Omalizumab

INTRODUCTION

Indications

Moderate-to-severe asthma not controlled by inhaled corticosteroids.

Action

Inhibits binding of IgE to receptors on mast cells and eosinophils, preventing the release of mediators of the allergic response. Also decreases amount of IgE receptors on basophils. Therapeutic Effects: ↓ incidence of exacerbations of asthma.

Adverse Reactions/Side Effects

Local: injection site reactions. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, ↑ risk of malignancy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Monitor signs of malignancy, including a change in bowel or bladder habits, nonhealing sores, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, respiratory rate, and other symptoms (wheezing, dyspnea, shortness of breath) (See Appendices I, J, K). Report changes in pulmonary function to help document the effects of drug therapy in treating asthma.

• Monitor subcutaneous injection sites for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Design and implement appropriate aerobic exercise and respiratory muscle training programs to maintain optimal cardiovascular and pulmonary function. Work with patient and family/caregivers to find forms of exercise (e.g., swimming) that can help improve respiratory function without triggering asthma attacks.

Patient/Client-Related Instruction

• Advise patients to consult physician before stopping this medication or other asthma medications. Stopping these medications suddenly may result in increased bronchoconstriction.

Pharmacokinetics

Absorption: 62% absorbed slowly from SC sites.

Distribution: Enters breast milk.

Metabolism and Excretion: Degraded similarly to IgG via binding degradation, reticuloendothelial system, and the liver.

Half-life: 26 days.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Acute bronchospasm.

Use Cautiously in: Chronic use of inhaled corticosteroids; Pregnancy, lactation, or children <12 yr (safety not established; use in pregnancy only if clearly needed).

Interactions

Drug-Drug: None noted.

Route/Dosage

SC (Adults and Children ...