Parenteral Manual

Abatacept (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): 
ORENCIA
Classification: 
Selective co-stimulation modulator (inhibits T-cell activation)
Original Date: 
January 2011
Revised Date: 
September 2011
Indications: 
  • Juvenile Idiopathic Arthritis / Juvenile Rheumatic Arthritis.
  • Adult Rheumatoid Arthritis
Reconstitution and Stability: 
VIAL SIZE STERILE WATER for INJECTION REQUIRED FINAL CONCENTRATION
   250 mg                                      10 mL                 25 mg/mL
  • Refrigerate unopened vials.  Protect from light.
  • Reconstitute  vial using a silicone-free disposable syringe provided with each vial
  • Do not use vial if vacuum is not present
  • Rotate vial with gentle swirling until contents are completely dissolved
  • DO NOT SHAKE
  • Solution is colorless to pale yellow
  • Diluted solution stable 24 hours refrigerated or at room temperature
Compatibility: 

-Solutions Compatible:  NS

-Additives/Above Cassette Compatible:  no information

-Y-site Compatible:  no information

Incompatible:  DO NOT infuse with any other medications

Administration: 

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

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES
Dilution:   <10 mg/mL
Total Volume:  100 mL
Infusion time:  30 minutes
-Administer with a low-protein binding filter -pore size less than 1.2 µm (micrometer))
IV Continuous Infusion NO
Dosage: 

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

Pediatric:

- 6 - 17 years < 75 kg:  10 mg/kg (max 750 mg)

- >  75 kg:  follow adult dosing regimen

- Dose should be given at 2 and 4 weeks after the first infusion and every 4 weeks thereafter

Adults:

- <60 kg:  500 mg

- 60 to 100 kg:  750 mg

- > 100 kg:  1000 mg

Potential hazards of parenteral administration: 
  • Most common:  acute infusion-related events (reported within 1 hour of the start of infusion):  dizziness, headache, and hypertension
  • Less common:  hypotension, hypertension, dyspnea, nausea, flushing, urticaria, cough, hypersensitivity, pruritis, rash and wheezing
  • Uncommon:  hypotension urticaria, and dyspnea may occur up to 24 hours post infusion
  • Rare:  allergic reactions - medications for treatment of hypersensitivity reactions should be available for immediate use
Notes: 
  • Patients should be screened for tuberculosis and viral hepatitis prior to treatment - treat latent TB before abatacept is used
  • DO NOT administer live vaccines concurrently with abatacept or within 3 months of discontinuation
  • Pre-medication to prevent hypersensitivity is NOT required
  • Avoid concurrent treatment with biologic rheumatoid arthritis agents (for example:  adalimumab, anakinra, etanercept, infliximab)
  • Serious infections, including sepsis and pneumonia, have been reported (increased in patients with concomitant immunosuppressive therapy)  -avoid in patients with active systemic or localized infections, chronic or latent infections
  • Patients who develop a new infection while receiving abatacept should be monitored closely
  • If a patient develops a serious infection while on abatacept, discontinue treatment
  • Glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) based glucose monitoring systems may react with the maltose present in abatacept, resulting in falsely elevated blood glucose readings on the day of infusion

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