Natalizumab

INTRODUCTION

Indications

To reduce the frequency of exacerbations of relapsing multiple sclerosis (MS).

Action

Binds to integrin receptors on nonneutrophil leukocytes which may alter adhesion and migration characteristics involved in the crossing of activated inflammatory cells into the CNS. Therapeutic Effects: Fewer exacerbations of relapsing multiple sclerosis.

Adverse Reactions/Side Effects

CNS: depression, fatigue. GI: cholelithiasis. Misc: allergic reactions, including anaphylaxis, infections, PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML), infusion-related reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of PML. Signs include memory lapses, decreased cognition, vision loss, speech problems, incoordination, ataxia, and muscle weakness that can progress to paralysis, seizures, and coma. Report these signs to the physician or nursing staff immediately.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, dermatitis). Be especially alert for responses that occur during and after administration (infusion related reactions). Notify physician or nursing staff immediately if these reactions occur.

• Periodically assess balance, coordination, spasticity, and other aspects of neuromuscular function to help document this drug's effectiveness in reducing MS exacerbations.

• Monitor personality changes, including depression and increased thoughts of suicide. Notify physician if these changes become problematic.

• Report signs of gallstones (cholelithiasis), including sudden intense pain in the abdomen or right side, jaundice, chills, and fever.

Interventions

• Design and implement coordination, balance, and other therapeutic exercises to maintain function, and complement drug effects in patients with MS.

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Instruct patient to report other troublesome side effects such as prolonged or severe fatigue or signs of infection.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: 7–15 days.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent use of immunosuppressants; History of PML; Children <18 yr.

Use Cautiously in: History of depression or suicide attempt; Pregnancy (use only if clearly needed).

Interactions

Drug-Drug: ↑ risk of infections with immunosuppressants (avoid concurrent use).

Route/Dosage

NOTE: Because of the risk of PML, natalizumab is available only under a special restricted distribution program, the TOUCH Prescribing ...