Dupilumab (Dupixent) Mechanism of Action |Nursing Implications |Patient Teachings

Last updated on December 28th, 2023

Introduction

In this article, you’ll learn about the Dupilumab (Dupixent) mechanism of action (MOA), nursing implications, and patient teachings. Also, its dosage, indication, contraindications, interactions, side effects, nursing assessment, and nursing interventions.

Dupilumab (Dupixent) is used to treat individuals with moderate-to-severe atopic dermatitis (eczema) when topical prescription medicines are ineffective or are contraindicated. It can be used in conjunction with or without topical corticosteroids.

Dupilumab (Dupixent) is also used in patients with asthma and chronic rhinitis with nasal polyps.

Generic Name: Dupilumab

Brand Names: Dupixent

Dupilumab (Dupixent) Class and Category

Pharmacologic class: Interleukin-4 receptor alpha antagonist

Therapeutic class: Anti-inflammatory

Pregnancy category: not specified (FDA, USA)

AU TGA pregnancy category: B1

Dupilumab (Dupixent) Dosage

Adults: SubQ: initially 600 mg (300 mg two doses administered consecutively to 2 different sites), then 300 mg alternative weeks (Q2W).
Children and Adolescents (6 – 17 years): SubQ:

Body Weight	Initial Dose	Subsequent Doses
15 to <30 kg	600mg (300mg 2 doses to 2 different sites)	300mg Q4W
30 to <60 kg	400mg (200mg 2 doses to 2 different sites)	200mg Q2W
≥ 60 kg	600mg (300mg 2 doses to 2 different sites)	300mg Q2W

Dupilumab (Dupixent) Dosage for Pediatric and Adolescents

Dupilumab (Dupixent) Pharmacokinetics and Pharmacodynamics

Route	Onset	Peak	Duration
Subcutaneous	–	1 week	–

Dupilumab (Dupixent) Pharmacokinetics and Pharmacodynamics

Absorption: Catabolic process degrades it into tiny peptides and amino acids. Subcutaneous administration has a bioavailability of approximately 64%.

Distribution: widely distributed.

Metabolism: unknown.

Half-life: unknown

Excretion: Dupilumab metabolic pathway has not been established. Clearance time to non-detectable plasma concentration for Q2w dose of 300mg is10 weeks and QW dose of 300mg is 13 weeks.

Dupilumab (Dupixent) Mechanism of Action

Dupilumab is a human monoclonal IgG4 antibody which specifically binds to the IL-4Rα subunit inhibiting interleukin-4 (IL-4) and interleukin-13 (IL-13). Dupilumab inhibits IL-4 signaling through the Type I receptor as well as both IL-4 and IL-13 signaling through the Type II receptor.

This results in cytokine-induced responses such as the release of proinflammatory cytokines, chemokines, and IgE.

Dupilumab’s mechanism of action in asthma has not been established.

Therapeutic effect: reduces skin inflammation due to atopic dermatitis.

What are the indications of dupilumab (Dupixent)?

Dupilumab (Dupixent) indications include:

To treat moderate-to-severe atopic dermatitis (eczema).
To treat moderate-to-severe asthma
To treat chronic rhinosinusitis with nasal polyposis

What are the contraindications of dupilumab (Dupixent)?

The contraindications of Dupilumab (Dupixent) are:

Hypersensitivity to dupilumab and its components.

Caution: History of herpes simplex infection; parasitic helminth infection.

Dupilumab (Dupixent) Interactions

Avoid using dupilumab (Dupixent) with live vaccines.
Eosinophil levels may increase.

Herbal/food interactions

Not known.

What are the side-effects of dupilumab (Dupixent)?

Dupilumab (Dupixent) side effects / adverse reactions include:

Injection site reactions
Eye pruritus
Dry eye
Eye irritation and/or inflammation
Adverse effects: Blepharitis, conjunctivitis, keratitis, oral herpes, and other herpes simplex virus infection.

Dupilumab (Dupixent) Nursing Implications [Nursing Considerations]

Dupilumab (Dupixent) nursing implications are divided into nursing assessment, nursing diagnosis, nursing interventions, and evaluation.

Dupilumab (Dupixent) nursing assessment

Obtain detailed medical and drug related history including hypersensitivity, herpes zoster infection, and recent use of live virus vaccines.
Assess for pre-exiting helminth (parasite) infection. Prior to the first dose, any such infection should be treated.
Perform through dermatologic assessment and document the characteristics of psoriatic lesions.
Assess the patient’s readiness to self-administer subcutaneous injection.

Dupilumab (Dupixent) nursing diagnosis

Risk for impaired skin integrity (indication).
Anxiety related chronic disease condition and progression of condition; treatment regimen.
Deficient knowledge related to drug’s adverse effects; disease process.
Risk for chronic low self-esteem

Dupilumab (Dupixent) nursing interventions/ actions

Monitor for signs and symptoms of hypersensitivity. If an allergic reaction occurs, withhold or stop the treatment.
Observe for any exacerbation of asthma symptoms, especially in those patients going off corticosteroids.
Administer topical calcineurin inhibitors ONLY on affected areas (such as face, neck, genitals, skin folds).
Teach the patient/caregiver how to administer subcutaneous Dupixent.

Dupilumab (Dupixent) subcutaneous administration considerations

Remove the Dupilumab (Dupixent) pre-filled syringe from the refrigerator and allow it to reach room temperature before injecting.
- Let 300 mg pre-filled syringe sit for 45 minutes without the needle cap being removed.
- Let 200 mg pre-filled syringe sit for 30 minutes without the needle cap being removed.
Assess for discoloration and presence of any precipitates in the syringe before administration.
Administer subcutaneous Dupilumab to a non-affected area of the abdomen, upper arm, or thigh. If it is administered to the abdomen, it should be done at least 5 cm (2 inches) away from the umbilicus.
Rotate the injections sites.
Assess the injection sites for signs of bleeding, hematoma, and necrosis.
DO NOT administer Dupixent on skin that is tender, broken, bruised, or scarred.
Discard any unused medication remaining in the pre-filled syringe.
Store in the refrigerator at 36°F to 46°F (2°C to 8°C) with the original packaging to protect from light.
Dupilumab (Dupixent) pre-filled syringes may be stored at room temperature less than 77°F (25°C) for a maximum of 14 days. It should be discarded if it is not used within 14 days.
DO NOT expose pre-filled Dupixent syringe to direct sunlight.
DO NOT freeze Dupixent pre-filled syringe.
DO NOT expose to heat Dupixent pre-filled syringe.
DO NOT shake Dupixent pre-filled syringe.

Evaluation

Evaluate the effectiveness of the dupilumab (Dupixent): Reassess the skin lesions for improvement.

Pregnancy/breastfeeding considerations for Dupilumab (Dupixent)

There is insufficient data on dupilumab to determine its usage during pregnancy. Dupilumab, like other IgG antibodies, is likely to cross the placental barrier. Therefore, Dupilumab (Dupixent) should only be used during pregnancy if the possible benefit outweighs the risk to the fetus.
It is unknown whether dupilumab (Dupixent) excretes in breastmilk. However, human IgG is known to be excreted in human milk.

What is the nurse patient teachings for dupilumab (Dupixent)?

The nursing patient teaching for dupilumab (Dupixent) should include the following points.

Teach the patient what to do in case of missed dose.
- For every other week regimen: Advise the patient to take the missed dose within 7 days and then continue with original schedule. If not taken within 7 days, then to wait for the next dose on the original schedule.
- For every four-week regimen: Advise the patient to take the missed dose within 7 days and then continue with original schedule. If not taken within 7 days, then instruct the patient to take missed dose as soon as possible and start a new schedule from this date.
Teach and demonstrate proper preparation and subcutaneous injection administration techniques before using medication at home.
Teach the patient/caregiver about adverse effects of Dupilumab (such as eye infection/inflammation) and to report it to the prescriber immediately.
Advise the patient/caregiver to seek medical treatment immediately in case of allergic reactions such as difficulty breathing, itching, hives, rash, swelling of the face or tongue.
Instruct the patient/caregiver to continue corticosteroid therapy as advised by the prescriber.
Instruct the patient/caregiver to continue asthma treatments as advised by the prescriber.
Inform the patient about live vaccines and instruct not to receive any live vaccine while on dupilumab therapy.

Treatment for Dupilumab (Dupixent) Overdose

Dupilumab (Dupixent) overdosage does not have a specific treatment. Symptomatic treatment should be given to the patient. Also, closely observe for adverse effects.

Conclusion

You’ve learned about dupilumab (Dupixent) mechanism of action (MOA), nursing implications (aka nursing considerations), and patient teaching in this article. In addition, you’ve learned about dupilumab’s pharmacokinetics, dosage and administration, indications, contraindications, side effects, nursing assessment, nursing diagnoses, and nursing interventions.