Elotuzumab – Uses, Dosage, Side Effects, Interaction

Elotuzumab is an antineoplastic agent and SLAMF7-directed immunostimulatory antibody used for the treatment of refractory multiple myeloma in combination with other antineoplastic agents. Elotuzumab is a humanized IgG1 (Immunoglobulin G) monoclonal antibody indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received one to three prior therapies. Elotuzumab targets SLAMF7, also known as Signaling Lymphocytic Activation Molecule Family member 7, a cell surface glycoprotein. Elotuzumab consists of the complementary determining regions (CDR) of the mouse antibody, MuLuc63, grafted onto human IgG1 heavy and kappa light chain frameworks. Elotuzumab is produced in NS0 cells by recombinant DNA technology. Elotuzumab has a theoretical mass of 148.1 kDa for the intact antibody. Elotuzumab was approved on November 30, 2015, by the U.S. Food and Drug Administration. Elotuzumab is marketed under the brand Empliciti™ by Bristol-Myers Squibb.

Mechanism of action

Elotuzumab is a humanized IgG1 monoclonal antibody that specifically targets the SLAMF7 (Signaling Lymphocytic Activation Molecule Family member 7) protein. SLAMF7 is expressed on myeloma cells independent of cytogenetic abnormalities. SLAMF7 is also expressed on Natural Killer cells, plasma cells, and at lower levels on specific immune cell subsets of differentiated cells within the hematopoietic lineage. Elotuzumab directly activates Natural Killer cells through both the SLAMF7 pathway and Fc receptors. Elotuzumab also targets SLAMF7 on myeloma cells and facilitates the interaction with Natural Killer cells to mediate the killing of myeloma cells through antibody-dependent cellular cytotoxicity (ADCC). In preclinical models, the combination of elotuzumab and lenalidomide resulted in enhanced activation of Natural Killer cells that was greater than the effects of either agent alone and increased anti-tumor activity in vitro and in vivo.

Elotuzumab is a humanized IgG1 monoclonal antibody that specifically targets the SLAMF7 (Signaling Lymphocytic Activation Molecule Family member 7) protein. SLAMF7 is expressed on myeloma cells independent of cytogenetic abnormalities. SLAMF7 is also expressed on
Natural Killer cells, plasma cells, and at lower levels on specific immune cell subsets of differentiated cells within the hematopoietic lineage. Elotuzumab directly activates Natural Killer cells through both the SLAMF7 pathway and Fc receptors. Elotuzumab also targets SLAMF7 on myeloma cells and facilitates the interaction with Natural Killer cells to mediate the killing of myeloma cells through antibody-dependent
cellular cytotoxicity (ADCC). In preclinical models, the combination of elotuzumab and lenalidomide resulted in enhanced activation of Natural Killer cells that was greater than the effects of either agent alone and increased anti-tumor activity in vitro and in vivo.

Indications

• Indicated in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received one to three prior therapies.
• Refractory Multiple Myeloma

Contraindications

• shingles
• a bad infection
• abnormal liver function tests
• pregnancy
• a patient who is producing milk and breastfeeding

Dosage

Strengths: 300 mg; 400 mg

Multiple Myeloma

IN COMBINATION WITH LENALIDOMIDE AND DEXAMETHASONE:

• Cycles 1 and 2: 10 mg/kg IV once a week on Days 1, 8, 15, and 22 of a 28-day cycle
• Cycle 3 and beyond: 10 mg/kg IV once every 2 weeks on Days 1 and 15 of a 28-day cycle until disease progression or unacceptable toxicity

PREMEDICATION:
(Note: Dexamethasone dosing differs depending on the chemotherapy regimen):

• Patients should be premedicated 45 to 90 minutes before administration of elotuzumab with dexamethasone 8 mg IV, an H1 blocker (e.g., diphenhydramine 25 to 50 mg IV or orally or equivalent); an H2 blocker (e.g., ranitidine 50 mg IV or equivalent), and acetaminophen 650 to 1000 mg orally.
• On days that elotuzumab is administered, give dexamethasone 28 mg orally 3 to 24 hours before elotuzumab (in addition to the dexamethasone 8 mg IV 45 to 90 minutes prior to elotuzumab).
• On days that elotuzumab is not administered but dexamethasone is scheduled (Days 8 and 22 of Cycle 3 and beyond) give dexamethasone 40 mg orally.

IN COMBINATION WITH POMALIDOMIDE AND DEXAMETHASONE:

• Cycles 1 and 2: 10 mg/kg IV once a week on Days 1, 8, 15, and 22 of a 28-day cycle
• Cycle 3 and beyond: 20 mg/kg IV once every 4 weeks on Day 1 of a 28-day cycle until disease progression or unacceptable toxicity

PREMEDICATION:
(Note: Dexamethasone dosing differs depending on the chemotherapy regimen):

• Patients should be premedicated 45 to 90 minutes before administration of elotuzumab with dexamethasone 8 mg IV, an H1 blocker (e.g., diphenhydramine 25 to 50 mg IV or orally or equivalent); an H2 blocker (e.g., ranitidine 50 mg IV or equivalent), and acetaminophen 650 to 1000 mg orally.

ADMINISTER DEXAMETHASONE AS FOLLOWS:
75 YEARS AND YOUNGER:

• On days that elotuzumab is administered, give dexamethasone 28 mg orally between 3 and 24 hours before elotuzumab (in addition to the dexamethasone 8 mg IV between 45 and 90 minutes before elotuzumab).
• On days that elotuzumab is not administered but a dose of dexamethasone is scheduled (days 8 and 22 of cycle 3 and all subsequent cycles), give 40 mg orally.

OLDER THAN 75 YEARS:

• On days that elotuzumab is administered, give dexamethasone 8 mg orally 3 to 24 hours before elotuzumab (in addition to the dexamethasone 8 mg IV 45 to 90 minutes prior to elotuzumab).
• On days that elotuzumab is not administered but dexamethasone is scheduled (Days 8 and 22 of Cycle 3 and beyond) give dexamethasone 20 mg orally.

Manufacturer recommended infusion rate for 10 mg/kg dose:
CYCLE 1, DOSE 1:

• Time interval 0 to 30 min: Rate 0.5 mL/min
• Time interval 30 to 60 min: Rate 1 mL/min
• Time interval 60 min or more: Rate 2 mL/min

CYCLE 1, DOSE 2:

• Time interval 0 to 30 min: Rate 3 mL/min
• Time interval 30 min or more: Rate 4 mL/min

CYCLE 1, DOSE 3 AND 4 AND ALL SUBSEQUENT CYCLES:

• Time interval 30 to 60 min: Rate 5 mL/min

Manufacturer recommended infusion rate for 20 mg/kg dose (patients who escalated to 5 mL/min at 10 mg/kg dose must decrease the rate to 3 mL/min at the first infusion at 20 mg/kg):
DOSE 1:

• Time interval 0 to 30 min: Rate 3 mL/min
• Time interval 30 min or more: Rate 4 mL/min

DOSE 2 AND ALL SUBSEQUENT DOSES:

• Time interval 30 min or more: Rate 5 mL/min
• Refer to the dexamethasone, lenalidomide, and pomalidomide prescribing information for additional information.
• In combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received 1 to 3 prior therapies
• In combination with pomalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least 5 prior therapies including lenalidomide and a proteasome inhibitor

Dose Adjustments

• If the dose of one drug in the regimen is delayed, interrupted, or discontinued, the treatment with the other drugs may continue as scheduled; however, if dexamethasone is delayed or discontinued, the decision on whether to administer elotuzumab should be based on clinical judgment (i.e., risk of hypersensitivity).
• If a Grade 2 or higher infusion reaction occurs, interrupt the infusion and institute appropriate medical measures. Upon resolution to Grade 1 or lower, restart elotuzumab at 0.5 mL per minute and gradually increase at a rate of 0.5 mL per minute every 30 minutes as tolerated to the rate at which the infusion reaction occurred. Resume the escalation regimen if there is no recurrence of the infusion reaction.
• For patients who experience an infusion reaction, monitor vital signs every 30 minutes during and for 2 hours after the end of the infusion in patients who experience an infusion reaction. If the reaction recurs, stop the infusion and do not restart on that day. Severe infusion reactions may require permanent discontinuation of therapy and emergency treatment.
• Dose delays and modifications for dexamethasone, pomalidomide, and lenalidomide should be performed as recommended in their Prescribing Information.

Side Effects

The Most Common

• diarrhea
• constipation
• headache
• vomiting
• mood changes
• weight loss
• night sweats
• numbness or decreased sense of touch
• bone pain
• muscle spasms
• Blindness
• burning, numbness, tingling, or painful sensations
• decreased appetite
• decreased vision
• decreased weight
• diarrhea
• difficulty having a bowel movement
• muscle aches
• night sweats
• pain in the arms or legs
• unsteadiness or awkwardness
• weakness in the arms, hands, legs, or feet
• swelling of your arms or legs
• chills, sore throat, fever, or cough; shortness of breath; pain or burning upon urination; painful rash; or other signs of infection
• numbness, weakness, tingling, or burning pain in your arms or legs
• chest pain
• nausea, extreme tiredness and lack of energy, loss of appetite, yellowing of the skin or eyes, dark urine, pale stools, confusion, pain in the upper right part of the stomach
• vision changes

More common

• Blurred vision
• body aches or pain
• chest pain
• chills
• clay-colored stools
• confusion
• cough
• dark urine
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• ear congestion
• fever
• headache
• hives, itching, skin rash
• hoarseness
• irritation
• joint pain, stiffness, or swelling
• loss of appetite
• loss of voice
• lower back or side pain
• nasal congestion
• nausea
• nervousness
• painful or difficult urination
• persistent sore that does not heal
• pink skin growth
• pounding in the ears
• reddish patch or irritated area
• redness of the skin
• runny nose
• shiny skin bump
• slow or fast heartbeat
• sneezing
• sore throat
• stomach pain or tenderness
• stuffy nose
• sweating
• swelling of the eyelids, face, lips, hands, or feet
• tightness in the chest
• troubled breathing or swallowing
• unusual tiredness or weakness
• vomiting
• white, yellow or waxy scar-like area on the skin
• yellow eyes or skin

Rare

• Agitation
• anxiety
• decreased awareness or responsiveness
• decreased urine output
• depression
• dizziness or lightheadedness
• fainting
• fast heartbeat
• hostility
• irritability
• loss of consciousness
• muscle twitching
• pale skin
• rapid weight gain
• seizures
• severe sleepiness
• troubled breathing with exertion
• unusual bleeding or bruising
• unusual drowsiness, dullness, or feeling of sluggishness

Drug interaction

DRUG	INTERACTION
Abciximab	The risk or severity of adverse effects can be increased when Abciximab is combined with Elotuzumab.
Adalimumab	The risk or severity of adverse effects can be increased when Adalimumab is combined with Elotuzumab.
Aducanumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Aducanumab.
Alemtuzumab	The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Elotuzumab.
Alirocumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Alirocumab.
Amivantamab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Amivantamab.
Anifrolumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Anifrolumab.
Ansuvimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ansuvimab.
Anthrax immune	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Anthrax immune globulin human.
Antilymphocyte	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Antilymphocyte immunoglobulin (horse).
Antithymocyte	The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Elotuzumab.
Articaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Articaine.
Asfotase alfa	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Asfotase alfa.
Atezolizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Atezolizumab.
Atoltivimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Atoltivimab.
Avelumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Avelumab.
Bamlanivimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Bamlanivimab.
Basiliximab	The risk or severity of adverse effects can be increased when Basiliximab is combined with Elotuzumab.
Bebtelovimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Bebtelovimab.
Belantamab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Belantamab mafodotin.
Belimumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Belimumab.
Benralizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Benralizumab.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Benzocaine.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Benzyl alcohol.
Besilesomab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Besilesomab.
Bevacizumab	The risk or severity of adverse effects can be increased when Bevacizumab is combined with Elotuzumab.
Bezlotoxumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Bezlotoxumab.
Bimekizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Bimekizumab.
Blinatumomab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Blinatumomab.
Brentuximab vedotin	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Brentuximab vedotin.
Brodalumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Brodalumab.
Brolucizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Brolucizumab.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Bupivacaine.
Burosumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Burosumab.
Butacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Butamben.
Canakinumab	The risk or severity of adverse effects can be increased when Canakinumab is combined with Elotuzumab.
Caplacizumab	The risk or severity of adverse effects can be increased when Caplacizumab is combined with Elotuzumab.
Capromab	The risk or severity of adverse effects can be increased when Capromab pendetide is combined with Elotuzumab.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Capsaicin.
Casirivimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Casirivimab.
Catumaxomab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Catumaxomab.
Cemiplimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Cemiplimab.
Certolizumab pegol	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Certolizumab pegol.
Cetuximab	The risk or severity of adverse effects can be increased when Cetuximab is combined with Elotuzumab.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Chloroprocaine.
Cilgavimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Cilgavimab.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Cinchocaine.
Cocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Cocaine.
Conjugated estrogens	Conjugated estrogens may increase the thrombogenic activities of Elotuzumab.
Daratumumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Daratumumab.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Elotuzumab.
Denosumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Denosumab.
Dienestrol	Dienestrol may increase the thrombogenic activities of Elotuzumab.
Diethylstilbestrol	Diethylstilbestrol may increase the thrombogenic activities of Elotuzumab.
Digoxin Immune	The risk or severity of adverse effects can be increased when Digoxin Immune Fab (Ovine) is combined with Elotuzumab.
Dinutuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Dinutuximab.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Diphenhydramine.
Dostarlimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Dostarlimab.
Dulaglutide	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Dulaglutide.
Dupilumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Dupilumab.
Durvalumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Durvalumab.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Dyclonine.
Ebola Zaire	The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Elotuzumab.
Eculizumab	The risk or severity of adverse effects can be increased when Eculizumab is combined with Elotuzumab.
Efalizumab	The risk or severity of adverse effects can be increased when Efalizumab is combined with Elotuzumab.
Eflapegrastim	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Eflapegrastim.
Eftrenonacog alfa	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Eftrenonacog alfa.
Emapalumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Emapalumab.
Emicizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Emicizumab.
Eptinezumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Eptinezumab.
Erenumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Erenumab.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Elotuzumab.
Esterified estrogens	Esterified estrogens may increase the thrombogenic activities of Elotuzumab.
Estetrol	Estetrol may increase the thrombogenic activities of Elotuzumab.
Estradiol	Estradiol may increase the thrombogenic activities of Elotuzumab.
Estradiol acetate	Estradiol acetate may increase the thrombogenic activities of Elotuzumab.
Estradiol benzoate	Estradiol benzoate may increase the thrombogenic activities of Elotuzumab.
Estradiol cypionate	Estradiol cypionate may increase the thrombogenic activities of Elotuzumab.
Estradiol valerate	Estradiol valerate may increase the thrombogenic activities of Elotuzumab.
Estriol	Estriol may increase the thrombogenic activities of Elotuzumab.
Estrone	Estrone may increase the thrombogenic activities of Elotuzumab.
Estrone sulfate	Estrone sulfate may increase the thrombogenic activities of Elotuzumab.
Ethinylestradiol	Ethinylestradiol may increase the thrombogenic activities of Elotuzumab.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Etidocaine.
Evolocumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Evolocumab.
Fanolesomab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Fanolesomab.
Fremanezumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Fremanezumab.
Galcanezumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Galcanezumab.
Gemtuzumab	The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Elotuzumab.
Golimumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Golimumab.
Guselkumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Guselkumab.
Hepatitis B	The risk or severity of adverse effects can be increased when Hepatitis B immune globulin is combined with Elotuzumab.
Cytomegalovirus	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Human cytomegalovirus immune globulin.
immunoglobulin G	The risk or severity of adverse effects can be increased when Human immunoglobulin G is combined with Elotuzumab.
mmune globulin	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Human Rho(D) immune globulin.
Human varicella	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Human varicella-zoster immune globulin.
Ibalizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ibalizumab.
Ibritumomab	The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Elotuzumab.

Idarucizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Idarucizumab.
Imdevimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Imdevimab.
Imlifidase	The therapeutic efficacy of Elotuzumab can be decreased when used in combination with Imlifidase.
Inebilizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Inebilizumab.
Infliximab	The risk or severity of adverse effects can be increased when Infliximab is combined with Elotuzumab.
Inotuzumab	The risk or severity of adverse effects can be increased when Inotuzumab ozogamicin is combined with Elotuzumab.
Ipilimumab	The risk or severity of adverse effects can be increased when Ipilimumab is combined with Elotuzumab.
Isatuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Isatuximab.
Ixekizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ixekizumab.
Lanadelumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Lanadelumab.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Levobupivacaine.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Lidocaine.
Loncastuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Loncastuximab tesirine.
Maftivimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Maftivimab.
Margetuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Margetuximab.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Meloxicam.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Mepivacaine.
Mepolizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Mepolizumab.
Mestranol	Mestranol may increase the thrombogenic activities of Elotuzumab.
Methoxy	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Elotuzumab.
Mirvetuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Mirvetuximab Soravtansine.
Mogamulizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Mogamulizumab.
Mosunetuzumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Mosunetuzumab.
Muromonab	The risk or severity of adverse effects can be increased when Muromonab is combined with Elotuzumab.
Natalizumab	The risk or severity of adverse effects can be increased when Natalizumab is combined with Elotuzumab.
Necitumumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Necitumumab.
Nivolumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Nivolumab.
Obiltoxaximab	The risk or severity of adverse effects can be increased when Obiltoxaximab is combined with Elotuzumab.
Obinutuzumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Obinutuzumab.
Ocrelizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ocrelizumab.
Odesivimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Odesivimab.
Ofatumumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ofatumumab.
Olaratumab	The risk or severity of adverse effects can be increased when Olaratumab is combined with Elotuzumab.
Omalizumab	The risk or severity of adverse effects can be increased when Omalizumab is combined with Elotuzumab.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Oxetacaine.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Oxybuprocaine.
Palivizumab	The risk or severity of adverse effects can be increased when Palivizumab is combined with Elotuzumab.
Panitumumab	The risk or severity of adverse effects can be increased when Panitumumab is combined with Elotuzumab.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Elotuzumab.
Pembrolizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Pembrolizumab.
Pertuzumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Pertuzumab.
Phenol	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Phenol.
Polatuzumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Polatuzumab vedotin.
Polyestradiol	Polyestradiol phosphate may increase the thrombogenic activities of Elotuzumab.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Pramocaine.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Prilocaine.
Procaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Procaine.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Proparacaine.
Propoxycaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Propoxycaine.
Quinestrol	Quinestrol may increase the thrombogenic activities of Elotuzumab.
Ramucirumab	The risk or severity of adverse effects can be increased when Ramucirumab is combined with Elotuzumab.
Ranibizumab	The risk or severity of adverse effects can be increased when Ranibizumab is combined with Elotuzumab.
Ravulizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Ravulizumab.
Raxibacumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Raxibacumab.
Reslizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Reslizumab.
Risankizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Risankizumab.
Rituximab	The risk or severity of adverse effects can be increased when Rituximab is combined with Elotuzumab.
Romosozumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Romosozumab.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Ropivacaine.
Sacituzumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Sacituzumab govitecan.
Sarilumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Sarilumab.
Secukinumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Secukinumab.
Siltuximab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Siltuximab.
Sotrovimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Sotrovimab.
Spesolimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Spesolimab.
Sulesomab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Sulesomab.
Sutimlimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Sutimlimab.
S Estrogens, A	Synthetic Conjugated Estrogens, A may increase the thrombogenic activities of Elotuzumab.
Estrogens, B	Synthetic Conjugated Estrogens, B may increase the thrombogenic activities of Elotuzumab.
Tafasitamab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tafasitamab.
Teplizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Teplizumab.
Tetanus immune	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tetanus immune globulin, human.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Elotuzumab is combined with Tetracaine.
Tezepelumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tezepelumab.
Tibolone	Tibolone may increase the thrombogenic activities of Elotuzumab.
Tildrakizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tildrakizumab.
Tisotumab vedotin	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tisotumab vedotin.
Tixagevimab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tixagevimab.
Tocilizumab	The risk or severity of adverse effects can be increased when Tocilizumab is combined with Elotuzumab.
Tositumomab	The risk or severity of adverse effects can be increased when Tositumomab is combined with Elotuzumab.
Tralokinumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tralokinumab.
Trastuzumab	The risk or severity of adverse effects can be increased when Trastuzumab is combined with Elotuzumab.
Trastuzumab deruxtecan	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Trastuzumab deruxtecan.
Trastuzumab emtansine	The risk or severity of adverse effects can be increased when Trastuzumab emtansine is combined with Elotuzumab.
Tremelimumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Tremelimumab.
Ustekinumab	The risk or severity of adverse effects can be increased when Ustekinumab is combined with Elotuzumab.
Vedolizumab	The risk or severity of adverse effects can be increased when Elotuzumab is combined with Vedolizumab.

Pregnancy and Lactation

AU TGA pregnancy category: C
US FDA pregnancy category: Not assigned

Pregnancy

There are no studies with EMPLICITI with pregnant women to inform of any drug-associated risks. Animal reproduction studies have not been conducted with elotuzumab. EMPLICITI is administered in combination with lenalidomide and dexamethasone. Lenalidomide can cause embryo-fetal harm and is contraindicated for use in pregnancy. Refer to the lenalidomide and dexamethasone prescribing information for additional information. Lenalidomide is only available through a REMS program. The background risk in the U.S. general population of major birth defects is 2% to 4% and miscarriage is 15% to 20% of clinically recognized pregnancies.

Lactation

There is no information on the presence of EMPLICITI in human milk, the effect on the breastfed infant, or the effect on milk production. Because of the potential for serious adverse reactions in breastfed infants from elotuzumab administered with lenalidomide/dexamethasone, breastfeeding is not recommended. Refer to the lenalidomide and dexamethasone prescribing information for additional information.

How should this medicine be used?

Elotuzumab comes as a powder to be mixed with sterile water and given intravenously (into a vein) by a doctor or nurse in a healthcare setting. When used in combination with lenalidomide and dexamethasone it is usually given once every week for the first 2 cycles (each cycle is a 28-day treatment period) and then once every 2 weeks. When used in combination with pomalidomide and dexamethasone it is usually given once a week for the first 2 cycles (each cycle is a 28-day treatment period) and then once every 4 weeks.

A doctor or nurse will watch you closely while you are receiving the infusion and after the infusion to be sure you are not having a serious reaction to the medication. You will be given other medications to help prevent reactions to elotuzumab. Tell your doctor or nurse immediately if you experience any of the following symptoms that may occur during the infusion or for up to 24 hours after you receive the infusion: fever, chills, rash, dizziness, lightheadedness, slowed heartbeat, chest pain, difficulty breathing, or shortness of breath.

Your doctor may decrease your dose of elotuzumab or permanently or temporarily stop your treatment. This depends on how well the medication works for you and the side effects you experience. Be sure to tell your doctor how you are feeling during your treatment with elotuzumab. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

What special precautions should I follow?

Before receiving an elotuzumab injection,

• tell your doctor and pharmacist if you are allergic to elotuzumab, any other medications, or any of the ingredients in elotuzumab injection. Ask your pharmacist or check the manufacturer’s patient information for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. 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 or if you have or have ever had liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving an elotuzumab injection, call your doctor.

References

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