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Darzalex Dosage

Medically reviewed by Drugs.com. Last updated on Aug 31, 2020.

Generic name: Daratumumab 100mg in 5mL
Dosage form: injection, solution, concentrate

Important Dosing Information

Recommended Dosage

Monotherapy and In Combination with Lenalidomide (D-Rd) or Pomalidomide (D-Pd) and Dexamethasone

The DARZALEX dosing schedule in Table 1 is for combination therapy (4-week cycle regimens) and monotherapy as follows:

-
combination therapy with lenalidomide and low-dose dexamethasone for newly diagnosed patients ineligible for autologous stem cell transplant (ASCT) and in patients with relapsed/refractory multiple myeloma
-
combination therapy with pomalidomide and low-dose dexamethasone for patients with relapsed/refractory multiple myeloma
-
monotherapy for patients with relapsed/refractory multiple myeloma.

The recommended dose of DARZALEX is 16 mg/kg actual body weight administered as an intravenous infusion according to the following dosing schedule:

Table 1: DARZALEX Dosing Schedule in Combination With Lenalidomide or Pomalidomide (4-Week Cycle) and Low-Dose Dexamethasone and for Monotherapy
Weeks Schedule
*
First dose of the every-2-week dosing schedule is given at Week 9
First dose of the every-4-week dosing schedule is given at Week 25
Weeks 1 to 8 weekly (total of 8 doses)
Weeks 9 to 24* every two weeks (total of 8 doses)
Week 25 onwards until disease progression every four weeks

For dosing instructions of combination agents administered with DARZALEX, see Clinical Studies (14) and manufacturer's prescribing information.

In Combination with Bortezomib, Melphalan and Prednisone (D-VMP)

The DARZALEX dosing schedule in Table 2 is for combination therapy with bortezomib, melphalan and prednisone (6-week cycle regimen) for patients with newly diagnosed multiple myeloma ineligible for ASCT.

The recommended dose of DARZALEX is 16 mg/kg actual body weight administered as an intravenous infusion according to the following dosing schedule:

Table 2: DARZALEX Dosing Schedule in Combination With Bortezomib, Melphalan and Prednisone ([VMP], 6-Week Cycle)
Weeks Schedule
*
First dose of the every-3-week dosing schedule is given at Week 7
First dose of the every-4-week dosing schedule is given at Week 55
Weeks 1 to 6 weekly (total of 6 doses)
Weeks 7 to 54* every three weeks (total of 16 doses)
Week 55 onwards until disease progression every four weeks

For dosing instructions of combination agents administered with DARZALEX see Clinical Studies (14.1).

In Combination with Bortezomib, Thalidomide and Dexamethasone (D-VTd)

The DARZALEX dosing schedule in Table 3 is for combination therapy with bortezomib, thalidomide, and dexamethasone (4-week cycle regimen) for patients with newly diagnosed multiple myeloma eligible for ASCT.

The recommended dose of DARZALEX is 16 mg/kg actual body weight administered as an intravenous infusion according to the following dosing schedule:

Table 3: DARZALEX Dosing Schedule in Combination With Bortezomib, Thalidomide and Dexamethasone ([VTd]; 4-Week Cycle)
Treatment phase Weeks Schedule
*
First dose of the every-2-week dosing schedule is given at Week 9
First dose of the every-2-week dosing schedule is given at Week 1 upon re-initiation of treatment following ASCT
Induction Weeks 1 to 8 weekly (total of 8 doses)
Weeks 9 to 16* every two weeks (total of 4 doses)
Stop for high dose chemotherapy and ASCT
Consolidation Weeks 1 to 8 every two weeks (total of 4 doses)

For dosing instructions of combination agents administered with DARZALEX, see Clinical Studies (14.1) and the manufacturer's prescribing information.

In Combination with Bortezomib and Dexamethasone (D-Vd)

The DARZALEX dosing schedule in Table 4 is for combination therapy with bortezomib and dexamethasone (3-week cycle) for patients with relapsed/refractory multiple myeloma.

The recommended dose of DARZALEX is 16 mg/kg actual body weight administered as an intravenous infusion according to the following dosing schedule:

Table 4: DARZALEX Dosing Schedule With Bortezomib and Dexamethasone (3-Week Cycle)
Weeks Schedule
*
First dose of the every-3-week dosing schedule is given at Week 10
First dose of the every-4-week dosing schedule is given at Week 25
Weeks 1 to 9 weekly (total of 9 doses)
Weeks 10 to 24* every three weeks (total of 5 doses)
Week 25 onwards until disease progression every four weeks

For dosing instructions of combination agents administered with DARZALEX see Clinical Studies (14.2) and manufacturer's prescribing information.

In Combination with Carfilzomib and Dexamethasone (DKd)

The recommended dosage for DARZALEX when administered in combination with carfilzomib and dexamethasone (4-week cycle) for patients with relapsed/refractory multiple myeloma is provided in Table 5.

Table 5: DARZALEX Dosing Schedule With Carfilzomib and Dexamethasone (4-Week Cycle)
Weeks DARZALEX Dose* Schedule
*
Based on actual body weight
First dose of the every-2-week dosing schedule is given at Week 9
First dose of the every-4-week dosing schedule is given at Week 25
Week 1 8 mg/kg days 1 and 2 (total 2 doses)
Weeks 2 to 8 16 mg/kg weekly (total of 7 doses)
Weeks 9 to 24 16 mg/kg every two weeks (total of 8 doses)
Week 25 onwards until disease progression 16 mg/kg every four weeks

For dosing instructions of combination agents administered with DARZALEX see Clinical Studies (14.1) and manufacturer's prescribing information.

Infusion Rates

Administer DARZALEX intravenously at the infusion rate described below in Table 6. Consider incremental escalation of the infusion rate only in the absence of infusion-related reactions.

The recommended dose of 16 mg/kg to be administered on Day 1 when DARZALEX is administered as monotherapy or in combination may be split over two consecutive days, such that an 8 mg/kg dose is administered on Day 1 and Day 2, respectively.

Table 6: Infusion Rates for DARZALEX (16 mg/kg) Administration
Dilution volume Initial rate (first hour) Rate increment* Maximum rate
*
Consider incremental escalation of the infusion rate only in the absence of infusion-related reactions.
Use a dilution volume of 500 mL for the 16 mg/kg dose only if there were no infusion-related reactions the previous week. Otherwise, use a dilution volume of 1,000 mL.
Use a modified initial rate (100 mL/hour) for subsequent infusions (i.e. Week 3 onwards) only if there were no infusion-related reactions during the previous infusion. Otherwise, continue to use instructions indicated in the table for the Week 2 infusion rate.
Week 1 Infusion
Option 1 (Single dose infusion)
Week 1 Day 1 (16 mg/kg) 1,000 mL 50 mL/hour 50 mL/hour every hour 200 mL/hour
Option 2 (Split dose infusion)
Week 1 Day 1 (8 mg/kg) 500 mL 50 mL/hour 50 mL/hour every hour 200 mL/hour
Week 1 Day 2 (8 mg/kg) 500 mL 50 mL/hour 50 mL/hour every hour 200 mL/hour
Week 2 (16 mg/kg) 500 mL 50 mL/hour 50 mL/hour every hour 200 mL/hour
Week 3 onwards (16 mg/kg) 500 mL 100 mL/hour 50 mL/hour every hour 200 mL/hour

Missed DARZALEX Doses

If a dose of DARZALEX is missed, administer the dose as soon as possible and adjust the dosing schedule to maintain the dosing interval.

Recommended Concomitant Medications

Pre-infusion Medication

Administer the following pre-infusion medications 1–3 hours before every DARZALEX infusion:

  • Corticosteroid (long- or intermediate-acting)
    Monotherapy:
    Administer methylprednisolone 100 mg (or equivalent) intravenously. Following the second infusion, consider reducing the dose to 60 mg (or equivalent) administered either orally or intravenously.
    In Combination:
    Administer dexamethasone 20 mg (or equivalent) orally or intravenously.
    When dexamethasone is the background regimen-specific corticosteroid, the dexamethasone dose that is part of the background regimen will serve as pre-medication on DARZALEX infusion days [see Clinical Studies (14)].
    Do not administer background regimen-specific corticosteroids (e.g. prednisone) on DARZALEX infusion days when patients have received dexamethasone (or equivalent) as a pre-medication.
  • Acetaminophen 650 to 1,000 mg orally
  • Diphenhydramine 25 to 50 mg (or equivalent) orally or intravenously.

Post-infusion Medication

Administer the following post-infusion medications:

Monotherapy:
Administer methylprednisolone 20 mg (or an equivalent dose of an intermediate- or long-acting corticosteroid) orally for 2 days starting the day after the administration of DARZALEX.
In Combination:
Consider administering oral methylprednisolone at a dose of less than or equal to 20 mg (or an equivalent dose of an intermediate- or long-acting corticosteroid) beginning the day after the administration of a DARZALEX infusion.
If a background regimen-specific corticosteroid (e.g. dexamethasone, prednisone) is administered the day after the DARZALEX infusion, additional corticosteroids may not be needed [see Clinical Studies (14)].

For patients with a history of chronic obstructive pulmonary disease, consider prescribing short and long-acting bronchodilators and inhaled corticosteroids. Following the first 4 DARZALEX infusions, consider discontinuing these additional post-infusion medications, if the patient does not experience a major infusion-related reaction.

Prophylaxis for Herpes Zoster Reactivation

Initiate antiviral prophylaxis to prevent herpes zoster reactivation within 1 week after starting DARZALEX and continue for 3 months following the end of treatment [see Adverse Reactions (6.1)].

Dosage Modifications for Adverse Reactions

No dose reductions of DARZALEX are recommended. Consider withholding DARZALEX to allow recovery of blood cell counts in the event of myelosuppression [see Warnings and Precautions (5.3, 5.4)].

For information concerning drugs given in combination with DARZALEX, see manufacturer's prescribing information.

Infusion-Related Reactions

For infusion-related reactions of any grade/severity, immediately interrupt the DARZALEX infusion and manage symptoms. Management of infusion-related reactions may further require reduction in the rate of infusion, or treatment discontinuation of DARZALEX as outlined below [see Warnings and Precautions (5.1)].

  • Grade 1–2 (mild to moderate): Once reaction symptoms resolve, resume the infusion at no more than half the rate at which the reaction occurred. If the patient does not experience any further reaction symptoms, infusion rate escalation may resume at increments and intervals as clinically appropriate up to the maximum rate of 200 mL/hour (Table 6).
  • Grade 3 (severe): Once reaction symptoms resolve, consider restarting the infusion at no more than half the rate at which the reaction occurred. If the patient does not experience additional symptoms, resume infusion rate escalation at increments and intervals as outlined in Table 6. Repeat the procedure above in the event of recurrence of Grade 3 symptoms. Permanently discontinue DARZALEX upon the third occurrence of a Grade 3 or greater infusion-related reaction.
  • Grade 4 (life threatening): Permanently discontinue DARZALEX.

Preparation and Administration

Preparation

DARZALEX is for single use only.

Prepare the solution for infusion using aseptic technique as follows:

  • Calculate the dose (mg), total volume (mL) of DARZALEX solution required and the number of DARZALEX vials needed based on patient actual body weight.
  • Check that the DARZALEX solution is colorless to pale yellow. Do not use if opaque particles, discoloration or other foreign particles are present.
  • Remove a volume of 0.9% Sodium Chloride Injection, USP from the infusion bag/container that is equal to the required volume of DARZALEX solution.
  • Withdraw the necessary amount of DARZALEX solution and dilute to the appropriate volume by adding to the infusion bag/container containing 0.9% Sodium Chloride Injection, USP as specified in Table 6 [see Dosage and Administration (2.2)]. Infusion bags/containers must be made of either polyvinylchloride (PVC), polypropylene (PP), polyethylene (PE) or polyolefin blend (PP+PE). Dilute under appropriate aseptic conditions. Discard any unused portion left in the vial.
  • Gently invert the bag/container to mix the solution. Do not shake.
  • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. The diluted solution may develop very small, translucent to white proteinaceous particles, as daratumumab is a protein. Do not use if visibly opaque particles, discoloration or foreign particles are observed.
  • Since DARZALEX does not contain a preservative, administer the diluted solution immediately at room temperature 15°C–25°C (59°F–77°F) and in room light. Diluted solution may be kept at room temperature for a maximum of 15 hours (including infusion time).
  • If not used immediately, the diluted solution can be stored prior to administration for up to 24 hours at refrigerated conditions 2°C–8°C (36°F–46°F) and protected from light. Do not freeze.

Administration

  • If stored in the refrigerator, allow the solution to come to room temperature. Administer the diluted solution by intravenous infusion using an infusion set fitted with a flow regulator and with an in-line, sterile, non-pyrogenic, low protein-binding polyethersulfone (PES) filter (pore size 0.22 or 0.2 micrometer). Administration sets must be made of either polyurethane (PU), polybutadiene (PBD), PVC, PP or PE.
  • Do not store any unused portion of the infusion solution for reuse. Any unused product or waste material should be disposed of in accordance with local requirements.
  • Do not infuse DARZALEX concomitantly in the same intravenous line with other agents.

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.