Parenteral Manual

Emapalumab (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): 
Interferon gamma blocking monoclonal antibody
Original Date: 
Oct 2019

Treatment of adult and pediatric (newborn and older) patients with primary hemophagocytic lymphohistiocytosis (HLH) with refractory, recurrent, or progressive disease who are intolerant of conventional HLH therapy. Off label for Macrophage Activation Syndrome.

Reconstitution and Stability: 

Dose per vial

Vial Size

Final Concentration

10 mg

 2 mL

5 mg/mL

50 mg

10 mL

5 mg/mL

  • Available as 10 and 50 mg preservative free, single use vials at a concentration of 5 mg/mL sterile solution
  • Clear to slightly opalescent, colorless or slightly yellow preservative-free solution. Do not administer if discolored or foreign particulate matter is present.
  • Store vials in original carton under refrigeration (2 - 8 degrees C) DO NOT FREEZE
  • Protect from light
  • Dilute with 0.9% NaCL injection to a concentration between 0.25 - 2.5 mg/mL. Discard any unused portion left in the vial(s).
  • Gently invert the infusion bag or syringe several times to ensure complete and homogenous distribution. Do not shake.
  • Reconstituted solution must be in a gamma irradiated latex-free, polvinyl chloride (PVC)-free syringe OR non-PVC polyolefin infusion bag.
  • Store diluted solution of emapalumab under refrigeration between 2 - 8 degrees C for up to 16 hours. If refrigerated, allow the diluted solution to come to room temperature prior to administration.
  • Solutions compatible: 0.9% NaCL
  • Additives/Above Cassette compatible: No information
  • Y-Site compatability: No information
  • Incompatible: DO NOT infuse any other medication or solution with emapalumab.

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

IV intermittent infusion

YES. Dilute between 0.25 mg/mL and 2.5 mg/mL.

Infusion time: 1 - 2 hours

  • For patients weighing less than 10 kg, the maximum volume to be administered should be 4 mL/kg/hr
  • For patients weighing between 10 - 20 kg, the maximum volume  to be administered should be 6 mL/kg/hr

Administer through a sterile, non-pyrogenic, low- protein binding 0.2 micron inline filter.

IV continuous infusion NO



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

Macrophage Activation Syndrome (off label)

Treatment Day Emapalumab Dose

6 mg/kg

3 3 mg/kg
6 3 mg/kg
9 3 mg/kg
12 3 mg/kg
15 3 mg/kg
Subsequent treatment days 3 mg/kg twice weekly

Emapalulab dose can be increased (or frequency between infusion shortened) guided by the clinical and laboratory response or pharmacokinetic data in the individual patient, only after receiving Novimmune's (the maker of emapalulmab) approval.

Potential hazards of parenteral administration: 
  • Infusion related reactions including drug eruption, anaphylaxis, pyrexia, rash, erythema, and hyperhidrosis. Interrupt infusion for infusion reactions and institute CHEO appropriate medical management prior to continuing infusion at a slower rate.
  • The most common reported adverse reactions (> 10%) include infection (56%), hypertension (41%), infusion related reactions (27%), pyrexia (24%), hypokalemia (15%), constipation (15%), rash (12%). abdominal pain (12%), CMV infection (12%), diarrhea (12%), lymphocytosis (12%), cough (12%), irritability (12%), tachycardia (12%), and tachypnea.
  • Rare adverse reactions (< 10%) include vomiting, acute kidney injury, asthenia, bradycardia, dyspnea, gastrointestinal hemorrhage, epistaxis, and peripheral edema.
  • No anaphylactic/anaphylactoid reactions or delayed hypersensitivity reactions have been observed; however, given the currently limited clinical experience, anaphylactic precautions should be taken when administering emapalumab.
  • Live or attenuated vaccines should not be administered for at least 4 weeks after the last dose of emapalumab. DO NOT administer live vaccines concurrently with emapalumab.

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

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