BLACK BOX WARNING
- anaphylaxis has occurred after any dose; administer only in healthcare settings prepared to manage anaphylaxis; observe patients for appropriate period of time
reslizumab
Brand: Cinqair
⚠ BBW Prototype: mepolizumab
Drug Class: biologic — anti-interleukin-5 (anti-IL-5) monoclonal antibody
Drug Family: biologic
Subclass: anti-eosinophilic biologic — IV formulation
Organ Systems: respiratoryimmunology
Mechanism of Action
Humanized IgG4 kappa monoclonal antibody that binds to IL-5 with high affinity, preventing IL-5 receptor engagement; reduces eosinophil production, survival, and activation, thereby decreasing eosinophilic airway inflammation in severe eosinophilic asthma.
interleukin-5 (IL-5)
Indications
- severe eosinophilic asthma (add-on maintenance therapy, adults 18 years or older)
Contraindications
- hypersensitivity to reslizumab
Adverse Effects
Common
- oropharyngeal pain
- elevated serum CK (muscle enzyme)
- injection site reactions
Serious
- anaphylaxis (occurs after any dose — may be severe)
- malignancy (signal from trials — clinical significance uncertain)
Pharmacokinetics (ADME)
| Absorption | IV infusion only (unique among anti-IL-5 agents — others are subcutaneous) |
| Distribution | Vd approximately 5 L |
| Metabolism | proteolytic degradation to peptides and amino acids |
| Excretion | proteolytic catabolism |
| Half-life | approximately 24 days |
| Onset | eosinophil reduction within weeks; exacerbation reduction over months |
| Peak | end of infusion |
| Duration | IV infusion once every 4 weeks |
| Protein Binding | N/A |
| Vd | approximately 5 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| live vaccines | potential reduction in vaccine response | moderate |
Nursing Considerations
- Reslizumab carries a black box warning for anaphylaxis; always administer in a healthcare setting equipped for anaphylaxis management; have epinephrine, IV fluids, and resuscitation equipment immediately available.
- Infuse IV over 20-50 minutes (dose: 3 mg/kg every 4 weeks); observe patient during and for 20 minutes after each infusion for signs of hypersensitivity (flushing, urticaria, throat tightness, hypotension).
- Reslizumab is weight-based (3 mg/kg) and administered intravenously — unique among approved anti-IL-5 biologics (mepolizumab and benralizumab are fixed-dose subcutaneous); confirm dose calculation and IV preparation before administration.
- Monitor serum creatine kinase (CK) at baseline and periodically; clinically significant elevations have been reported and may indicate myopathy.
Clinical Pearls
- Reslizumab is the only anti-IL-5 biologic administered intravenously and weight-based; the IV route eliminates injection-site reactions but requires infusion center visits, adding patient burden compared with home-based subcutaneous alternatives.
- The black box warning for anaphylaxis with reslizumab (occurring after any dose, not just first dose) is a critical safety differentiator from mepolizumab; this requirement for healthcare setting administration has limited its adoption compared with the subcutaneous anti-IL-5 agents.
Safety Profile
Pregnancy avoid
Lactation insufficient-data
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.