What is Xolair (Omalizumab)?
Xolair is a subcutaneous (under the skin) injectable medication used for treating and managing moderate to severe allergic asthma in adults and children aged six and older, chronic idiopathic urticaria in adults and children aged twelve and older, and nasal polyps in adults who are eighteen years of age and older.
How does Xolair Work?
Xolair belongs to a drug class called Monoclonal antibodies, anti-asthmatics. Xolair works by inhibiting the binding of IgE-to-IgE receptors on mast cells and basophils. This prevents the release of histamine, which causes inflammation within the body. Histamine is also known to cause symptoms such as runny nose, watery eyes, tissue swelling, itchy skin, and hives.
Xolair should be stored in the refrigerator between 36?F to 46?F (2?C to 8?C).
How to Take
Xolair comes in a prefilled syringe that is injected subcutaneously (under the skin). Xolair should be refrigerated until the time of use. If Xolair is left at room temperature for longer than two days, it should be discarded. Depending on your doctor’s recommendation, Xolair is usually given every 2 or 4 weeks. Xolair should be injected into the stomach, thigh, or upper arm. The prefilled syringe contains a single dose of Xolair and should be discarded into a sharps container once injected.
Xolair prefilled syringes are available in 75mg and 150mg doses.
Dosing for Adults and Children
The recommended dose of Xolair for treating moderate to severe asthma in adults and children aged six and older is 150-375mg every 2-4 weeks. Your total IgE level and body weight determine the dosage and frequency.
Chronic Idiopathic Urticaria
The recommended dose of Xolair for treating chronic idiopathic urticaria in adults and children aged 12 and older is 150-300mg every four weeks. The dosage is not dependent on IgE level or body weight but is determined by your doctor.
The recommended dose of Xolair for the treatment of nasal polyps in adults aged 18 and older for the treatment of nasal polyps is 75-600mg every 2-4 weeks. The total IgE level and body weight determine the dosage and frequency.
If you miss a dose of Xolair, call your doctor for further instructions and a new dosing schedule.
Taking too much Xolair can lead to serious side effects. If you suspect an overdose, seek emergency medical attention or call the poison control helpline at 1-800-222-1222.
If you experience signs and symptoms of an allergic reaction, such as hives, rash, itching, difficulty breathing, or swelling of the face, mouth, or throat, seek medical attention immediately.
The most common side effects of Xolair include:
- Joint pain or bone fractures
- Arm and leg pain
- Nausea, vomiting, diarrhea, and stomach pain
- Ear infection or ear pain
- Pain, bruising or swelling at the injection site
- Cold symptoms such as stuffy nose, sneezing, sinus pain, cough, and sore throat
Some serious side effects can also occur. Call your doctor or seek immediate medical attention if you experience any of the following symptoms:
- Ongoing nausea, vomiting, severe or watery diarrhea
- Difficulty breathing
- Numbness or tingling in the arms and legs
- Fever, muscle pain, and rash within a few days of injection
- Fever, ear pain or full feeling, trouble hearing, or ear drainage (signs of an ear infection)
- Chest pain or pressure, jaw or shoulder pain (signs of a heart attack)
- Sudden numbness or weakness, problems with vision or speech, coughing up blood, swelling or redness in an arm or leg (signs of a blood clot)
Warnings and Precautions
Xolair is contraindicated in those who have a known allergy or sensitivity to Xolair or any of its ingredients.
Xolair is approved for treating moderate to severe asthma in children aged six and older and treating chronic idiopathic urticaria in children aged twelve and older.
It is not known if Xolair is safe during pregnancy as IgE crosses the placenta and there may be a potential harm to the fetus. Uncontrolled asthma in pregnancy is associated with preeclampsia, prematurity, and low birth weight. Xolair can be used in pregnancy under a doctor’s supervision if the benefit outweighs the risk.
Xolair is approved for use in women who are breastfeeding. Studies have shown that there have been no adverse effects on breastfed infants.
Patients taking Xolair exhibited a higher rate of cancer during observational studies. The cancers reported include breast cancer, non-melanoma skin, prostate, melanoma, and parotid gland. It is unknown if more prolonged exposure to Xolair results in a higher risk of cancer development. Speaking to your doctor about your cancer risk before starting Xolair is essential.
Xolair has not been shown to alleviate acute asthma exacerbations. Do not use Xolair for the treatment of acute attacks or acute bronchospasm.
Do not abruptly discontinue systemic or inhaled corticosteroids upon initiation of Xolair for asthma. Corticosteroids should be decreased gradually under the supervision of a doctor.
Some patients taking Xolair presented with severe systemic eosinophilia. Patients taking Xolair should be monitored for eosinophilia intermittently while receiving treatment.
Fever, Rash and Arthralgia
Some patients taking Xolair experienced arthritis/arthralgia, rash, fever, and lymphadenopathy. Patients exhibiting these symptoms should have Xolair discontinued.
Patients at high risk of parasitic infection should be monitored throughout treatment with Xolair for active infection. Studies have shown an increased risk of parasitic infections while taking Xolair. Patients who develop symptoms of parasitic infection should be rested appropriately.
Patients taking Xolair showed an elevated serum total IgE level after one year of use.
This is not a complete list of potential drug interactions. Before taking Xolair, tell your doctor if you take any medications, herbal supplements, or vitamins.
Efgartigimod alfa, a medication used in the treatment of generalized myasthenia gravis, may reduce the blood levels and effects of Xolair.
Omacetaxine, a medication used in treating chronic myelogenous leukemia, may increase the risk of serious infections when used with Xolair.
Other drugs are available to treat asthma, chronic idiopathic urticaria, and nasal polyps. Speak to your doctor to discuss other medications.
Corticosteroids reduce inflammation, swelling, and mucous production in the airways of people with asthma. Available corticosteroids include prednisone and methylprednisone (Medrol)
Leukotriene modifiers work by blocking leukotrienes, reducing breathing problems in people with asthma. Available leukotriene modifiers include montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo)
Biologic medications work by inhibiting overactive signaling of IL-4 and IL-13. These proteins contribute to the inflammation that causes moderate-to-severe asthma. Available biologic medications include amepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair), and dupilumab (Dupixent).