Parenteral Manual

Eculizumab (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): 
Humanized Monoclonal C5 Antibody
Original Date: 
December 2019
  • Atypical Hemolytic Uremic Syndrome (HUS)
Reconstitution and Stability: 
  • Available as 300 mg vials containing 30 mL of 10 mg/mL
  • Store vials in original carton refrigerated (2-8°C) .  DO NOT FREEZE
  • Protect from light
  • Add exact volume of 0.9% sodium chloride equal to the eculizumab required to an empty viaflex bag (see table below)
Dose Vial Size Volume ot  0.9% Sodium
Total Volume Final
300 mg 30 mL x 1             30 mL       60 mL 5 mg/mL
600 mg 30 mL x 2             60 mL      120 mL 5 mg/mL
900 mg 30 mL x 3             90 mL      180 mL 5 mg/mL
1200 mg 30 mL x 4            120 mL      240 mL 5 mg/mL
  • Slowly inject measured volume of eculizumab into prepared bag of 0.9% sodium chloride
  • Gently invert the infusion bag to ensure mixing.  DO NOT SHAKE
  • Diluted solution stable 24 hours refrigerated or at room temperature
  • Protect from light
  • Discard any unused portion in the vial as product does not contain preservatives
  • Do not infuse if solution is discoloured or contains particulate matter
  • Prior to administration, the admixture should adjust to room temperature (18-25°C)

- Solution Compatible:  0.9% Sodium Chloride, 0.45% Sodium Chloride, 5% Dextrose in Water,  Ringer's Solution


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

IV Push NO
IV Intermittent Infusion YES - Large Volume Pump ONLY
Usual Dilution:  5 mg/mL
Infusion time:  35 minutes (may be up to 2 hours if patient experiences an infusion reaction)
IV Continuous Infusion NO

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

  • Induction dosing:
    5 to <10 kg:  300 mg IV x 1 weekly dose
    10 to <20 kg:  600 mg IV x 1 weekly dose
    20 to <30 kg:  600 mg IV every week x 2 doses
    30 to <40 kg:  600 mg IV every week x 2 doses
    greater than or equal to 40 kg:  900 mg IV every week x 4 doses
  • Maintenance dosing:
    5 to <10 kg:  300 mg IV every 3 weeks, starting week 2
    10 to <20 kg:  300 mg IV every 2 weeks starting week 2
    20 to <30 kg:  600 mg IV every 2 weeks, starting week 3
    30 to <40 kg:  900 mg IV every 2 weeks,starting week 3
    greater than or equal to 40 kg:  1200 mg IV every 2 weeks, starting week 5
  •  Should be administered  at the recommended dosage regimen time points, or within 2 days of these time points
  • See product monograph or contact pharmacy for supplemental dosing with plasmapheresis/ plasma exchange/ fresh frozen plasma exchange


Potential hazards of parenteral administration: 
  • Administration may result in infusion reactions, including anaphylaxis or other hypersensitivity reactions :  urticaria, dyspnea, hypotension
  • Headache, stuffy nose, sore throat, nausea, fever, joint aches and pains, fatigue, and herpes simplex (cold sores)
  • Eculizumab increases the risk of meningococcal infections
    - all patients must be vaccinated with a meningococcal vaccine at least 2 weeks prior to receiving the first dose of Eculizumab

    - revaccinate according to current medial guidelines for vaccine use: quadravalent, conjugated meningococcal vaccines against serotypes A,C,Y,W are strongly recommended
    - all patients must be monitored for early signs of meningococcal infections, evaluated immediately if infection is suspected, and treated with antibiotics, if necessary
    - vaccination may not prevent all meningococcal infections
  • Patients treated with Eculizumab have increased susceptibility to infection with other encapsulated organisms, such as Haemophilus influenza and Streptococcus pneumonia
  • Monitor patient for at least 1 hour following the completion of infusion for signs or symptoms of an infusion reaction
  • Monitoring after Eculizumab Discontinuation:  patients who discontinue treatment  may be at increased risk for serious hemolysis (identified by serum LDH levels greater than the pre-treatment level, along with any of the following:
    - a hemoglobin level of <50 g/L or a decrease of >40 g/L in 1 week or less
    - angina
    -change in mental status
    - a 50% increase in serum creatinine level
    - thrombosis
  • Monitor any patient who discontinues Eculizumab for at least 8 weeks to detect serious hemolysis and other reactions
  • Have Epinephrine Anaphylaxis Kit at bedside


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