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- Recombinant α-L-Iduronidase (Glycosaminoglycan α-L-Iduronohydrolase)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aldurazyme: 2.9 mg/5 mL (5 mL) [contains mouse protein (murine) (hamster), polysorbate 80]
Brand Names: U.S.
Laronidase is a recombinant (replacement) form of α-L-iduronidase derived from Chinese hamster cells. α-L-iduronidase is an enzyme needed to break down endogenous glycosaminoglycans (GAGs) within lysosomes. A deficiency of α-L-iduronidase leads to an accumulation of GAGs, causing cellular, tissue, and organ dysfunction as seen in MPS I. Improved pulmonary function and walking capacity have been demonstrated with the administration of laronidase to patients with Hurler, Hurler-Scheie, or Scheie (with moderate-to-severe symptoms) forms of MPS.
Infants and Children 6 months to 5 years: Vd: 0.12-0.56 L/kg
Children ≥6 years and Adults: Vd: 0.24-0.6 L/kg
Infants and Children 6 months to 5 years: Clearance: 2.2-7.7 mL/minute/kg
Children ≥6 years and Adults: Clearance: 1.7-2.7 mL/minute/kg; during the first 12 weeks of therapy the clearance of laronidase increases proportionally to the amount of antibodies a given patient develops against the enzyme. However, with long-term use (≥26 weeks) antibody titers have no effect on laronidase clearance.
Infants and Children 6 months to 5 years: 0.3-1.9 hours
Children ≥6 years and Adults: 1.5-3.6 hours
Use: Labeled Indications
Treatment of Hurler and Hurler-Scheie forms of mucopolysaccharidosis I (MPS I); treatment of Scheie form of MPS I in patients with moderate-to-severe symptoms
There are no contraindications listed within the manufacturer’s U.S. labeling.
Canadian labeling: Severe hypersensitivity to laronidase or any component of the formulation
Note: Premedicate with antipyretic and/or antihistamines 1 hour prior to start of infusion.
IV: Children ≥6 months and Adults: 0.58 mg/kg once weekly; dose should be rounded up to the nearest whole vial
Dosage adjustment in renal impairment: No dosage adjustment provided in manufacturer’s labeling.
Dosage adjustment in hepatic impairment: No dosage adjustment provided in manufacturer’s labeling.
Allow vials to come to room temperature prior to admixture. Prepare the infusion using a low protein-binding container (there is no compatability information of diluted laronidase in glass containers). Total volume of infusion is determined by body weight. For patients weighing ≤20 kg (or weighing up to 30 kg and with cardiac or respiratory compromise), dilute the required dose in 100 mL NS; for patients weighing >20 kg, dilute required dose in 250 mL NS. Determine the number of vials to dilute by calculating the required dose and rounding up to the nearest whole vial. Remove and discard a volume of NS from the infusion bag equal to the volume of the calculated dose of laronidase. Slowly withdraw from vial(s) and slowly add laronidase to the NS; avoid excessive agitation, do not use filter needle. Gently rotate infusion bag to mix (do not shake).
Administer using an infusion set with low protein-binding and 0.2 micrometer in-line filter. Antipyretics and/or antihistamines should be administered 60 minutes prior to infusion. Volume and infusion rate are based on body weight; deliver infusion over ~3-4 hours. Vital signs should be monitored every 15 minutes, if stable; rate may be increased as follows:
≤20 kg: Total infusion volume: 100 mL
2 mL/hour for 15 minutes
4 mL/hour for 15 minutes
8 mL/hour for 15 minutes
16 mL/hour for 15 minutes
32 mL/hour for remainder of infusion (~3 hours)
>20 kg: Total infusion volume: 250 mL
5 mL/hour for 15 minutes
10 mL/hour for 15 minutes
20 mL/hour for 15 minutes
40 mL/hour for 15 minutes
80 mL/hour for remainder of infusion (~3 hours)
Note: A total infusion volume of 100 mL NS and slower infusion rate may be considered for patients with cardiac or respiratory compromise who weigh up to 30 kg. In case of infusion-related reaction in any patient, decrease the rate of infusion, temporarily discontinue the infusion, and/or administer additional antipyretics/antihistamines.
Stable in NS.
Store vials under refrigeration at 2°C to 8°C (36°F to 46°F); do not freeze. Protect from light. Do not shake. Following dilution, solution for infusion should be used immediately; however, if not used immediately, diluted solutions should be refrigerated at 2°C to 8°C (36°F to 46°F) for up to 36 hours.
There are no known significant interactions.
Note: Unless otherwise noted, frequency of adverse reactions is reported for patients ≥6 years of age.
Cardiovascular: Flushing (11% to 23%), poor venous access (14%)
Central nervous system: Fever 11% (infants and children 6 months to 5 years: 30%), chills (infants and children 6 months to 5 years: 20%)
Dermatologic: Rash (13% to 36%; infants and children 6 months to 5 years: ≥5%)
Immunologic: Antibody development (93% to 97%; children 6 months to 5 years: 100%)
Local: Injection site reaction (18%)
Neuromuscular & skeletal: Hyper-reflexia (14%), paresthesia (14%)
Otic: Otitis media (infants and children 6 months to 5 years: 20%)
Respiratory: Upper respiratory tract infection (32%)
Miscellaneous: Infusion reactions (32% to 49%; may be severe; infants and children 6 months to 5 years: 35%)
1% to 10%:
Cardiovascular: Hypertension (infants and children 6 months to 5 years: 10%), tachycardia (infants and children 6 months to 5 years: 10%), chest pain (9%), edema (9%), facial edema (9%), hypotension (9%), pallor (infants and children 6 months to 5 years: ≥5%)
Central nervous system: Headache (9%)
Dermatologic: Pruritus (4%), urticaria (4%), hyperhidrosis
Gastrointestinal: Abdominal pain/discomfort (9%), diarrhea (7%), vomiting (4%)
Hematologic: Thrombocytopenia (9%)
Hepatic: Bilirubinemia (9%)
Local: Abscess (9%), injection site pain (9%)
Neuromuscular & skeletal: Tremor (infants and children 6 months to 5 years: ≥5%), arthralgia (4%), back pain, musculoskeletal pain
Ocular: Corneal opacity (9%)
Respiratory: Oxygen saturation decreased (infants and children 6 months to 5 years: 10%), crepitations (infants and children 6 months to 5 years: ≥5%), respiratory distress (infants and children 6 months to 5 years: ≥5%), wheezing (infants and children 6 months to 5 years: ≥5%), bronchospasm, cough, dyspnea
Miscellaneous: Feeling warm/cold (7%), allergic reaction (severe/serious 1%)
<1% (Limited to important or life-threatening): Anaphylaxis, angioedema, cardiac failure, cardiorespiratory arrest, cyanosis, erythema, extravasation, pneumonia, respiratory failure
Concerns related to adverse effects:
• Hypersensitivity/anaphylactoid reactions: [U.S. Boxed Warning]: Anaphylactic reactions have been observed during infusion, immediate treatment for hypersensitivity reactions should be available during administration. Additional monitoring may be required in patients with compromised respiratory function or acute respiratory disease; may be at increased risk for acute exacerbation of respiratory symptoms due to infusion reaction. Reactions, which may include airway obstruction, bradycardia, bronchospasm, hypotension, hypoxia, respiratory distress/failure, stridor, tachypnea, and urticaria, may be severe and tend to occur during or within 3 hours after administration. Immediately discontinue infusion if severe reactions occur; medical support should be available during administration. Risks and benefits should be carefully considered prior to readministration following a severe hypersensitivity reaction. Patients who initially experience severe reactions may require prolonged monitoring. In the case of anaphylaxis, caution should be used if epinephrine is being considered; many patients with MPS I have pre-existing heart disease.
• Infusion reactions: Infusion reactions may occur; use caution and consider delaying treatment in patients with acute febrile/respiratory illness; may result in increased risk for infusion-related reactions. Pretreatment with antipyretics and antihistamines is recommended. Decrease infusion rate, temporarily discontinue infusion, and/or administer additional antipyretics and antihistamines to manage infusion reactions.
• Fluid overload: Use with caution in patients at risk for fluid overload or in conditions where fluid restriction is indicated (eg, acute underlying respiratory illness, compromised cardiac and/or respiratory function); conditions may be exacerbated during infusion. Extended observation may be necessary for some patients.
• MPS I: Appropriate use: Has not been studied in patients with mild symptoms of the Scheie form of MPS I. Not indicated for the CNS manifestations of the disorder.
• Sleep apnea: Use with caution in patients with sleep apnea; evaluate patients prior to initiation of therapy. Apnea treatment options should be readily available (eg, CPAP or supplemental oxygen) during infusion or with use of sedating antihistamines.
Dosage form specific issues:
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson, 2002; Lucente 2000; Shelley, 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade, 1986; CDC, 1984). See manufacturer’s labeling.
• Registry: A patient registry has been established and all patients are encouraged to participate. Registry information may be obtained at www.MPSIregistry.com or by calling 800-745-4447.
Vital signs; injection site reactions, infusion reactions
Pregnancy Risk Factor
Teratogenic effects were not observed in animal reproduction studies. Patients are encouraged to enroll in the MPS I registry (800-745-4447 or www.MPSIregistry.com).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience flushing, headache, dyspepsia, or diarrhea. Have patient report immediately to prescriber angina, tachycardia, dyspnea, severe dizziness, syncope, chills, paresthesia, tachypnea, ecchymosis, hemorrhaging, edema, vision changes, or injection site irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about laronidase
- Other brands: Aldurazyme