ANAKINRA
| ANAKINRa (an-a-kin'ra) Kineret Classifications: immunomodulator; interleukin-1 receptor antagonist; Therapeutic: antirheumatic Pregnancy Category: B |
Availability
100 mg prefilled syringes
Action
Anakinra is a recombinant human interleukin-1 (IL-1) receptor antagonist (IL-1R1). It blocks the biologic activity of IL-1 by inhibiting it from binding to interleukin receptors that are present in both bone and cartilage as well as other kinds of tissues. Interleukin-1 is produced in response to inflammation. IL-1 mediates various responses of tissues, including inflammatory and immunologic responses.
Therapeutic Effect
Ana-kinra competes with interleukin-1 (IL-1) by inhibiting it from binding to its receptor sites in tissues.
Uses
Treatment of rheumatoid arthritis in patients failing other disease modifying antirheumatic drugs (DMARDs). Usually given in combination with another DMARD.
Contraindications
Hypersensitivity to anakinra, E. coli–derived products, latex; active infections; live vaccines.
Cautious Use
Neutropenia, immunosuppressed patients, or patients with frequent, serious infections; asthmatics; elderly; renal impairment; concomitant use of tumor necrosis factor blocking agents (TNF), etanercept, or infliximab; pregnancy (category B), lactation, children.
Route & Dosage
| Rheumatoid Arthritis Adult: SC 100 mg daily |
Administration
Subcutaneous- Do not give anakinra if the patient has an active infection.
- Note that anakinra should not ordinarily be given with tumor necrosis factor (TNF) blocking agents.
- Discard any unused portions as the drug contains no preservative.
- Check expiration date and do not use if expired.
- Store in the refrigerator at 2° to 8° C (36° to 46° F). DO NOT FREEZE OR SHAKE. Protect from light.
Adverse Effects (≥1%)
Body as a Whole: Bacterial infections (URI, sinusitis, flu, other). CNS: Headache. GI: Nausea, diarrhea, abdominal pain. Hematologic: Decreased neutrophil count, antibody formation. Other: Injection site reactions (erythema, ecchymosis, edema, inflammation, pain).Interactions
Drug: Increased risk of infection with live virus vaccine, etanercept, infliximab. Increased risk of neutropenia as well as infection with etanercept and infliximab.Pharmacokinetics
Absorption: 95% absorbed SC site. Peak: 3–7 h. Elimination: In urine. Half-Life: 4–6 h.Nursing Implications
Assessment & Drug Effects
- Monitor for S&S of infection (e.g., pneumonia or other URI, cellulitis). Withhold drug and notify physician if these appear.
- Lab tests: Monitor absolute neutrophil count (ANC) prior to initiating anakinra, monthly for 3 mo, and q3mo thereafter for 1 y; monitor periodically WBC and platelet counts.
- Monitor closely patients with impaired renal function for S&S of adverse drug reactions.
- Assess for injection site reactions manifested by erythema, ecchymosis, inflammation, and pain.
Patient & Family Education
- Review carefully the "Information for Patients and Caregivers" leaflet for detailed instructions on handling and injecting anakinra.
- Give the injection at approximately the same time every day.
- Administer only 1 dose (the entire contents of 1 prefilled glass syringe) per day. Discard any unused portions as the drug contains no preservative. Do not save unused drug.
- Do not permit vaccination with live vaccines while taking anakinra.
- Withhold drug and notify physician for S&S of upper respiratory, skin, or other infection(s).
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug