Parenteral Manual

Canakinumab (NON-FORMULARY)

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): 
Disease-Modifying Antirheumatic Drug; Interleukin-1 Receptor Antagonist
Original Date: 
June 2013
  • Active Systemic Juvenile Idiopathic Arthritis (SJIA)
  • Cryopyrin-Associated Periodic Syndromes (CAPS) (Familial Cold Autoinflammatory Syndrome & Muckle-Wells Syndrome)
  • Neonatal-Onset Multisystem Inflammatory Disease (NOMID)/Chronic Infantile Neurological, Cutaneous, Articular Syndrome (CINCA)
Reconstitution and Stability: 
  • Available as 150 mg vial - single use, preservative-free
  • Refrigerate vials;  DO NOT freeze;  Protect from light
  • Reconstitute each vial by slowly injecting 1 mL of preservative-free Sterile Water for Injection to get a 150 mg/mL solution
  • Swirl vial slowly at an angle  (about 45 degrees) for approximately 1 minute and allow to stand for 5 minutes
  • Gently turn vial upside down and back again 10 times
  • Allow to stand 15 minutes at room teperature to obtain a clear soltuion
  • DO NOT use if particulate matter is present in the solution - final product should be free from particulates and colourless to slightly brownish-yellow tint.  DO NOT use if solution has a distinctly brown discoloration
  • Slight foaming of the product upon reconstitution is not unusual
  • Refrigerate syringe and protect from light;  Stable 60 minutes at room temperature or 24 hours refrigerated

-  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
IV Push NO
IV Intermittent Infusion NO
IV Continuous Infusion NO

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


-  Systemic Juvenile Idiopathic Arthritis (SJIA):

  • greater than or equal to 7.5 kg:  4 mg/kg/dose (up to MAXIMUM 300 mg) subcutaneously every 4 weeks

-  Cryopyrin-Associated Periodic Syndromes (CAPS):

  • less than or equal to 40 kg:  2 mg/kg/dose (up to 3 mg/kg/dose if inadequate response) subcutaneously every 8 weeks
  • greater than 40 kg:  150 mg subcutaneously every 8 weeks
Potential hazards of parenteral administration: 
  • Contraindicated in patients with active, severe infections or neutropenia
  • There have been some cases of mild hypersensitivity reactions in clinical trials.  No anaphylactic reactions have been reported, but the risk of severe hypersensitivity reactions cannot be excluded
  • Monitor for injection site reactions (mild to moderate)
  • DO NOT inject live vaccines concurrently - ensure immunizations are up to date before initiating therapy (including pneumococcal and inactivated influenza vaccine)
  • DO NOT inject into scar tissue (may result in insufficient exposure)
  • Possible adverse reactions:  increased incidence of severe infections, high blood pressure, neutropenia, hypersensitivity or injection - site reactions, elevated transaminases or bilirubin, and vertigo
  • Monitor ANC
  • Annual monitoring for changes in lipid profile is recommended

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