Parenteral Manual

Onasemnogene abeparvovec-xioi

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): 
Adeno-associated virus vector-based gene therapy
Original Date: 
February 2020
  • Treatment of patients less than 2 years of age with spinal muscular dystrophy (SMA) with bi-allelic mutations in the survival motor neuron (SMN1) gene
Reconstitution and Stability: 
  • Supplied in 10 mL single use vials containing a volume of either 5.5 or 8.3 mL or supplied as 5 mL single use vials containing 1 mL or 5 mL.
  •  Stable for 14 days in the fridge once thawed.
  • Thaw Zolgensma before use. The contents of the Zolgensma kit will thaw in approximately 12 hours if placed in a fridge, or in approximately 4 hours if placed at room temperature. If thawed in fridge, remove from fridge on day of dosing.
  • When thawed, Zolgensma is a clear to slightly opaque, colorless to faint white liquid, free of particles. Visually inspect vial for particulate matter and discoloration prior to infusion. Do not use vials is particulate or discoloration are present.
  • Draw the appropriate dose volume from all vials into a syringe, remove air from the syringe, cap the syringe, and deliver the syringe at room temperature to the patient infusion location
  • Use Zolgensma within 8 hours of drawing into syringe.
  •  NaCL 0.9% 
  • No other compatibility information

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

IV Direct



IV Intermittent Infusion


Usual dilution: Undiluted

Infusion time: 60 minutes. Administer into a peripheral limb vein (arm or leg)

Flush with saline following completion of infusion

IV Continuous Infusion NO



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

  • 1.1 x 1014 vector genomes (vg)/kg
2.6 - 3.0 16.5
3.1 - 3.5 19.3
3.6 - 4.0 22.0
4.1 - 4.5 24.8
4.6 - 5.0 27.5
5.1 - 5.5 30.3
5.6 - 6.0 33.0
6.1 - 6.5 35.8
6.6 - 7.0 38.5
7.1 - 7.5 41.3
7.6 - 8.0 44.0
8.1 - 8.5 46.8
8.6 - 9.0 49.5
9.1 - 9.5 52.3
9.6 - 10.0 55.0
10.1 - 10.5 57.8
10.6 - 11.0 60.5
11.1 - 11.5 63.3
11.6 - 12.0 66.0
12.1 -12.5 68.8
12.6 - 13.0 71.5
13.1 - 13.5b 74.3

a Dose volume is calculated using the upper limit of the patient weight range for patients less than 2 years of age between 2.6 and 3.5 kg

b Dose volume for patients less than 2 years of age weighing greater than or equal to 13.6 kg will require a combination of Zolgensama kits



Potential hazards of parenteral administration: 
  • Most common adverse reactions (>5%): elevated aminotransferases and vomiting
  • Hepatic: elevated aminotransferases, acute serious liver injury
  • Cardiovascular: transient increases in cardiac troponin
  • Hematologic: thrombocytopenia
  • One day prior to Zolgensma infusion, begin administration of systemic corticosteroids equivalent to prednisolone at 1 mg/kg/day for a total of 30 days
  • Prior to infusion, assess liver function. Continue to monitor liver function for at least 3 months after infusion.
  • Monitor platelet counts  before infusion, and weekly for the 1st month and then every other week for the 2nd & 3rd month until platelet counts return to baseline.
  • Monitor troponin before infusion and then weekly for the 1st mnth and then monthly for the 2nd and 3rd month until troponin-1 level returns to baseline.


  • Zolgensma Drug Product Monograph

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