Kimyrsa: Antibiotic Solution for Resistant Skin Infections

Published on by Dr. Robert Hakim, PharmD

Kimyrsa, also known by its generic name, oritavancin, is a potent, long-acting antibiotic typically prescribed for the treatment of bacterial skin infections in adults. This antibacterial medication is classified as a glycopeptide antibiotic. It is effective against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, and Enterococcus faecalis.

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Kimyrsa was first approved by the U.S. Food and Drug Administration in August 2014 for the treatment of bacterial skin infections. It is given as a single, one-hour IV infusion. This reduces the need for long hospital stays or repeated doses compared to other antibiotics, such as vancomycin.

Key Modes of Action

Bacteria have a protective layer called a cell wall, which works like a sturdy armor that protects and allows them to survive under harsh surrounding environments (i.e., stress, heat, or antibiotics).

Kimyrsa belongs to the lipoglycopeptide class of antibiotics. It has rapid bactericidal (bacterial killing) activity and works by targeting the bacteria’s cell wall. The cell wall is needed for bacterial growth and survival. Kimyrsa infusions combat bacteria through three bactericidal mechanisms of action:

1. Blocking Cell Wall Synthesis

Kimyrsa blocks the bacteria from being able to build a cell wall around itself.

2. Disturbing Bacterial Membrane Integrity

Kimyrsa disturbs bacterial membrane integrity by creating tiny holes in the cell wall, leading to depolarization, permeabilization, and rapid cell death.

3. Inhibiting Key Steps in Cell Wall Synthesis

Kimyrsa blocks key steps (i.e., transglycosylation and transpeptidation) in the cell wall synthesis process, which makes it difficult for resistant bacteria (bacteria that are difficult to treat and have limited treatment options) to survive.

Through these three mechanisms of action, Kimyrsa and other glycopeptide antibiotics are able to target certain resistant gram-positive bacteria that can cause severe and complicated skin infections, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus species (VRE), and others.

Indication and Usage

Kimyrsa infusions are approved for the treatment of adults with acute bacterial skin and skin structure infections (ABSSSI). ABSSSI includes cellulitis (severe infection in the deeper layer of the skin), skin abscesses (buildup of the pus within the skin surface), and wound infections.

These infections are suspected to be caused by antimicrobial-resistant gram-positive bacteria, including MRSA and Staphylococcus aureus, Streptococcus pyogenes, and Enterococcus faecalis.

Kimyrsa is recommended only for treating or preventing infections that are known or strongly suspected to be caused by bacteria. This helps prevent the development of drug-resistant bacteria and maintains the effectiveness of Kimyrsa and other antibiotic medications.

Dosage and Administration of Kimyrsa

Kimyrsa is available in a single-dose vial containing 1,200 mg of lyophilized powder of oritavancin.

The recommended dose of Kimyrsa for adult patients is 1,200 mg, which is administered slowly in the vein (IV infusion) by a healthcare provider over 1 hour.

Preparation of Kimyrsa for Intravenous Infusion

  1. Before being administered, the powdered form of Kimyrsa must be reconstituted with 40 ml of sterile water.
  2. Further dilute the reconstituted solution by first removing 40 ml from a 250 ml IV diluent bag of dextrose 5% in water (D5W) or 0.9% sodium chloride, and then inject the 40 ml of Kimyrsa into the IV diluent bag, for a total volume of 250 ml.
  3. Kimyrsa shouldn’t be infused with any other medications in the same IV line.
  4. Infusion bags containing diluted intravenous solution should be used within 4 hours if stored at room temperature or within 12 hours if refrigerated between 2° and 8°C (36° and 46°F).

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Reported Adverse Effects (Side Effects)

kimyrsa-woman-arm-itching

Kimyrsa and other glycopeptide antibiotics are generally well-tolerated, but they can still cause side effects that you should consider before taking them.

Common Side Effects

The most common side effects reported by ≥3% of patients after undergoing Kimyrsa infusions were headaches, nausea, vomiting, limb abscesses, tachycardia (fast heart rate), subcutaneous abscesses, and diarrhea.

Serious Side Effects

The adverse reactions occurring in ≥2 patients after taking Kimyrsa were hypersensitivity (anaphylaxis), pruritus (itching), chills, severe diarrhea (watery or bloody stool), stomach pain, and pyrexia (fever).

Kimyrsa Contraindications

Patients with known hypersensitivity should not take oritavancin products. Furthermore, intravenous unfractionated heparin sodium, an anticoagulant (blood thinner), should not be used for 5 days (120 hours) after taking oritavancin. This is because oritavancin can cause the activated partial thromboplastin time (aPTT) test, which measures blood clotting, to show falsely high results for up to 5 days.

Precautions

Before receiving a Kimyrsa antibiotic treatment, tell your healthcare provider if you:

  • Are pregnant or intend to become pregnant
  • Are breastfeeding or plan to breastfeed
  • Are allergic to oritavancin
  • Are receiving heparin injections
  • Are taking any prescription medications, over-the-counter medications, vitamins, herbal products, or nutritional supplements
  • Have preexisting liver disease or coagulation disorders (bleeding problems)

Drug Interactions

Kimyrsa can interact with other medications, which can reduce its effectiveness or raise the risk of side effects. For example, anticoagulants such as heparin or warfarin should not be taken together with Kimyrsa because they can interfere with coagulation tests.

Similarly, Kimyrsa should also not be mixed or administered alongside other antibiotics in the same IV line due to potential incompatibility.

Consult your healthcare provider if you’re taking any of these medications.

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Kimyrsa Cost

Kimyrsa infusions are an expensive treatment, and its high price can be a barrier for patients without insurance coverage. The approximate cost for a single 1,200 mg dose of Kimyrsa, available as an intravenous powder for injection, is around $5,629, though prices may vary by pharmacy.

Kimyrsa Benefits

Kimyrsa is an antibiotic that exerts a long-lasting effect on patients. It is designed to work with just one dose because it stays active in the body for a long time — about 16 days. Kimyrsa is slowly removed from the body and as a result, it continues to fight bacteria for many days after it is given. This feature of Kimyrsa reduces the need for multiple doses, allowing the infection to be effectively treated without requiring a lengthy hospital stay.

Understanding Elevated Liver Enzymes Related to TPN Administration: Causes & Management

Published on by Neil Marshall, DACM, BSN, LAc, RN, CRNI, NCCAOM®

While TPN (total parenteral nutrition) can be life-saving for individuals with severe or long-term intestinal failure, it can also lead to a potentially life-threatening condition called transaminitis. Transaminitis is more commonly known as elevated liver enzymes.

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In this article, we will discuss elevated liver enzymes in individuals receiving TPN therapy.

A Quick Overview of Elevated Liver Enzymes

Transaminitis, or elevated liver enzymes, occurs when the levels of one or both key liver enzymes, alanine transaminase (ALT) and aspartate transaminase (AST), are elevated above the normal range.

ALT and AST belong to a family of enzymes called transaminases, or aminotransferases. The liver needs these enzymes to break down substances and remove toxic chemicals from the body.

Transaminitis is not a disease; it is a sign of injury to the liver cells. Several conditions can cause elevated transaminases, such as:

  • Fat build-up in the liver
  • Viral hepatitis
  • Heavy drinking
  • Liver damage due to certain medications

Below, we will examine the occurrence of elevated liver enzymes in patients receiving total parenteral nutrition.

Further Reading: TPN and Liver Damage: A Comprehensive Overview

TPN and Transaminitis: Are Elevated Liver Enzymes Common?

Can TPN cause elevated liver enzymes? An increase in blood transaminase levels is one of the most frequent TPN-associated issues. It typically occurs during the first 2 to 3 weeks after starting TPN [1].

Other TPN-associated conditions include:

  • Steatosis (fatty liver)
  • Cholestasis (slowed bile flow)
  • Gallstones

How TPN Can Cause Elevated Liver Enzymes

Several mechanisms are thought to cause liver injury during long-term TPN.

People on long-term TPN therapy often have lower blood levels of choline. Choline deficiency is associated with both steatosis (fatty liver) and elevated transaminases [2][3].

Some studies suggest choline supplementation may help reverse these TPN-associated abnormalities.

Also Read: TPN and Cholestasis: 7 Frequently Asked Questions

The risk of elevated liver enzymes may be higher in individuals receiving first-generation, soybean-based lipid preparations. In contrast, second-generation and third-generation preparations appear to carry a lower risk.

In addition, minerals in TPN preparations, such as copper and manganese, may accumulate in the liver. An excess of these minerals can cause elevated liver enzymes and even liver damage.

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TPN and Transaminitis: Strategies To Manage Elevated Liver Enzymes During Long-Term TPN Therapy

If you or anyone you love has TPN-associated elevated liver enzymes, your provider may [4]:

  • Treat the underlying liver disease.
  • Advise you to try avoiding medicines that can damage liver cells, such as antibiotics, pain medications, and certain herbal preparations.
  • Treat bacterial overgrowth.
  • Avoid overfeeding.
  • Adjust the lipid (fat) content of the TPN formulation.
  • Prescribe specific medications to reduce liver damage.
  • Switch to enteral nutrition where possible.

Your provider may also decide to administer intravenous nutrient solutions using a method called cyclic TPN. Unlike continuous TPN, this method offers your body a “metabolic” rest, allowing your liver to heal.

According to a 2017 study, cyclic TPN significantly reduces both ALT and AST levels [5].

Likewise, using SMOFlipid as part of the TPN formulation — an injectable lipid emulsion — can help reduce ALT and AST levels in children [6].

Key Points

  1. Transaminitis (elevated liver enzymes) is one of the most common TPN-associated complications.
  2. Other factors, such as heavy drinking and hepatitis, can also cause elevated liver enzymes.
  3. While transaminitis is not a disease, it is one of the earliest signs of liver injury.
  4. TPN-associated transaminitis is thought to occur, in part, due to choline deficiency.
  5. Several measures can help improve elevated liver enzymes. These include treating underlying liver disease, avoiding overfeeding, and switching to cyclic TPN.

Understanding Erbitux: Uses, Side Effects, and Pricing

Published on by Dr. Samantha Kaeberlein, PharmD

Erbitux injection is an FDA-approved cancer medication. It is used to treat certain types of head and neck cancer and cancers of the large intestine (colon) and rectum. In this article, you will learn about its mechanism of action, side effects, cost, and more.

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Important Erbitux Warnings

Severe or Fatal Infusion Reactions

Erbitux medication can cause severe or fatal reactions during an infusion. Though these reactions can occur at any time during therapy, the risk is often highest with the first infusion.

Your healthcare provider will watch you closely during and at least one hour after each infusion.

Inform your provider or tell your caregiver if you experience the following reactions during or after an infusion:

  • Sudden breathing problems
  • Shortness of breath
  • Noisy breathing
  • Swelling of the eyes, face, mouth, lips or throat
  • Hoarseness
  • Hives
  • Dizziness
  • Fainting
  • Nausea
  • Fever
  • Chills
  • Chest pain

Should any of these reactions occur, your provider will slow, temporarily stop or permanently discontinue treatment.

Cardiopulmonary Arrest and Sudden Death

If you take Erbitux injections with radiation therapy for head and neck cancer, you may be at a higher risk of cardiopulmonary arrest and sudden death during or after therapy.

Cardiopulmonary arrest is when your heart suddenly stops beating. Your healthcare provider will monitor your electrolyte levels during and after Erbitux infusions.

The risk of cardiopulmonary arrest and sudden death is also higher if you take this medication with platinum-based medicine and fluorouracil for head and neck cancer.

Inform your provider if you have or have ever had:

  • Coronary artery disease (narrowing of the heart arteries)
  • Heart failure (heart failing to pump blood throughout the body)
  • Irregular heartbeat
  • Any heart disease
  • Low blood levels of magnesium, potassium, or calcium

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Before Taking Erbitux

Before you receive your first dose of the cancer drug Erbitux, inform your provider if you:

  • Are allergic to this product, any product component, red meat, mouse protein, or galactose
  • Have or have ever had heart disease, lung disease, difficulty breathing, abnormal heart rhythm, or clogged arteries
  • Have had a tick bite
  • Are pregnant or plan to get pregnant
  • Are breastfeeding

Erbitux Introduction and Uses

Erbitux is a brand-name prescription medication. The active ingredient in Erbitux medication is cetuximab, which belongs to a class of targeted drug therapy called monoclonal antibodies (mAbs). Monoclonal antibodies are lab-created proteins that can suppress, mimic, or enhance your immune response.

Erbitux injections are used to treat:

  • A specific type of head and neck cancer that has spread to other body parts. For this purpose, Erbitux injection may be used alone or with radiation therapy.
  • A specific type of head and neck cancer that has spread to other parts of the body or reappears after treatment. For this purpose, this medication is used with or after chemotherapy.
  • A specific type of colorectal cancer (cancer of the colon and rectum) that has spread to other body parts. For this purpose, Erbitux injection may be used alone or with chemotherapy.

Erbitux Mechanism of Action

The cancer drug Erbitux blocks the action of a protein called epidermal growth factor receptor (EGFR). In cancer cells, this protein has mutated, or they are in large abundance in the cells. Erbitux works to stop EGFR from interacting with other signals in the body, thereby resulting in inhibition of growth and cell death.

Erbitux makes cancer cells more sensitive to radiation therapy.

Erbitux Dosage

Erbitux medication comes as a liquid to be injected slowly (infusion) into a vein. The following strengths are available in the US:

  • A single-dose 50 ml vial, which contains 100 mg of active drug (2 mg/ml).
  • A single-dose 100 ml vial, which contains 200 mg of active drug (2 mg/ml).

A healthcare provider will inject this medication in a medical office or an infusion center. The first infusion lasts two hours, while subsequent infusions last one hour.

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Usual Adult Dose for Colorectal Cancer

(May be used alone or with other cancer drugs)

  • Weekly: Initial dose: 400 mg/m2 IV over 120 minutes; subsequent dose: 250 mg/m2 IV over 60 minutes once a week.
  • Biweekly: 500 mg/m2 IV over 120 minutes every 2 weeks.

With encorafenib (a cancer drug):

  • Initial Dose: 400 mg/m2 IV over 120 minutes.
  • Subsequent dose: 250 mg/m2 IV over 60 minutes once a week.

Usual Adult Dose for Head and Neck Cancer

With radiation therapy:

  • Initial dose: 400 mg/m2 IV over 120 minutes one week before starting radiation therapy.
  • Maintenance dose: 250 mg/m2 IV over 60 minutes once a week for 6 to 7 weeks.

With other cancer drugs or alone:

  • Weekly: Initial dose: 400 mg/m2 IV over 120 minutes; subsequent dose: 250 mg/m2 IV over 60 minutes once a week.
  • Biweekly: 500 mg/m2 IV over 120 minutes every 2 weeks.

Erbitux Side Effects

Smiling young woman with a bald head, resting chin on her hands

Common Side Effects

Call your healthcare provider if the following symptoms worsen or don’t go away after taking an Erbitux injection:

  • Acne-like skin rash
  • Dry or cracking skin
  • Itching
  • Changes in the fingernails or toenails
  • Hair loss
  • Increased hair growth on head, face, eyelashes, or chest
  • Headache
  • Tiredness
  • Confusion
  • Numbness in the arms or legs
  • Dry mouth
  • Sores on the lips, mouth, or throat
  • Sore throat
  • Nausea
  • Vomiting
  • Taste changes
  • Loss of appetite or weight
  • Constipation
  • Diarrhea
  • Heartburn
  • Joint or bone pain
  • Pain or swelling at the injection site
  • Fever
  • Chills

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Serious Side Effects

Call your healthcare provider immediately if you experience:

  • Loss of vision
  • Blistering, peeling, or shedding skin
  • Red, swollen, or infected skin
  • New or worsening cough, shortness of breath, or chest pain

Allergic Reactions

Seek emergency medical care if you experience:

  • Hives
  • Breathing difficulty
  • Swelling in the face or throat

Use During Pregnancy and Lactation

If you are a woman of childbearing age, your provider will order a test to check if you are pregnant. The cancer drug Erbitux can harm your unborn baby. Use effective contraception during treatment and for at least 60 days after the last dose. Call your provider if you become pregnant during treatment.

Avoid breastfeeding during treatment and for 60 days after the last dose.

Erbitux Cost

The cost of Erbitux injections can vary depending on your insurance plan, location, and pharmacy. Contact your insurance provider to find out if your plan covers Erbitux medication or if you need prior authorization.

According to Eli Lilly and Company, the manufacturer of Erbitux, the list price of this cancer drug is $16,081.73 per month.

Switching From IVIG to SCIG: What You Need to Know

Published on by Dr. Christine Leduc, PharmD

Over the past few decades, medical advancements have introduced a variety of treatment options for individuals with immunodeficiency disorders. Intravenous immunoglobulin (IVIG) is often the standard treatment prescribed for those with such conditions. However, with ongoing scientific progress, subcutaneous immunoglobulin (SCIG) has emerged as an alternative. In this article, we will explore the key details you need to know if you’re considering switching from IVIG to SCIG as a treatment option for your immunodeficiency disorder.

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What Is IVIG and SCIG?

Primary immunodeficiency disease (PIDD) refers to a group of more than 300 disorders that occur when the body’s ability to produce antibodies is impaired for an unknown reason. Antibodies are crucial proteins that help defend the body against harmful invaders like viruses and bacteria. As a result, individuals with PIDD are more susceptible to infections and other illnesses [1]. For these individuals, immunoglobulin (IG) replacement therapy is an effective treatment option to help support and maintain a healthy immune system.

Intravenous immunoglobulin (IVIG) is an immunoglobulin (IG) replacement therapy made from the blood plasma of thousands of donors. It contains many antibodies that help fight against viruses and bacteria. IVIG is administered intravenously through a vein. IVIG can help treat various health conditions like PIDD, chronic inflammatory demyelinating polyneuropathy (CIDP), and Kawasaki disease.

Subcutaneous Immunoglobulin (SCIG) contains the same immunoglobulin (IG) product, but the difference is that you receive SCIG under your skin rather than in a vein. This infusion method allows you to self-infuse at home, providing more flexibility than IVIG.

Benefits of Switching From IVIG to SCIG

There are some benefits of SCIG over IVIG [2]:

Improved Quality of Life: Unlike IVIG, you can take SCIG on your own in your home. This significantly reduces visits to the clinic. The length of infusion also decreases with the infusion running about 1.5 hours, whereas a typical IVIG regimen may take up to 4 to 6 hours. Unlike IVIG, the frequent dosing schedule of SCIG helps your body maintain steady immunoglobulin levels. This reduces your risk of getting an infection and improves your overall health. The convenience of self-infusing over shorter periods of time and achieving consistent medication levels can greatly improve your quality of life.

Lower Risk of Side Effects: SCIG is well tolerated and comes with a lower risk of side effects than IVIG.

Lower Healthcare Cost: SCIG use could lead to fewer hospital visits due to its tolerability and shorter nursing times, with patients learning how to self-infuse.

Greater Patient Preference: People tend to prefer SCIG over IVIG. In a clinical study, 81% of patients preferred SCIG over IVIG [3]. In another study, seven out of eight patients preferred SCIG over IVIG [4].

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Steps for Switching From IVIG to SCIG

Doctor consulting with patient about switching from IVIG to SCIG

If you are considering switching from IVIG to SCIG, the recommended steps are discussed below [2][5][6]:

Consult With Healthcare Provider: The first step in transitioning is to consult your doctor. Your doctor will check your medical records, your need for transition, and the potential benefits and challenges of the transition.

Calculate the SCIG Dosage: You need a personalized treatment plan that suits you. For this, your doctor will calculate the proper SCIG dosage for you. You should get your first SCIG dose one week after your last IVIG dose.

Obtain Supplies: A pump and infusion supplies will be provided by your pharmacy.

Receive Training: You need proper training if you want to infuse SCIG on your own. A healthcare professional will show you how to prepare for the infusion, insert the needle, and maintain your infusion logbook.

Monitoring and Adjustments: You should receive regular monitoring from your doctor to check for the effectiveness of SCIG and the side effects. Your doctor may also make necessary adjustments to your dosing regimen.

Conclusion

Switching from IVIG to SCIG can offer you benefits like improved quality of life, greater flexibility, and reduced side effects. Several studies have shown that patients on SCIG report a higher satisfaction with their treatment than those on IVIG. However, switching to SCIG also requires careful planning, proper training, and regular monitoring.

If you want to switch from IVIG to SCIG, then you should have a detailed discussion with your doctor about all the pros and cons and get a personalized treatment plan. With the right approach, SCIG can be a viable and preferable alternative to IVIG.

Understanding Orbactiv: Dosing, Side Effects, Costs, and Clinical Benefits

Published on by Dr. Mark Alfonso, PharmD, BCMTMS

Some gram-positive bacteria have become resistant to currently available antibiotics. If you are fighting against such bacteria, drugs like Orbactiv can be a lifesaver for you. In this article, we will explore everything you need to know about Orbactiv, including its dosing, side effects, cost, and more.

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What Is Orbactiv?

Orbactiv (oritavancin) is an antibiotic drug. The FDA approved this drug on August 6, 2014, for treating acute bacterial skin and skin structure infections (ABSSSI) in adults [1]. This drug is especially useful in treating infections caused by some specific bacteria resistant to conventional antibiotics. 

Doctors can only use Orbactiv to treat infections caused by specific gram-positive microorganisms. Otherwise, this drug can create antibiotic-resistant bacteria. Orbactiv is given via intravenous infusion, which takes about 3 hours. You only have to take a single dose for it to work.

What Is Orbactiv Used To Treat?

Orbactiv (oritavancin) is a branded prescription antibiotic. It treats adults with acute bacterial skin and skin structure infections caused by specific microorganisms. ABSSSI are serious bacterial infections that affect your skin and the tissues under your skin. These infections can be life-threatening. Symptoms of these infections include pain, redness, fever, chills, fatigue, and pus-filled bumps or sores.

Doctors can only use this medication to treat or prevent infections proven or strongly suspected to be caused by certain gram-positive microorganisms. These microorganisms include [2]:

  • Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant isolates)
  • Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus)
  • Streptococcus agalactiae
  • Streptococcus pyogenes
  • Enterococcus faecalis (vancomycin-susceptible isolates only)
  • Streptococcus dysgalactiae

Orbactiv carries the possibility of creating drug-resistant microorganisms. So, you should only receive Orbactiv infusions to treat or prevent infections caused by the bacteria mentioned above, lower the risk of developing drug-resistant bacteria, and maintain the efficacy of Orbactiv and other medicines.

How Does Orbactiv Work?

Orbactiv is a branded antibiotic that contains the active ingredient oritavancin. It kills bacteria in three ways [2]. First, it blocks the bacteria from creating its own protective outer wall. Second, it can prevent the parts of the bacteria’s cell walls from linking together. Third, it damages the bacteria’s outer membrane, causing it to leak. Together, these three actions make this medication very effective in killing bacteria.

Side Effects

Woman with headache as a side effect of taking Orbactiv

Orbactiv can cause side effects ranging from mild to severe. You should immediately consult your doctor if you encounter any severe side effects. Let’s talk about some common and severe side effects of receiving Orbactiv infusions [3]:

Common Side Effects

Common side effects include:

  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Skin and soft tissue infection

Severe Side Effects

Severe side effects include the following:

Hypersensitivity Reactions: Orbactiv can cause severe allergic reactions, including anaphylaxis, which can be life-threatening. Signs of an allergic reaction include hives, difficulty breathing, and swelling of the face, lips, or tongue. If you are allergic to glycopeptides, you should be careful when using this medication. Immediately stop using Orbactiv if you experience any allergic reaction while taking it.

Clostridioides difficile Associated Disease (CDAD): This is a severe type of diarrhea that can even be fatal. Contact your doctor right away if you encounter diarrhea after taking Orbactiv.

Infusion-Related Reactions: You may experience some side effects during Orbactiv infusions. Tell your doctor right away if you feel chills, dizziness, light-headedness, chest pain, or back pain. Stopping or slowing the injection can help reduce the symptoms.

Development of Drug-Resistant Bacteria: Orbactiv is only effective in treating infections caused by certain bacteria. So, you should only use it when the presence of certain specific bacteria is proven or highly suspected. Otherwise, it can create drug-resistant bacteria.

Please note that this is not a list of all possible side effects. Consult your doctor if you encounter any other side effects after receiving this medication.

Dosing

This drug can only be used in adult patients. Your doctor will give you Orbactiv via intravenous infusion. It will take about three hours for your infusion to complete. The recommended dosage is 1,200 mg as a single-dose intravenous infusion [2]. But remember that your doctor may modify your dose based on your situation. So, always follow your doctor’s recommendation.

Cost

Orbactiv is available as a powder for injection, with a strength of 400 mg per vial. Each vial costs around $1,225 [4]. For a single dose, you need 3 vials. So, the total cost of treatment is around $3,675. However, the actual cost depends on your insurance coverage, location, treatment plan, and the pharmacy you visit.

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FAQs

Here are some frequently asked questions about Orbactiv:

1. Does Orbactiv cause hair loss?

No, it does not cause hair loss. In clinical trials, patients didn’t mention hair loss (alopecia) as a side effect [2]. However, if you experience any hair loss after taking Orbactiv, consult your doctor.

2. Can I use Orbactiv if I have liver or kidney problems?

You can safely receive Orbactiv infusions if you have mild to moderate liver or kidney problems. There is no need to adjust your dosage in these cases. However, there is no clinical safety data on severe liver or kidney disease patients [2]. So, you should consult your doctor for more information.

3. Is Orbactiv safe during pregnancy or breastfeeding?

There is still no data on the safety of Orbactiv usage during pregnancy or breastfeeding [2]. You should only use it during pregnancy or breastfeeding if your doctor thinks that the benefits outweigh the potential risks. 

4. Is Orbactiv effective against all types of bacteria?

No. Orbactiv is only effective against some specific gram-positive bacteria, including resistant strains like MRSA. So, be sure to only use it according to your doctor’s recommendation.

5. Does Orbactiv interact with other medications?

Yes. It can interact with some medicines, including blood thinner drugs like heparin or warfarin. If you are already taking heparin or warfarin, then Orbactiv may increase your risk of bleeding. So, you should inform your doctor about all the medicines you take, including over-the-counter drugs, before getting Orbactiv infusions.

6. What are the clinical benefits?

According to the clinical trial data, the majority of patients treated with Orbactiv were able to stop the spread of their skin infection and recover from their fever in two to three days [2]. In another study, researchers found that Orbactiv cured 68 patients out of 75 who suffered from gram-positive infections [5].

A Complete Guide to Hemophilia Medications: Types, Benefits, and Side Effects

Published on by Dr. Robert Hakim, PharmD

Hemophilia is a rare genetic disorder that prevents your body from forming blood clots. As a result, you can experience severe bleeding episodes, even from minor cuts and injuries. If you have hemophilia, it is very important to know about the available treatment options so that you can live a normal life. In this article, we will cover everything you need to know about hemophilia medications, including their types, side effects, and how they work.

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What Is Hemophilia?

Before we delve into hemophilia treatment drugs, let’s discuss what hemophilia is. Hemophilia is a rare genetic disorder where your blood doesn’t clot properly. It can lead to bleeding that happens for no reason or heavy bleeding from minor cuts or injuries. 

Normally, a healthy person’s blood contains some proteins called clotting factors that help stop bleeding. However, a person with hemophilia has a low level of clotting factors. The lower the level of clotting factor a patient has, the more severe the hemophilia will be. Fortunately, hemophilia medications are available to manage symptoms and prevent complications.
Hemophilia can cause symptoms like nosebleeds, bruising, and bleeding after injury. It can also cause bleeding within joints, which can lead to joint diseases. In addition, hemophilia may cause bleeding inside your head, leading to seizures and paralysis [1].

What Are the Types of Hemophilia?

There are mainly two types of hemophilia. They are [1]:

  • Hemophilia A: This type of hemophilia is caused by a lack or low level of clotting factor VIII (8).
  • Hemophilia B: This type of hemophilia is caused by a lack or low level of clotting factor IX (9).

Both of these types of hemophilia mainly affect males. This disease is usually inherited, meaning people get it from their parents. Fortunately, there are several hemophilia treatment drugs that are available for both of these types of disorders.

Available Hemophilia Medications

Replacement Therapy

Replacement therapy is the most common treatment for hemophilia. Replacement therapy works by directly injecting the missing clotting factor into your bloodstream. If you have hemophilia A, you will receive factor VIII, and if you have hemophilia B, you will receive factor IX. These clotting factors are derived from human blood or made in a laboratory [2].

Examples of brand-name factor VIII replacement therapies for hemophilia A patients are Advate and Kogenate [3][4]. Examples of brand-name factor IX replacement therapies for hemophilia B patients are Benefix and Alprolix [5][6].

Like any other hemophilia medications, these clotting factor replacement therapies can also cause side effects, including allergic reactions, headaches, and dizziness. Additionally, over time, your body can develop inhibitors against the clotting factors. Inhibitors are proteins created by your body that attack the clotting factors and reduce the effectiveness of the replacement therapy.

Desmopressin 

Streaming blood cells on red background

Desmopressin is a medication that is similar to a hormone that is naturally produced in your body. This medication can release factor VIII stored in your tissues, thus increasing the levels of factor VIII in your body. People with mild to moderate hemophilia A can use this treatment drug instead of replacement therapies. Some brand names for desmopressin are DDAVP (desmopressin injection) and Stimate (desmopressin nasal spray) [2].

Desmopressin can cause side effects like dry mouth, headache, dizziness, abdominal pain, chills, and nausea. Talk to your healthcare provider if you notice any of these side effects.

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Antifibrinolytics

Antifibrinolytics are medications that stop bleeding by preventing the breakdown of blood clots. Common antifibrinolytics include aminocaproic acid (Amicar) and tranexamic acid (Cyklokapron and Lysteda) [7]. Antifibrinolytics are often used together with other hemophilia medications. 
Antifibrinolytics are mainly used for people undergoing dental injuries or surgery because they block a substance found in your saliva that breaks down blood clots [2].

Gene Therapy

Gene therapy can be a long-term solution for hemophilia and offers an alternative to conventional medications. 

The traditional treatment of hemophilia primarily involves replacement therapy. But, in replacement therapy, you have to regularly receive the medication, which can be a hassle for some people. It also comes with the risk of developing inhibitors, which can lower how well the medication works for you over time. However, gene therapy is a one-time treatment that has the potential to give you long-term relief.

In hemophilia patients, the genes responsible for creating clotting factors aren’t working properly. Gene therapy replaces these faulty genes, enabling the body to produce the proper clotting factors and reducing reliance on traditional hemophilia treatment drugs.

As of October 2024, there is only one FDA-approved gene therapy for hemophilia A known as Roctavian [8]. There are two FDA-approved gene therapies for hemophilia B: Hemgenix and Beqvez [9][10]. 
Some common side effects of gene therapy include changes in liver function, headaches, fatigue, and vomiting [8][9][10].

The Bottom Line

Living with hemophilia can be challenging. But with proper care and the right hemophilia medications, you can live a normal life. Learning about your treatment options can help you find what is best for you.

Understanding Dalvance: A Powerful Antibiotic for Treating Skin Infections

Published on by Dr. Saba Rassouli, PharmD

Dalvance is a prescription antibiotic drug for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by specific bacteria. If you have ABSSSI, Dalvance can be a very good option for you because of its strong effectiveness. In this article, we will take a deep dive into this medication and discuss its dosing, side effects, cost, and more.

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What Is Dalvance?

Dalvance (dalbavancin) is an FDA-approved antibiotic drug that fights bacteria. The FDA first approved this drug on May 23, 2014 [1]. Dalvance infusions can treat acute bacterial skin and skin structure infections (ABSSSI). However, you can only use this drug to treat infections caused by specific bacteria. If used excessively, this medication can lead to the development of antibiotic-resistant bacteria.

Dalvance works by stopping the bacteria from forming their cell walls, which leads to the death of the bacteria. This drug is very effective in stopping infection when used correctly.

What Is Dalvance Used To Treat?

Dalvance (dalbavancin) is a prescription antibiotic drug used to treat adults and children with acute bacterial skin and skin structure infections (ABSSSI) caused by specific bacteria. ABSSSI are serious bacterial infections that affect the skin and the underlying tissues. These infections can cause symptoms like redness, swelling, pain and tenderness, fever and chills, blisters, and sores.

You can only use Dalvance when the ABSSSI is proven to be caused by or highly suspected to be caused by some specific strains of Gram-positive microorganisms [2]. These microorganisms include:

  • Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant isolates)
  • Streptococcus pyogenes
  • Streptococcus agalactiae
  • Streptococcus dysgalactiae
  • The streptococcus anginosus group (including S. anginosus, S. intermedius, S. constellatus) 
  • Enterococcus faecalis (vancomycin susceptible isolates)

Dalvance infusions come with the risk of developing drug-resistant bacteria. To reduce this risk and to maintain the effectiveness of Dalvance and other antibiotic drugs, you should only use it to treat or prevent infections caused by the microorganisms listed above.

How Does Dalvance Work?

The active ingredient in Dalvance is dalbavancin, which is an antibiotic. This drug works by preventing bacteria from creating their protective outer layer (the cell wall) [2]. Without this outer layer, bacteria can not survive and eventually die.  

How Is Dalvance Administered?

Dalvance is administered via intravenous infusion over a period of 30 minutes in order to minimize the chances of infusion-related reactions.

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Side Effects

Dalvance can have side effects that range from mild to severe. If you encounter any severe side effects, you should immediately consult your provider. 

Below are some of the mild and severe side effects [3]:

Mild Side Effects

Mild side effects include:

  • Nausea
  • Headache
  • Diarrhea
  • Fever
  • Infusion site reactions such as pain, swelling, or redness at the injection site

These mild side effects only last a few hours to a few days. However, consult your healthcare provider if these side effects do not go away or worsen.

Severe Side Effects

The severe side effects include:

  • Hypersensitivity Reactions: Dalvance can cause life-threatening severe allergic reactions and skin problems. If you are allergic to glycopeptide antibiotics, you should be careful when using this medication. This is because you are more likely to have an allergic reaction. Stop using Dalvance immediately if you experience any allergic reactions.
  • Clostridioides Difficile-Associated Diarrhea (CDAD): Dalvance can cause a type of diarrhea whose severity ranges from mild to fatal.
  • Liver Problems: In some cases, Dalvance can damage the liver.
  • Development of Drug-Resistant Bacteria: Dalvance is only effective for certain bacteria. You should only use it when the presence of certain specific bacteria is proven or highly suspected. Otherwise, it increases the risk of developing drug-resistant bacteria.

Please note that this list does not contain all the possible side effects. Consult your doctor immediately if you encounter any severe side effects.

Dosing

Bacterial infection on microscopic background

Dalvance can be used in both adults and children. Your doctor will give you this medication as an intravenous infusion into a vein (IV). The infusion will take about 30 minutes to complete. Below are the usual recommended dosages that a doctor may prescribe for adults and children [2]:

Dosage in Adult Patients: The recommended dose of the antibiotic drug Dalvance is 1,500 mg in a single-dose regimen. In a double-dose regimen, the recommended dose is 1,000 mg, followed one week later by 500 mg.

Dosage in Children: Dalvance is given to children as a single intravenous infusion dose. For children whose age is less than 6 years, the recommended dose is 22.5 mg per kg of body weight. For children aged between 6 to 18 years, the recommended dose is 18 mg per kg of body weight.

Remember that the dosages given above are the commonly prescribed dosages. Your doctor may recommend a different dosage depending on your situation. So, be sure to consult your doctor and follow their instructions.

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Cost

Dalvance antibiotic medication is available as a powder for injection with a dose strength of 500 mg. The price of one vial containing 500 mg is about $1,883 [4]. A single-dose regimen may require up to a 1,500 mg infusion in adult patients. The total cost of Dalvance treatment can therefore be about $5,649. However, the actual cost varies depending on your location, insurance coverage, treatment plan, and the pharmacy you visit. You can contact AmeriPharma if you are interested in receiving copay assistance for Dalvance.

FAQs

Here are some frequently asked questions about Dalvance:

1. Does this medication cause hair loss?

No. Dalvance does not cause hair loss. In clinical trials, hair loss was not reported as a side effect. However, you may want to consult your doctor if you experience hair loss after taking Dalvance.

2. Is it safe to use Dalvance during pregnancy or breastfeeding?

There is still not enough data to verify the safety of using the antibiotic drug Dalvance during pregnancy and breastfeeding [2]. If you are pregnant or breastfeeding, please consult your doctor about the potential risks and benefits before using Dalvance. 

3. Can I use Dalvance if I have liver problems?

Yes, you can. But you have to be careful. If you have moderate to severe liver problems, your doctor may have to adjust your dose. This is because there is not enough data about the safety of Dalvance in these conditions [3].

4. What are the clinical benefits?

According to the results of clinical trials, the majority of patients treated with Dalvance infusions stopped the spread of their skin infection and their fever in two to three days [2].

Multiple Sclerosis Diet Tips for Better Symptom Management

Published on by Dr. Robert Hakim, PharmD

Multiple sclerosis (MS) is a common neurological condition affecting over two million people worldwide. It’s an autoimmune condition that causes debilitating symptoms such as fatigue, muscle spasticity, and movement difficulties.

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There is currently no cure for multiple sclerosis. However, MS symptoms are manageable by following the appropriate treatment regimen and a balanced multiple sclerosis diet.

In this article, we will discuss what a healthy diet for multiple sclerosis looks like. We will list the foods you should eat and avoid and also examine different multiple sclerosis diet plans to help you choose the best option.

The Impact of Diet on MS

Did you know that MS is more common in Western countries? This epidemiological observation has led researchers to believe there is a connection between MS and dietary habits.

While nutrition cannot replace disease-modifying therapies for MS, a well-balanced multiple sclerosis diet may help with several factors, such as:

  • Reduce flare-ups
  • Improve the quality of life
  • Slow down disease progression
  • Manage and alleviate symptoms

By following a healthy diet for multiple sclerosis, you may be able to ease symptoms such as fatigue, inflammation, mood swings, bladder issues, and more. What foods should you include in this diet? Let’s find out.

Foods To Eat if You Have MS

A person preparing a healthy lunchbox

There isn’t a single nutritional solution for multiple sclerosis. To manage symptoms effectively, you must include a combination of nutrients in your multiple sclerosis diet.

Here are some of the most MS-friendly foods you can eat.

Fruits and Vegetables

Fresh fruits and vegetables are in most multiple sclerosis diet plans. Their high fiber content can help with bowel problems, while their essential vitamins may lower disease activity.

Fruits and vegetables are also fantastic sources of antioxidants, which can help reduce inflammation throughout the body and might slow the disease from worsening.

Whole Grains

Whole grains, such as oats, rice, and quinoa, are another great source of fiber. They are also full of complex carbohydrates, which can provide energy to help combat fatigue.

Research shows that those who include whole grains in their multiple sclerosis diet have less severe symptoms and disability.

Protein

Lean protein sources, such as chicken, fish, legumes, and soy products, offer various benefits for managing MS symptoms. A healthy diet for multiple sclerosis that is high in protein will provide essential amino acids necessary for muscle maintenance and repair.

Fish is especially beneficial for MS patients because it’s high in anti-inflammatory omega-3 fatty acids and vitamin D, which can strengthen bones. Red meat can also be a good source of vitamin D. However, it’s best to consume it in moderation. Be sure to consult your healthcare provider to determine a safe amount of red meat for your diet.

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Dairy Products

Your multiple sclerosis diet can also include dairy products. However, research on the effects of dairy products on MS is mixed.

Some suggest they might worsen MS symptoms, while others point to their high calcium and vitamin D content and their benefits for bone health and muscle repair.

If you decide to include dairy products in your multiple sclerosis diet plan, take note of your symptoms and talk to a healthcare provider if they worsen.

Healthy Fats

Healthy, unsaturated fats, like those found in avocados, nuts, seeds, olive oil, and oily fish, can be an excellent addition to your multiple sclerosis diet.

Studies show that these healthy fats possess anti-inflammatory properties and can protect the nerves from further damage. In addition, they can improve energy levels and reduce the risk of heart disease.

Probiotics and Prebiotics

A healthy diet for multiple sclerosis includes probiotic and prebiotic-rich foods.

Probiotics found in fermented foods, such as yogurt, kimchi, and kefir, can increase the levels of beneficial gut bacteria. Meanwhile, prebiotic fibers, such as those found in leeks, artichokes, garlic, and asparagus, can nourish these bacteria.

The actions of probiotics and prebiotics can help support gut health and improve MS symptoms by lowering inflammation and boosting immune response.

Foods to Avoid if You Have MS

You should limit certain foods in your multiple sclerosis diet to manage your symptoms better. Most of these food groups cause inflammation, so excluding them from your diet can help make living with multiple sclerosis easier.

Refined Carbs and Sugar

Scientists have not yet studied the effects of a high-sugar diet in people with MS. However, it’s recommended to exclude foods containing refined sugars and carbohydrates, like white bread and pasta, from your multiple sclerosis diet plan.

Rodent studies show that these carbs can worsen MS symptoms in some subjects. They can also increase the risk of other health conditions, such as cardiac disease and diabetes.

Highly Processed Foods

Another food you should exclude from your multiple sclerosis diet is ultra-processed foods. These foods contain high amounts of unhealthy fats, sodium, sugar, and other additives that can contribute to inflammation and fatigue.

They also lack the essential nutrients and antioxidants you need for a healthy body. Avoid packaged snacks, fast foods, and processed meats as much as possible. Instead, focus on nutrient-dense foods.

Saturated Fats and Trans Fats

A healthy diet for multiple sclerosis is low in saturated and trans fats. Studies show that these unhealthy fats increase inflammation, risk of relapse, and disability in those with MS.

To follow a multiple sclerosis diet free of saturated and trans fats, you must eliminate foods such as full-fat dairy products, fried foods, cured meats, palm oils, margarine, and baked goods.

Sodium

A high sodium (salt) diet can increase blood pressure and cause heart conditions, such as hypertension (high blood pressure) or heart failure. Those with MS should especially avoid it because they are more prone to coronary artery disease and are at an increased risk of fatigue and muscle weakness.

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Alcohol

While moderate alcohol consumption may be safe for some individuals, too much intake of it can have adverse effects on the body and worsen MS symptoms such as:

  • Fatigue
  • Depression
  • Bladder problems
  • Coordination issues
  • Cognitive impairment

Alcohol in a multiple sclerosis diet may also interact with certain medications and reduce their efficacy. It’s best to consult a healthcare professional about alcohol consumption if you’re on MS medications.

Special Multiple Sclerosis Diet Plans

A fork and a knife surrounding letter chips reading paleo diet

There isn’t a universal diet plan for this demyelinating disease. However, several plans exist that may help patients better manage their symptoms.

Here is a closer look at some of these diets.

Paleo Diet

The paleo diet, based on the presumed dietary patterns of ancient humans, emphasizes whole, unprocessed foods while avoiding grains and dairy.

Foods included in this diet plan include:

  • Fish
  • Nuts
  • Fruits
  • Meats
  • Vegetables

Research shows that those with relapsing-remitting multiple sclerosis who followed a modified paleo diet experienced less severe fatigue and better quality of life.

Swank Diet

Another healthy diet for multiple sclerosis is the Swank diet. Developed by Dr. Roy Swank in 1948, the Swank diet is a low-fat eating plan designed to support MS patients by reducing fat intake.

Foods included in this diet are:

  • Low-fat dairy products
  • Nuts and seeds (as snacks)
  • White fish and shellfish (unlimited)
  • Cod liver oil and multivitamins (daily)
  • Whole-grain starches (pasta, bread, rice)
  • Fruits and vegetables (at least 2 cups each daily)

Research suggests that adherence to the Swank diet may lead to fewer and less severe MS attacks.

Wahls Diet

The Wahls diet for multiple sclerosis patients was created by Dr. Terry Wahls in 2008. This plan is a modified paleo diet that focuses on nutrient-dense foods such as:

  • Nutritional yeast
  • Seaweed and algae
  • Intense-colored fruits
  • Sulfur-rich vegetables
  • Green, leafy vegetables
  • Minimally processed animal proteins
  • Limited gluten-free grains and legumes

Research indicates that the Wahls diet may improve quality of life and reduce fatigue for MS patients.

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Best Bet Diet

Another multiple sclerosis diet plan is the Best Bet diet. This diet aims to reduce inflammation by excluding food items that aggravate symptoms. It emphasizes wholesome nutrition while minimizing potentially harmful substances.

Foods in this diet include:

  • Olive oil
  • Fish and lean meats
  • Fruits and vegetables
  • Nutritional supplements (vitamin D, calcium, magnesium, omega-3 fatty acids)

Anecdotal reports suggest positive effects for some individuals with MS.

Overcoming MS Diet

The Overcoming MS diet is a plant-based diet specifically designed for helping to control MS. It emphasizes whole foods while eliminating processed items, meat, dairy, and saturated fats.

Foods included in this healthy diet for multiple sclerosis are:

  • Fish and seafood
  • Daily supplements (flaxseed oil or fish oil)
  • Additional nutrients (protein, iron, calcium)
  • Plant-based foods (fruits, vegetables, whole grains, legumes)

According to studies, this multiple sclerosis diet may enhance the patient’s mental and physical health.

Gluten-Free Diet

The last multiple sclerosis diet plan on our list is the gluten-free diet. Research shows that MS patients are more prone to developing celiac disease, a condition where your body responds to gluten with inflammation.

Therefore, they should avoid gluten-rich foods, such as bread and pasta, that are made with:

  • Rye
  • Wheat
  • Barley

Manage MS At Home With AmeriPharma™ Specialty Pharmacy

While the above diets for multiple sclerosis are healthy and effective for many, they have not been studied that well. Until research conclusively confirms the benefits of these plans for MS, it’s best to consult your healthcare team about your dietary needs.

Your healthcare provider can suggest the best multiple sclerosis diet that won’t interfere with your treatment. Once you have your diet plan, you can receive at-home IVIG therapy from AmeriPharma™ Specialty Pharmacy.

Our specialty pharmacy provides home infusion services and hard-to-find medications for individuals battling MS in over 40 US states and territories.

Contact us now to speak to a patient navigator and start receiving specialty care at home with full-service coordination, copay assistance, and 24/7/365 support.

Does IVIG Cause Fluid Retention?

Published on by Dr. Samantha Kaeberlein, PharmD

Fluid retention is a condition that occurs when the body is unable to maintain its fluid balance. As a result, excess fluid accumulates or is trapped inside the body’s tissues. This condition is known as edema, and it is often restricted to particular locations, affecting any body area, such as the legs, ankles, feet, or hands.

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Does IVIG cause fluid retention? IVIG therapy, which is a life-saving treatment for several inflammatory and immune-related disorders, can cause fluid retention in certain patients with other underlying conditions, such as heart and kidney problems.

Let’s review how IVIG therapy can cause fluid retention, what its initial symptoms are, and how you can manage this side effect.

IVIG and Fluid Retention: Basic Understanding

Generally, your body controls and regulates fluid (water) balance via a complex system. Hormonal factors, the liver, kidneys, cardiovascular system, and urinary system, all work together within this system to maintain fluid balance.

However, if there is a problem with any component of this system, your body fails to expel excess fluid as it should. When this happens, fluid starts to build up within the body’s tissues, causing swelling or puffiness in certain areas of the body, such as the legs or feet.

How IVIG Can Cause Fluid Retention

Fluid retention is one of the common side effects of IVIG therapy. Certain patients who received IVIG therapy experience fluid retention due to the following factors: 

The Volume of IVIG Infusion

IVIG products contain large amounts of fluid, and depending on the prescribed dose and the patient’s weight, a significant volume of IVIG solution may be administered into the bloodstream. The higher the dose, the larger the volume of fluid that is delivered into the patient’s bloodstream.

For patients with heart and kidney problems, IVIG administered in larger doses does cause fluid retention because the extra fluid volume leads to fluid overload due to their organs not working properly. This disturbs the fluid balance in their body, leading to fluid accumulation in the body’s tissues.

Osmotic Load and Protein Content

Man on bed receiving IVIG therapy at home

Since IVIG solutions contain a high concentration of immunoglobulin G (IgG), the large amount of IgG antibodies exerts an osmotic pressure, which alters the fluid balance between blood vessels and tissues.

The high osmotic pressure causes fluid shift from the surrounding tissues into the bloodstream, leading to increased blood volume and fluid overload. In certain patients, this contributes to fluid retention when their heart and kidneys are unable to eliminate excess fluid from the body.

Immune Response and Inflammation

IVIG therapy may cause fluid retention due to the immune response it triggers. This therapy usually initiates an immune response that includes mild inflammation. The inflammation causes capillary leakage, resulting in fluid moving from small blood vessels into surrounding tissues, which leads to swelling.

Impaired Kidney Functions

Patients with impaired kidney functions are more likely to experience fluid retention during or after IVIG treatment. Since their kidneys do not function properly, they fail to remove excess fluids, which results in fluid retention in their body’s tissues.

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What Are the Signs and Symptoms of Fluid Retention?

The following are some common signs and symptoms of fluid retention that you may experience during or after IVIG treatments:

  • Weight gain
  • Swelling in the legs, ankles or feet
  • Shortness of breath
  • Decreased urine output
  • Abdominal discomfort

Who Is at High Risk of Fluid Retention During or After IVIG Therapy?

IVIG therapy may cause fluid retention in those who:

  • Have a history of heart failure and kidney disease 
  • Are older adults
  • Are prescribed high dosages of IVIG infusions (a few hundred milliliters to several liters)

How Can You Manage Fluid Retention During or After IVIG Therapy?

You or your healthcare provider can take the following precautions to avoid fluid retention during or after IVIG therapy:

Monitor Fluid Intake and Output

You can monitor fluid intake and output during IVIG infusion to ensure your body processes IVIG solutions properly. However, if you see any unusual changes, such as decreased urination or swelling in feet or ankles, immediately consult your doctor.

Adjust Infusion Rate

You can adjust your infusion rate to avoid fluid overload. For example, slowing down the infusion in patients with heart or kidney problems can prevent the risk of fluid retention from IVIG by giving the body more time to eliminate excess fluids.

Medications

In some cases, diuretic medications are prescribed to patients with heart or kidney diseases to manage fluid retention. Diuretics help the kidneys remove excess fluid and sodium from the body and into the urine, preventing fluid accumulation in the body’s tissues.

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Conclusion

It is important to always consult your healthcare provider before receiving IVIG therapy, especially if you have a history of kidney disease or heart failure. This way, your healthcare provider can optimize your treatment plan to reduce the risk of fluid retention during IVIG therapy. 

Understanding that IVIG may cause fluid retention helps patients and providers take proactive measures to manage this side effect.

Rheumatoid Arthritis vs. Lupus: Similarities and Differences

Published on by Dr. Mark Alfonso, PharmD, BCMTMS

Rheumatoid arthritis and lupus are two autoimmune disorders that affect thousands of people worldwide. While they both affect the joints and share similar symptoms, they also have several differences.

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To better understand and manage these conditions, you must know the similarities and differences between lupus and rheumatoid arthritis.

In this guide, we will examine rheumatoid arthritis and lupus in more detail. We will examine their symptoms, discuss their causes, and explore their treatments to help you better understand each condition.

Overview

Let’s start with an overview of rheumatoid arthritis and lupus.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that occurs when the immune system attacks the lining of joints (synovium) and causes inflammation. The synovium won’t be able to lubricate the joints properly and will cause further damage.

Rheumatoid arthritis involves symmetric stiffness, meaning if the joints in your right hand are affected, the joints in the left hand will also be affected.

Lupus

Lupus is an autoimmune disorder in which the body mistakenly attacks its healthy tissues. Inflammation caused by lupus can spread throughout the body and affect different areas.

Depending on the area affected, lupus can fall into the following categories:

  • Systemic Lupus Erythematosus (SLE): This is the most common type of lupus, affecting 7 out of 10 patients and spreading throughout the body.
  • Cutaneous Lupus Erythematosus: A broad category that covers different types of lupus affecting the skin.
  • Drug-Induced Lupus Erythematosus: A temporary condition triggered by certain medications.
  • Neonatal Lupus: A rare condition in which antibodies from a mother with lupus pass to her newborn.

Symptoms of Rheumatoid Arthritis vs. Lupus

Below, we will compare the symptoms of rheumatoid arthritis and lupus.

Symptoms of Rheumatoid Arthritis

The main differences between lupus and rheumatoid arthritis are in their symptoms. Rheumatoid arthritis is often limited to the small joints in the fingers, toes, hands, and feet.

Some patients may notice symptoms in their wrists, elbows, knees, ankles, and other areas.

The primary joint-related signs of RA are:

  • Pain
  • Stiffness
  • Swelling
  • Tenderness

Other symptoms include:

  • Fever
  • Fatigue
  • Dry eyes
  • Pale skin
  • Dry mouth
  • Chest pain
  • Weight loss
  • Joint deformity
  • Loss of appetite
  • Kidney impairment
  • Shortness of breath
  • Rheumatoid nodules
  • Numbness in the hands and feet

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Symptoms of Lupus

Symptoms of lupus are not limited to joints. While they share similarities such as pain, stiffness, and swelling, lupus has distinct symptoms that distinguish it from RA.

Lupus-specific symptoms include:

  • Cough
  • Hair loss
  • Seizures
  • Headache
  • Weakness
  • Chest pain
  • Sun sensitivity
  • Dry and itchy eyes
  • Memory impairment
  • Nausea and vomiting
  • Pale or anemic appearance
  • Ulcers in the mouth or nose
  • Pale or bluish fingers and joints when cold or stressed
  • Butterfly-shaped rash (malar rash) over the cheeks and nose

Causes of Rheumatoid Arthritis vs. Lupus

Since both conditions result from the immune system attacking the body, many think there are no differences between the causes of lupus and rheumatoid arthritis.

However, there are subtle variances in what causes lupus and rheumatoid arthritis. Let’s examine them.

Causes of Rheumatoid Arthritis

Doctors don’t yet know the exact cause of RA. However, they suggest several factors may trigger the disease.

Some of these risk factors include:

  • Genetics
  • Infections
  • Hormones
  • Physical stress
  • Emotional stress

In addition, overweight women between the ages of 40-60 and a family history of RA are more prone to developing this disease.

Causes of Lupus

Similar to RA, the exact cause of lupus is unknown. However, several factors may trigger the development of the disease, particularly in people with a genetic predisposition to it.

The triggering factors for lupus include:

  • Infections
  • Hormones
  • Emotional or physical stress
  • Smoking history
  • Exposure to sunlight
  • Certain medications, such as:
    • Antibiotics
    • Anti-seizure medications
    • Blood pressure medications
  • Environmental factors such as air pollution

Additionally, lupus is more common in 15 – 45-year-old African American and Hispanic women.

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Diagnosis

To diagnose each condition, doctors begin by examining your medical history. They will ask about your symptoms and conduct the necessary blood tests.

Several differences exist between the diagnostic tests performed for lupus and rheumatoid arthritis.

Diagnosing Rheumatoid Arthritis

Your doctor will conduct the diagnostic tests for RA if you visit them with signs of fatigue and morning joint stiffness lasting over an hour.

Tests for diagnosing rheumatoid arthritis include:

  • Blood tests assessing:
    • Rheumatoid Factor (RF): Present in many RA patients but not all.
    • Anti-citrullinated Protein Antibody (anti-CCP): Highly specific for RA.
  • Imaging: X-rays or MRIs may reveal joint erosion or changes.
  • Physical Examination: Focused on swollen joints and tenderness.
  • ACR-EULAR Criteria: Requires scoring based on joint involvement, serology, and duration of symptoms.

Diagnosing Lupus

Your doctor will perform tests specific to lupus if you visit them with a skin rash, signs of photosensitivity, and joint pain.

These tests include:

  • Blood tests assessing:
    • Antinuclear Antibody (ANA): Highly sensitive but not specific.
    • Anti-double-stranded DNA and Anti-Smith Antibodies: More specific for lupus.
  • Urinalysis: To check for kidney involvement.
  • Imaging: To assess the involvement of other organs.
  • Fulfillment of Criteria: The American College of Rheumatology (ACR) criteria require at least four out of 11 specific criteria, including mucosal ulcers, serositis, and hematological disorders.

Treatment

A woman holding a pill and a glass of water

Neither condition has a cure yet. However, several treatments exist that can reduce the severity of symptoms and make life more manageable.

Let’s look at the treatment differences between lupus and rheumatoid arthritis.

Treatments for Rheumatoid Arthritis

Medications

To treat rheumatoid arthritis, doctors start with mild medications. The goal is to stop RA’s progression.

The most common medications used include:

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These medications can help reduce pain and inflammation. Over-the-counter NSAIDs such as ibuprofen and naproxen may suffice for some patients, while others may receive a prescription for stronger NSAIDs.
  • Corticosteroids: Steroids such as prednisone can help control inflammation and provide quick relief from pain.
  • Disease-Modifying Antirheumatic Drugs (DMARDs): These medications modify the immune system to slow disease progression and joint deterioration. Common DMARDs for rheumatoid arthritis include Olumiant, Xeljanz, and Rinvoq.
  • Biologics: Biologic drugs target specific components of the immune system. Common biologics for RA include Kevzara, Humira, and Enbrel.

IVIG

Another emerging treatment for RA is intravenous immunoglobulin or IVIG therapy. It involves administering antibodies obtained from healthy donated blood to the patient.

Receiving IVIG for rheumatoid arthritis can help modulate the immune response, reduce inflammation, and alleviate symptoms. This treatment is for people who have not responded to RA medications and have severe disease activity.

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Surgery

One of the differences between lupus and rheumatoid arthritis is that doctors can turn to surgery if other treatments don’t work for RA.

Depending on the patient’s condition, doctors may consider one of the following surgical options for rheumatoid arthritis:

  • Joint fusion
  • Synovectomy
  • Tendon repair
  • Total joint replacement

Treatments for Lupus

Lupus treatment varies significantly from one person to another. The goal of each treatment is to manage symptoms and prevent flares.

Medications

The first line of therapy for lupus involves medications such as:

  • NSAIDs: Over-the-counter options like ibuprofen and naproxen are often the first line of defense for joint pain and inflammation in SLE patients. Prescription-strength NSAIDs can also help with more severe symptoms.
  • Antimalarial Drugs: In lupus, antimalarial medications such as Plaquenil and chloroquine can reduce the risk of flares and alleviate other symptoms, including fatigue, rashes, and ulcers.
  • Corticosteroids: Low-dose corticosteroids like prednisone can help reduce inflammation.
  • Immunosuppressants: Medications such as azathioprine and mycophenolate mofetil help control an overactive immune response, especially in cases affecting vital organs.
  • Biologics: In some cases, biologics such as rituximab or belimumab may offer a more personalized therapy.

IVIG

Like RA, IVIG is an effective option for managing lupus symptoms. Those receiving IVIG treatment for lupus can expect a regulated immune response with lower inflammation and alleviated symptoms.

Outlook

A woman sitting in front of a beach

The outlook and disease progression is another factor that varies in lupus vs. rheumatoid arthritis patients.

Outlook for Rheumatoid Arthritis Patients

Rheumatoid arthritis is a chronic condition that can be progressive and requires a long-term treatment plan. Early intervention is necessary to minimize joint deterioration and enhance function.

Outlook for Lupus Patients

Disease activity in those affected by lupus can vary. Many experience periods of remission, but flares are not uncommon.

Systemic lupus erythematosus can affect your lifespan if you don’t receive treatment on time or skip regular doctor visits. However, you can expect a normal lifespan with proper therapy and monitoring.

Receive Specialty Treatments for Rheumatoid Arthritis and Lupus at Home From AmeriPharma™ Specialty Pharmacy

Knowing the differences between lupus and rheumatoid arthritis allows you to manage your condition effectively and live your best life.

If you are battling lupus or rheumatoid arthritis and need specialty treatment, AmeriPharma™ Specialty Pharmacy can help.

The licensed experts at our ACHC-accredited specialty pharmacy understand the needs of lupus and rheumatoid arthritis patients. We provide at-home IVIG therapy in over 40 US states and territories with full-service coordination, 24/7/365 support, and thorough copay assistance.

Contact us now to speak to a patient navigator and start receiving specialty care at home.