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Ravulizumab Dosage

Medically reviewed by Drugs.com. Last updated on Nov 3, 2020.

Applies to the following strengths: 10 mg/mL; 100 mg/mL

Usual Adult Dose for Paroxysmal Nocturnal Hemoglobinuria

40 KG TO LESS THAN 60 KG:
-Loading dose: 2400 mg IV
-Maintenance dose: 3000 mg IV every 8 weeks starting 2 weeks after the loading dose
60 KG TO LESS THAN 100 KG:
-Loading dose: 2700 mg IV
-Maintenance dose: 3300 mg IV every 8 weeks starting 2 weeks after the loading dose
100 KG OR GREATER:
-Loading dose: 3000 mg IV
-Maintenance dose: 3600 mg IV every 8 weeks starting 2 weeks after the loading dose

ADMINISTRATION (dilute this drug to a final concentration of 5 mg/mL):
40 KG TO LESS THAN 60 KG:
-Infuse loading dose (2400 mg in a total volume of 480 mL) at 252 mL/hour IV over a minimum of 1.9 hours.
-Infuse maintenance dose (3000 mg in a total volume of 600 mL) at 257 mL/hour IV over a minimum of 2.3 hours.
60 KG TO LESS THAN 100 KG:
-Infuse loading dose (2700 mg in a total volume of 540 mL) at 317 mL/hour IV over a minimum of 1.7 hours.
-Infuse maintenance dose (3300 mg in a total volume of 660 mL) at 330 mL/hour IV over a minimum of 2 hours.
100 KG OR GREATER:
-Infuse loading dose (3000 mg in a total volume of 600 mL) at 333 mL/hour IV over a minimum of 1.8 hours.
-Infuse maintenance dose (3600 mg in a total volume of 720 mL) at 327 mL/hour IV over a minimum of 2.2 hours.

Comments:
-This drug has not been studied in patients with PNH who weigh less than 40 kg.

Use: For the treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH)

Usual Adult Dose for Hemolytic Uremic Syndrome

5 KG TO LESS THAN 10 KG:
-Loading dose: 600 mg IV
-Maintenance dose: 300 mg IV every 4 weeks starting 2 weeks after the loading dose
10 KG TO LESS THAN 20 KG:
-Loading dose: 600 mg IV
-Maintenance dose: 600 mg IV every 4 weeks starting 2 weeks after the loading dose
20 KG TO LESS THAN 30 KG:
-Loading dose: 900 mg IV
-Maintenance dose: 2100 mg IV every 8 weeks starting 2 weeks after the loading dose
30 KG TO LESS THAN 40 KG:
-Loading dose: 1200 mg IV
-Maintenance dose: 2700 mg IV every 8 weeks starting 2 weeks after the loading dose
40 KG TO LESS THAN 60 KG:
-Loading dose: 2400 mg IV
-Maintenance dose: 3000 mg IV every 8 weeks starting 2 weeks after the loading dose
60 KG TO LESS THAN 100 KG:
-Loading dose: 2700 mg IV
-Maintenance dose: 3300 mg IV every 8 weeks starting 2 weeks after the loading dose
100 KG OR GREATER:
-Loading dose: 3000 mg IV
-Maintenance dose: 3600 mg IV every 8 weeks starting 2 weeks after the loading dose

ADMINISTRATION (dilute this drug to a final concentration of 5 mg/mL):
5 TO LESS THAN 10 KG:
-Infuse loading dose (600 mg in a total volume of 120 mL) at 31 mL/hour IV over a minimum of 3.8 hours.
-Infuse maintenance dose (300 mg in a total volume of 60 mL) at 31 mL/hour IV over a minimum of 1.9 hours.
10 TO LESS THAN 20 KG:
-Infuse loading dose (600 mg in a total volume of 120 mL) at 63 mL/hour IV over a minimum of 1.9 hours.
-Infuse maintenance dose (600 mg in a total volume of 120 mL) at 63 mL/hour IV over a minimum of 1.9 hours.
20 TO LESS THAN 30 KG:
-Infuse loading dose (900 mg in a total volume of 180 mL) at 120 mL/hour IV over a minimum of 1.5 hours.
-Infuse maintenance dose (2100 mg in a total volume of 420 mL) at 127 mL/hour IV over a minimum of 3.3 hours.
30 TO LESS THAN 40 KG:
-Infuse loading dose (1200 mg in a total volume of 240 mL) at 184 mL/hour IV over a minimum of 1.3 hours.
-Infuse maintenance dose (2700 mg in a total volume of 540 mL) at 192 mL/hour IV over a minimum of 2.8 hours.
40 TO LESS THAN 60 KG:
-Infuse loading dose (2400 mg in a total volume of 480 mL) at 252 mL/hour IV over a minimum of 1.9 hours.
-Infuse maintenance dose (3000 mg in a total volume of 600 mL) at 257 mL/hour IV over a minimum of 2.3 hours.
60 KG TO LESS THAN 100 KG:
-Infuse loading dose (2700 mg in a total volume of 540 mL) at 317 mL/hour IV over a minimum of 1.7 hours.
-Infuse maintenance dose (3300 mg in a total volume of 660 mL) at 330 mL/hour IV over a minimum of 2 hours.
100 KG OR GREATER:
-Infuse loading dose (3000 mg in a total volume of 600 mL) at 333 mL/hour IV over a minimum of 1.8 hours.
-Infuse maintenance dose (3600 mg in a total volume of 720 mL) at 327 mL/hour IV over a minimum of 2.2 hours.

Use: For the treatment of atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy (TMA)

Usual Pediatric Dose for Hemolytic Uremic Syndrome

ONE MONTH AND OLDER:
5 KG TO LESS THAN 10 KG:
-Loading dose: 600 mg IV
-Maintenance dose: 300 mg IV every 4 weeks starting 2 weeks after the loading dose
10 KG TO LESS THAN 20 KG:
-Loading dose: 600 mg IV
-Maintenance dose: 600 mg IV every 4 weeks starting 2 weeks after the loading dose
20 KG TO LESS THAN 30 KG:
-Loading dose: 900 mg IV
-Maintenance dose: 2100 mg IV every 8 weeks starting 2 weeks after the loading dose
30 KG TO LESS THAN 40 KG:
-Loading dose: 1200 mg IV
-Maintenance dose: 2700 mg IV every 8 weeks starting 2 weeks after the loading dose
40 KG TO LESS THAN 60 KG:
-Loading dose: 2400 mg IV
-Maintenance dose: 3000 mg IV every 8 weeks starting 2 weeks after the loading dose
60 KG TO LESS THAN 100 KG:
-Loading dose: 2700 mg IV
-Maintenance dose: 3300 mg IV every 8 weeks starting 2 weeks after the loading dose
100 KG OR GREATER:
-Loading dose: 3000 mg IV
-Maintenance dose: 3600 mg IV every 8 weeks starting 2 weeks after the loading dose

ADMINISTRATION (dilute this drug to a final concentration of 5 mg/mL):
5 TO LESS THAN 10 KG:
-Infuse loading dose (600 mg in a total volume of 120 mL) at 31 mL/hour IV over a minimum of 3.8 hours.
-Infuse maintenance dose (300 mg in a total volume of 60 mL) at 31 mL/hour IV over a minimum of 1.9 hours.
10 TO LESS THAN 20 KG:
-Infuse loading dose (600 mg in a total volume of 120 mL) at 63 mL/hour IV over a minimum of 1.9 hours.
-Infuse maintenance dose (600 mg in a total volume of 120 mL) at 63 mL/hour IV over a minimum of 1.9 hours.
20 TO LESS THAN 30 KG:
-Infuse loading dose (900 mg in a total volume of 180 mL) at 120 mL/hour IV over a minimum of 1.5 hours.
-Infuse maintenance dose (2100 mg in a total volume of 420 mL) at 127 mL/hour IV over a minimum of 3.3 hours.
30 TO LESS THAN 40 KG:
-Infuse loading dose (1200 mg in a total volume of 240 mL) at 184 mL/hour IV over a minimum of 1.3 hours.
-Infuse maintenance dose (2700 mg in a total volume of 540 mL) at 192 mL/hour IV over a minimum of 2.8 hours.
40 TO LESS THAN 60 KG:
-Infuse loading dose (2400 mg in a total volume of 480 mL) at 252 mL/hour IV over a minimum of 1.9 hours.
-Infuse maintenance dose (3000 mg in a total volume of 600 mL) at 257 mL/hour IV over a minimum of 2.3 hours.
60 KG TO LESS THAN 100 KG:
-Infuse loading dose (2700 mg in a total volume of 540 mL) at 317 mL/hour IV over a minimum of 1.7 hours.
-Infuse maintenance dose (3300 mg in a total volume of 660 mL) at 330 mL/hour IV over a minimum of 2 hours.
100 KG OR GREATER:
-Infuse loading dose (3000 mg in a total volume of 600 mL) at 333 mL/hour IV over a minimum of 1.8 hours.
-Infuse maintenance dose (3600 mg in a total volume of 720 mL) at 327 mL/hour IV over a minimum of 2.2 hours.

Use: For the treatment of pediatric patients one month and older with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy (TMA)

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended.

Precautions

The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for ravulizumab. It includes elements to assure safe use. For additional information: http://www.accessdata.fda.gov/scripts/cder/rems/index.cfm

US BOXED WARNINGS:
WARNING: SERIOUS MENINGOCOCCAL INFECTIONS:
-Life-threatening meningococcal infections/sepsis have occurred in patients treated with this drug and may become rapidly life-threatening or fatal if not recognized.
-Comply with the most current Advisory Committee on Immunization Practices (ACIP) recommendations for meningococcal vaccination in patients with complement deficiencies.
-Immunize patients with meningococcal vaccines at least 2 weeks prior to administering the first dose unless the risks of delaying therapy outweigh the risks of developing a meningococcal infection.
-Vaccination reduces, but does not eliminate, the risk of meningococcal infection.
-Monitor for meningococcal infections and evaluate immediately if infection is suspected.
-This drug is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Under the ULTOMIRIS REMS, prescribers must enroll in the program.

CONTRAINDICATIONS:
-In patients with unresolved Neisseria meningitidis infection
-Patients who are not currently vaccinated against Neisseria meningitidis, unless the risks of delaying treatment outweigh the risks of developing a meningococcal infection

Safety and efficacy have not been established in patients younger than 18 years for PNH and in patients younger than 1 month for aHUS.

Consult WARNINGS section for additional precautions.

Dialysis

No adjustment recommended.

Other Comments

Administration advice:
-Healthcare professionals who prescribe this drug must enroll in the ULTOMIRIS REMS.
-Vaccinate patients for meningococcal disease according to current guidelines to reduce the risk of serious infection.
-Provide 2 weeks of antibacterial drug prophylaxis to patients if this drug must be initiated immediately and vaccines are administered less than 2 weeks before.
-The dosing schedule can vary within 7 days of the scheduled infusion day (except for the first maintenance dose) but the subsequent dose should be administered according to the original schedule.
-When converting from eculizumab to this drug, administer the loading dose of this drug 2 weeks after the last eculizumab dose and then administer maintenance doses once every 8 weeks or every 4 weeks (depending on body weight) starting 2 weeks after loading dose administration.
-Administer this drug IV through a 0.2 or 0.22 micron filter.
-If an adverse reaction occurs during administration, the infusion may be slowed or stopped at the discretion of the physician.
-Administration of PE/PI (plasmapheresis or plasma exchange, or fresh frozen plasma infusion) may reduce serum levels of this drug. There is no experience with administration of supplemental doses of this drug.
-Monitor for at least 1 hour following completion of the infusion for an infusion reaction.

Storage requirements:
-Store unused vials in the refrigerator at 2C to 8C (36F to 46F) in the original carton to protect from light. Do not freeze. Do not shake.

Reconstitution/preparation techniques:
-Each vial is intended for single-dose only.
-This drug requires dilution to a final concentration of 5 mg/mL.
-Use aseptic technique to prepare this drug as follows:
1) The number of vials to be used is based on patient weight and the desired dose.
2) Do not use if there is particulate matter or precipitation in the original vial.
3) Withdraw the calculated volume from the appropriate number of vials and dilute in an infusion bag using 0.9% sodium chloride injection to a final concentration of 5 mg/mL.
4) The product should be mixed gently. Do not shake. Protect from light. Do not freeze.
5) Administer the prepared solution immediately following preparation.
6) Administer through a 0.22-micron filter.
7) If the diluted solution is not used immediately, store in refrigerator at 2C to 8C (36F to 46F) not exceeding 24 hours. When removed from refrigeration, administer the infusion solution within 6 hours.

IV compatibility:
-This drug should only be mixed with 0.9% sodium chloride injection.

Patient advice:
-This drug can increase the risk of meningococcal infection/sepsis (e.g., headache with nausea or vomiting, headache and a fever, headache with a stiff neck or stiff back, fever, fever and a rash, confusion, muscle aches with flu-like symptoms; eyes sensitive to light). Report symptoms immediately to your healthcare provider.
-Carry your Patient Safety Card with you at all times. This card describes symptoms which, if experienced, should be promptly reported.

Further information

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