Anakinra (patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Why this medication is prescribed

Anakinra is used, alone or in combination with other medications, to reduce the pain and swelling associated with rheumatoid arthritis. Anakinra is in a class of medications called interleukin antagonists. It works by blocking the activity of interleukin, a protein in the body that causes joint damage.

How this medication should be used

Anakinra comes as a solution to inject subcutaneously (under the skin). It is usually injected once a day, at the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take anakinra exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Anakinra comes in prefilled glass syringes. There are seven syringes in each box, one for each day of the week. Use each syringe only once and inject all the solution in the syringe. Even if there is still some solution left in the syringe after you inject, do not inject again. Dispose of used syringes in a puncture-resistant container. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

Do not shake prefilled syringes. If the solution is foamy, allow the syringe to sit for a few minutes until it clears. Do not use a syringe if its contents look discolored or cloudy or if it has anything floating in it.

You can inject anakinra in the outer thigh or stomach. If someone else is giving you the injection, it can be injected in the back of the arms or buttocks. To reduce the chances of soreness or redness, use a different site for each injection. You do not have to change the part of the body every day, but the new injection should be given about 1 inch away from the previous injection. Do not inject close to a vein you can see under the skin.

Before you use anakinra for the first time, read the manufacturer's information for the patient that comes with it. Ask your doctor or pharmacist to show you how to inject anakinra.

To administer the injection, follow these steps:

1. Clean the injection site with an alcohol wipe using a circular motion, starting from the middle and moving outwards. Let the area dry completely.
2. Hold the syringe and pull the needle cover off by twisting the cover while pulling on it. Do not touch the needle.
3. Hold the syringe in the hand you use to inject yourself. If possible, use your other hand to pinch a fold of skin at the injection site. Do not lay the syringe down or allow the needle to touch anything.
4. Hold the syringe between your thumb and fingers so you have steady control. Insert the needle into the skin with a quick, short motion at a 45 to 90 degree angle. The needle should be inserted at least halfway.
5. Gently let go of the skin, but make sure the needle remains in your skin. Slowly push the plunger down into the syringe until it stops.
6. Remove the needle and do not recap it. Press dry gauze (NOT an alcohol wipe) over the injection site.
7. You may apply a small adhesive bandage over the injection site.
8. Place the entire used syringe in a puncture-resistant container.

It may take several weeks before you feel the full benefit of anakinra.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special precautions

Before taking anakinra:

• tell your doctor and pharmacist if you are allergic to anakinra, proteins made from bacterial cells (E. coli), latex, or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: etanercept (Enbrel); infliximab (Remicade); and medications that suppress the immune system such as azathioprine (Imuran), cyclosporine (Neoral, Sandimmune), methotrexate (Rheumatrex), sirolimus (Rapamune), and tacrolimus (Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have an infection, asthma, HIV infection or AIDS, or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking anakinra, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking anakinra.
• do not have any vaccinations (e.g., measles or flu shots) without talking to your doctor.

Special dietary instructions

Unless your doctor tells you otherwise, continue your normal diet.

What to do if you forget a dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Side Effects

Minor Side Effects

Anakinra may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• redness, swelling, bruising, or pain at the site of injection
• headache
• upset stomach
• diarrhea
• runny nose
• stomach pain

Severe Side Effects

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• rash
• flu-like symptoms
• fever, sore throat, chills, and other signs of infection
• coughing, wheezing, or chest pain
• hot, red, swollen area on the skin

Anakinra may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for this medication

Keep syringes and injection supplies out of the reach of children. Store anakinra syringes in the refrigerator. Do not freeze. Protect from light. Do not use a syringe that has been at room temperature for more than 24 hours. Throw away any medication left after the expiration date on the carton. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Other information

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before and during treatment to check your body's response to anakinra.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names

• Kineret®