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Uses
Raxibacumab is indicated for the treatment of adult and pediatric patients with inhalational anthrax due to Bacillus anthracis in combination with appropriate antibacterial drugs. Raxibacumab is also indicated for prophylaxis of inhalational anthrax when alternative therapies are not available or are not appropriate.
The effectiveness of raxibacumab is based solely on efficacy studies in animal models of inhalational anthrax. It is not ethical or feasible to conduct controlled clinical trials with intentional exposure of humans to anthrax. [See Clinical Studies (14.1).]
Safety and pharmacokinetics (PK) of raxibacumab have been studied in adult healthy volunteers. There have been no trials of safety or PK of raxibacumab in the pediatric population. A population PK approach was used to derive dosing regimens that are predicted to provide pediatric patients with exposure comparable to the observed exposure in adults. [See Use in Specific Populations (8.4).]
Raxibacumab binds to the protective antigen (PA) of B. anthracis; it does not have direct antibacterial activity. Raxibacumab does not cross the blood-brain barrier and does not prevent or treat meningitis. Raxibacumab should be used in combination with appropriate antibacterial drugs.
History
There is currently no drug history available for this drug.
Other Information
Raxibacumab is a human IgG1λ monoclonal antibody that binds the PA component of B. anthracis toxin. Raxibacumab has a molecular weight of approximately 146 kilodaltons. Raxibacumab is produced by recombinant DNA technology in a murine cell expression system.
Raxibacumab is supplied as a sterile, liquid formulation in single-dose vials for intravenous infusion. Each vial contains 50 mg/mL raxibacumab in citric acid (0.13 mg/mL), glycine (18 mg/mL), polysorbate 80 [0.2 mg/mL (w/v)], sodium citrate (2.8 mg/mL), and sucrose (10 mg/mL), with a pH of 6.5. Each vial contains a minimum of 35.1 mL filled into a 50 mL vial (to allow delivery of 1,700 mg/34 mL). Raxibacumab is a clear to opalescent, colorless to pale yellow, liquid.
Sources
Raxibacumab Manufacturers
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Human Genome Sciences, Inc.
Raxibacumab | Human Genome Sciences, Inc.
2.1 Dose and Schedule for AdultsAdminister raxibacumab as a single dose of 40 mg/kg intravenously over 2 hours and 15 minutes after dilution in 0.9% Sodium Chloride Injection, USP (normal saline) to a final volume of 250 mL. Administer 25 to 50 mg diphenhydramine within 1 hour prior to raxibacumab infusion to reduce the risk of infusion reactions. Diphenhydramine route of administration (oral or IV) should be based on the temporal proximity to the start of raxibacumab infusion. [See Warnings and Precautions (5.1), Adverse Reactions (6.1).]
2.2 Dose and Schedule for Pediatric PatientsThe recommended dose for pediatric patients is based on weight as shown in Table 1.
Table 1. Recommended Pediatric Dose Pediatric Body Weight Pediatric DoseGreater than 50 kg
40 mg/kg
Greater than 15 kg to 50 kg
60 mg/kg
15 kg or less
80 mg/kg
Premedicate with diphenhydramine within 1 hour prior to raxibacumab infusion. Diphenhydramine route of administration (oral or IV) should be based on the temporal proximity to the start of raxibacumab infusion. Infuse raxibacumab over 2 hours and 15 minutes. No pediatric patients were studied during the development of raxibacumab. The dosing recommendations in Table 1 are derived from simulations designed to match the observed adult exposure to raxibacumab at a 40 mg/kg dose. [See Use in Specific Populations (8.4).]
2.3 Preparation for AdministrationThe recommended dose of raxibacumab is weight-based, given as an intravenous infusion after dilution in a compatible solution to a final volume of 250 mL (adults and children 50 kg or heavier) or to a volume indicated based on the child’s weight (Table 2). Dilute raxibacumab using one of the following compatible solutions:
• 0.9% Sodium Chloride Injection, USP • 0.45% Sodium Chloride Injection, USPKeep vials in their cartons prior to preparation of an infusion solution to protect raxibacumab from light. Raxibacumab vials contain no preservative.
Table 2. Raxibacumab Dose, Diluents, Infusion Volume and Rate by Body WeightBody Weight
(kg)
Preparation
Administration
Dose
(mg/kg)
Total Infusion Volume (mL)
Type of Diluent
Infusion Rate (mL/h)
Infusion Rate (mL/h)
First 20 Minutes
Remaining Infusion
1 or less
80
7
0.45% or 0.9% NaCl
0.5
3.5
1.1 to 2
15
1
7
2.1 to 3
20
1.2
10
3.1 to 4.9
25
1.5
12
5 to 10
50
3
25
11 to 15
100
0.9% NaCl
6
50
16 to 30
60
100
6
50
31 to 40
250
15
125
41 to 50
250
15
125
Greater than 50 or adult
40
250
15
125
Preparation: Follow the steps below to prepare the raxibacumab intravenous infusion solution.
1. Calculate the milligrams of raxibacumab injection by multiplying the recommended mg/kg dose in Table 2 by patient weight in kilograms. 2. Calculate the required volume in milliliters of raxibacumab injection needed for the dose by dividing the calculated dose in milligrams (step 1) by the concentration, 50 mg/mL. Each single-use vial allows delivery of 34 mL raxibacumab.Based on the total infusion volume selected in Table 2, prepare either a syringe or infusion bag as appropriate following the steps below.
Syringe Preparation
3. Select an appropriate size syringe for the total volume of infusion to be administered, as described in Table 2. 4. Using the selected syringe, withdraw the volume of raxibacumab as calculated in step 2. 5. Withdraw an appropriate amount of compatible solution to prepare a total volume infusion syringe as specified in Table 2. 6. Gently mix the solution. Do not shake. 7. Discard any unused portion remaining in the raxibacumab vial(s). 8. The prepared solution is stable for 8 hours stored at room temperature.Infusion Bag Preparation
3. Select appropriate size bag of compatible solution (see compatible solutions listed in Table 2), withdraw a volume of solution from the bag equal to the calculated volume in milliliters of raxibacumab in Table 2. Discard the solution that was withdrawn from the bag. 4. Withdraw the required volume of raxibacumab injection from the raxibacumab vial(s). 5. Transfer the required volume of raxibacumab injection to the selected infusion bag (step 3). Gently invert the bag to mix the solution. Do not shake. 6. Discard any unused portion remaining in the raxibacumab vial(s). 7. The prepared solution is stable for 8 hours stored at room temperature.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Discard the solution if particulate matter is present or color is abnormal. [See Description (11).]
Administration: Administer the infusion solution as described in Table 2. The rate of infusion may be slowed or interrupted if the patient develops any signs of adverse reactions, including infusion-associated symptoms.
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