em-i-siz-ue-mab kxwh

Trade Name(s)

  • Hemlibra

Ther. Class.
hemostatic agents

Pharm. Class.
monoclonal antibodies


Routine prophylaxis to prevent or reduce the frequency of bleeding in patients with hemophilia A (congenital factor VIII deficiency) (with or without factor VIII inhibitors).


Bridges activated factor IX and factor X to restore the function of missing activated factor VIII that is needed for effective hemostasis.

Therapeutic Effect(s):

Prevention or reduction in frequency of bleeding.


Absorption: 80–93% absorbed following subcutaneous administration.

Distribution: Minimally distributed to tissues.

Metabolism and Excretion: Unknown.

Half-life: 27 days.

TIME/ACTION PROFILE (plasma concentrations)



Contraindicated in:

  • None known.

Use Cautiously in:

  • OB:  Use only if potential maternal benefit exceeds potential fetal risk
  • Lactation: Safety not established;
  • Rep:  Women of reproductive potential.

Adverse Reactions/Side Effects

CNS: headache

GI: diarrhea

MS: arthralgia

Misc: injection site reactions, fever

* CAPITALS indicate life-threatening.
Underline indicate most frequent.



↑ risk of thrombotic microangiopathy and thromboembolism when used concurrently with  activated prothrombin complex concentrate.


SC (Adults and Children): 3 mg/kg once weekly for 4 wks, followed by maintenance dose of 1.5 mg/kg once weekly  or  3 mg/kg every 2 wks  or 6 mg/kg every 4 wks.


Solution for subcutaneous injection: 30 mg/mL, 60 mg/0.4 mL, 105 mg/0.7 mL, 150 mg/mL


  • Monitor for signs and symptoms of thrombotic angiopathy (thrombocytopenia, microangiopathic hemolytic anemia, acute kidney injury). Discontinue therapy immediately if clinical or lab symptoms occur. Symptoms may resolve within 1 wk of discontinuation.
    • Monitor for signs and symptoms of thromboembolism (swelling in arms or legs, feel faint, pain or redness in arms or legs, headache, dyspnea, numbness in face, chest pain or tightness, eye pain or swelling, tachycardia, vision changes, hemoptysis) during therapy. Discontinue therapy immediately if clinical or lab symptoms occur. Symptoms may resolve within 1 month of discontinuation.
    • Monitor plasma factor VIII inhibition factor activity to determine dosing for factor replacement or anti-coagulation. Do not use activated clotting time (ACT), activated partial thromboplastin time (aPTT), and all assays based on aPTT, such as one-stage factor VIII (FVIII) activity to monitor activity due to the effects of emicizumab. Assess patient for signs of bleeding.

Potential Diagnoses


  • May continue Factor VIII (FVIII) products for prophylaxis during 1st wk of therapy. Discontinue prophylactic use of bypassing agents the day before starting therapy.
  • SC Do not combine vials of different concentrations in a single injection. Solution is colorless to slight yellow; do not administer solutions that are discolored or contain particulate matter. Refrigerate solution and protect from light; do not freeze or shake. May be stored at room temperature for up to 7 days. Administer doses up to 1 mL with a 1 mL syringe and doses >1 mL with a 2 mL or 3 mL syringe of transparent polypropylene or polycarbonate with Luer-Lock tip, graduation 0.01 mL, sterile, for injection only, single-use, latex-free and nonpyrogenic. Use a 18 gauge, 1–1½ inch, single bevel or semi-blunted tip needle for transfer and a 25 – 27 gauge), 3 /8 to ½ inch needle for injection. Administer into upper outer arms, thighs, or any quadrant of abdomen; rotate sites with each dose. Avoid moles, scars, or areas where the skin is tender, bruised, red, hard, or not intact.

Patient/Family Teaching

  • Instruct patient and caregiver in the correct technique for preparation, injection, and how to dispose of materials. Take missed doses as soon as possible; do not take 2 doses same day. Advise patient and caregiver to read  Medication Guide  prior to starting and with each refill in case of changes.
  • Advise patient to notify health care professional immediately if signs and symptoms of thrombotic microangiopathy (confusion, abdomen or back pain, weakness, nausea, vomiting, swelling of arms and legs, feeling sick, yellowing of skin and eyes, decreased urination).
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise women of childbearing potential to use contraception during therapy and notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Prevention or reduction in frequency of bleeding.

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