygous defect in HLH genes (5-7)
Reconstitution and Stability: 
  • Available as 100 mg / 0.67mL prefilled syringe - single use, preservative free
  • Refrigerate -do not freeze
  • Protect from light
  • Do not shake
  • Prepare dose just prior to administration
  • Needle cover contains latex
  • Solutions Compatible:  No information
  • Additives/Above Cassette Compatible:  No information
  • Y-site Compatible:  No information

Incompatible:  No information



(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

Rotate injection sites
-thigh, abdomen,upper arm
IV Direct YES - slow IV push over 3 minutes
- flush with Normal Saline
IV Intermittent Infusion NO
IV Continuous Infusion NO




(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 1-2 mg/kg/day up to a maximum dose of 100 mg
  • Macrophage activation syndrome:   2 - 48 mg/kg/day subcutaneously or slow IV push divided 2 - 4 times daily. 
    - Typical regimen for hospitalized patients less than 40 kg:  10 mg/kg/day  divided twice daily SC or slow IV push
                                                     greater than 40 kg:  100 mg SC or slow IV push Q6H


  • 100 mg once daily  -administer at approximately the same time each day
  • CrCl less than 30 mL/minute and/or end-stage renal disease:  100 mg every other day
Potential hazards of parenteral administration: 
  • Injection site reactions:  redness, rash, pruritus,pain  (in 60-80% of patients)
  • Headache, nausea, diarrhea, abdominal pain
  • Allergic reactions rare  -medications for treatment of hypersensitivity reactions should be available for immediate use
  • May increase susceptibility to  infections
  • DO NOT administer live vaccines concurrently  -bring immunizations up to date before initiating therapy
  • DO NOT use in combination with tumor necrosis factor -blocking agents  (ie. etanercept )
  • Use with caution in patients with a history of new / recurrent infections , conditions that predispose them to infections, or  chronic,latent or localized infections.

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