Glatiramer Acetate
Pronouncation: (glah-TEER-ah-mer ASS-eh-tate)Class: Immunosuppressive
Trade Names:
Copaxone
- Injection 20 mg
Pharmacology
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Unknown. May modify the immune processes that are thought to be responsible for multiple sclerosis (MS).
Indications and Usage
To reduce the frequency of relapses in patients with relapsing-remitting MS.
Contraindications
Hypersensitivity to glatiramer acetate or mannitol.
Dosage and Administration
AdultsSubcutaneous 20 mg every day.
General Advice
- For subcutaneous administration only. Not for intradermal, IM, IV, or intra-arterial administration.
- Allow syringe to warm to room temperature before administering. This may take up to 20 min.
- Rotate injection sites (hips, thighs, abdomen, back of arms). Use a different area than where the last injection was administered. Do not inject into areas that are tender, bruised, red, or hard.
- Do not administer if particulate matter, cloudiness, or discoloration noted.
- Discard any unused solution. Do not save for future use.
Storage/Stability
Store prefilled syringes in refrigerator (36° to 46°F). Protect from freezing and exposure to light. Discard any syringes that have been frozen. If a refrigerator is not available, the syringes may be stored at room temperature (59° to 86°F) for up to 7 days.
Drug Interactions
None well documented.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Vasodilation (27%); palpitation (17%); syncope, tachycardia (5%); hypertension (at least 1%); thrombosis, peripheral vascular disease, pericardial effusion, MI, deep thrombophlebitis, coronary occlusion, CHF, cardiomyopathy, cardiomegaly, arrhythmia, angina pectoris (postmarketing).
CNS
Asthenia (41%); anxiety (23%); hypertonia (22%); tremor (7%); vertigo (6%); migraine (5%); agitation (4%); foot drop (3%); confusion, nervousness, nystagmus, speech disorder (2%); abnormal dreams, emotional lability, stupor (at least 1%); meningitis, CNS neoplasm, cerebrovascular accident, brain edema, abnormal dreams, aphasia, convulsion, neuralgia, myelitis (postmarketing).
Dermatologic
Pruritus, rash (18%); sweating (15%); erythema, herpes simplex, urticaria (4%); skin nodule (2%); eczema, herpes zoster, pustular rash, skin atrophy, warts (at least 1%).
EENT
Rhinitis (14%); eye pain (7%); eye disorder (4%); visual field changes (at least 1%); glaucoma, blindness, visual field defect (postmarketing).
GI
Nausea (22%); diarrhea (12%); anorexia (8%); vomiting (6%); GI disorder (5%); gastroenteritis (3%); bowel urgency, oral moniliasis, salivary gland enlargement, tooth caries and ulcerations (at least 1%); tongue edema, stomach ulcer, GI hemorrhage, eructation (postmarketing).
Genitourinary
Urinary urgency (10%); vaginal moniliasis (8%); dysmenorrhea (6%); amenorrhea, hematuria, impotence, menorrhagia, suspicious papanicolaou smear, urinary frequency, vaginal hemorrhage (at least 1%); urogenital neoplasm, urine abnormality, ovarian carcinoma, nephrosis, kidney failure, breast carcinoma, bladder carcinoma, urinary frequency (postmarketing).
Hematologic-Lymphatic
Lymphadenopathy (12%); ecchymosis (8%); thrombocytopenia, lymphoma-like reaction, acute leukemia (postmarketing).
Hepatic
Abnormal liver function, liver damage, hepatitis, liver cirrhosis, cholelithiasis (postmarketing).
Local
Injection-site pain (73%); injection-site erythema (66%); injection-site inflammation (49%); injection-site pruritus (40%); injection-site mass (27%); injection-site induration (13%); injection-site welt (11%); injection-site hemorrhage, injection-site urticaria (5%); injection-site edema, atrophy, abscess or hypersensitivity (at least 1%).
Metabolic-Nutritional
Weight gain (3%); hypercholesterolemia (postmarketing).
Musculoskeletal
Arthralgia (24%); back pain (16%); neck pain (8%); rheumatoid arthritis, generalized spasm (postmarketing).
Respiratory
Dyspnea (19%); bronchitis (9%); laryngismus (5%); hyperventilation; hay fever (at least 1%); pulmonary embolus, pleural effusion, lung carcinoma, (postmarketing).
Miscellaneous
Infection (50%); pain (28%); chest pain (21%); flu syndrome (19%); peripheral edema (7%); fever (8%); face edema (6%); bacterial infection (5%); chills (4%); edema (3%); cyst (2%); sepsis, lupus erythematosus syndrome, hydrocephalus, enlarged abdomen, allergic reaction, anaphylactoid reaction (postmarketing).
Precautions
Pregnancy
Category B .
Lactation
Undetermined.
Children
Safety and efficacy in children younger than 18 yr of age not established.
Immunity
Could possibly interfere with useful immune function (eg, decreased defense against infection or tumor surveillance).
Immediate postinjection reaction
Approximately 10% of patients experience a constellation of symptoms immediately after injection. Symptoms may include the following: flushing, chest pain, palpitations, anxiety, dyspnea, constriction of throat, urticaria. These symptoms are usually transient and self-limited and generally occur several months after starting therapy.
Patient Information
- Advise patient, family, or caregiver that medication is not a cure for MS, but it may decrease the number of flare-ups and slow development of some physical disabilities caused by MS.
- Advise patient or caregiver to review the patient information leaflet before using first time and with each refill.
- If patient or caregiver will be administering at home, ensure that the patient or caregiver has reviewed the patient information leaflet for self-injection procedure and understands how to store, prepare and administer dose, and dispose of used equipment and supplies. The first injection should be performed under supervision of a qualified health care provider.
- Instruct patient to rotate injection sites as described in the patient information leaflet to reduce likelihood of severe injection-site reactions developing.
- Advise patient not to change the dose or stop taking unless advised by health care provider.
- Instruct patient to notify health care provider immediately if any of the following occur: hives, skin rash with irritation, dizziness, sweating, chest pain, trouble breathing, or severe pain at injection site. Caution patient not to administer any more injections unless advised by health care provider.
- Patient may experience a short-term reaction right after injecting the glatiramer (eg, flushing, chest pain tightness with heart palpitations, anxiety, trouble breathing). Advise patient that these symptoms appear a few minutes after an injection, last a few minutes, and go away by themselves without further problems. Instruct patient to discontinue use and immediately seek medical care if symptoms become severe and not to administer any more injections unless advised by health care provider.
- Advise patient that injection-site reactions (eg, redness, pain, swelling, itching, or lump at injection site) are the most common adverse reactions and to inform health care provider if they occur and are bothersome.
- Advise patient to contact health care provider if experiencing bothersome adverse reactions or experience any unusual problems.
- Caution patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined.
- Instruct patient on proper self-injection techniques to ensure safe administration.
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