Why is this medication prescribed?

Efalizumab is used to treat chronic (long-lasting) plaque psoriasis (a skin disease in which red scaly patches form on some areas of the body) in patients who cannot be treated with medications that are applied to the skin. Efalizumab is in a class of medications called immunosuppressants. It works by stopping the action of cells in the body that cause the symptoms of psoriasis.

How should this medicine be used?

Efalizumab comes as a powder to mix with sterile water and inject subcutaneously (under the skin). It is usually injected once a week. You should inject efalizumab on the same day every week. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use efalizumab exactly as directed. Do not use more or less of it or use it more often or for a longer period of time than prescribed by your doctor.

Your doctor will probably start you on a low dose of efalizumab and increase your dose after 1 week.

Efalizumab controls chronic plaque psoriasis but does not cure it. It may take several weeks before you feel the full benefit of efalizumab. Do not stop taking efalizumab without talking to your doctor.

You can inject efalizumab yourself or have a friend or relative give the injections. Your doctor will train the person who will be injecting the medication, and will test him to be sure he can give the injections correctly. Be sure that you and the person who will be giving the injections read the manufacturer's information for the patient that comes with efalizumab before you use it for the first time at home.

If you are injecting efalizumab yourself, you can inject it anywhere on your thighs or stomach. If someone else will be giving you your injections, he or she can also inject the medication anywhere on the back of your upper arms or buttocks. To reduce the chances of soreness or redness, choose a different area for each injection. If your doctor has told you to use two injections for each dose, choose two spots that are at least 1 inch apart. Do not inject efalizumab near a vein that you can see through the surface of the skin. Try to inject efalizumab in skin that is free of symptoms of psoriasis.

Never reuse needles, syringes, vials of efalizumab, or syringes of sterile water. You can throw away used alcohol pads, needle caps, and vials in the trash. Throw away used needles and syringes in a puncture-resistant container out of the reach of children. Talk to your doctor or pharmacist about what to do with the puncture-resistant container when it is full.

Never mix efalizumab powder with any liquid other than the sterile water provided. Never add any other medications to the syringe you will use to inject efalizumab.

To prepare and inject efalizumab, follow these steps:

• Take one or two blister trays of efalizumab and supplies out of the refrigerator and place the tray(s) on a clean, well-lit, flat work surface. You will need one tray if your doctor has told you to inject 1.25 mL or less each week or two trays if your doctor has told you to inject more than 1.25 mL each week. You will also need to prepare sterile gauze and an adhesive bandage.
• Wash your hands well with soap and warm water.
• Open the blister tray(s) and place the contents on the work surface. Each tray should contain one vial of efalizumab, one prefilled syringe of sterile water, two alcohol pads, and two needles. The vial(s) of efalizumab and syringe(s) of sterile water should be marked with expiration dates that have not passed. Call your pharmacist if your tray(s) do not contain all of these supplies or if your medication or water has expired.
• Wait to allow the medication and water to warm to room temperatureSteps 5-14 tell how to mix efalizumab with sterile water. If your dose is more than 1.25 mL, you will need to follow these directions twice to prepare two separate vials of efalizumab.
• Remove the plastic cap from the vial of efalizumab and wipe the rubber stopper with an alcohol pad. When you handle the vial, be careful not to touch the rubber stopper with your fingers.
• Remove one of the needles from its package, but do not remove the cap.
• Remove the cap from the tip of the prefilled syringe, and place the capped needle onto the syringe tip. Twist the needle cap to secure it into place.
• Remove the cap from the needle but be careful not to touch the needle with your fingers.
• Place the vial of efalizumab upright on a firm surface and slowly push the needle through the rubber stopper.
• Aim the tip of the needle toward the wall of the vial and slowly push down on the plunger to inject all of the sterile water into the vial. The powder in the vial may foam when you inject the water.
• Leave the needle and syringe in the vial stopper. Pick up the vial and swirl it gently to mix the medication. Do not shake the vial.
• Wait 5 minutes to allow the medication to dissolve.
• Look at the vial to be sure it contains a clear or pale yellow liquid. Call your pharmacist and do not use the liquid if it is cloudy, contains particles, or is a different color.Steps 14-29 tell how to fill the syringe with the correct amount of medication and inject the medication. If your dose is more than 1.25 mL, you will need to follow these steps twice to fill and inject two syringes that each contain half of your dose.
• Pick up the vial and turn it upside down without removing the needle. The entire tip of the needle should be covered by the liquid in the vial.
• Pull back the plunger to fill the syringe with the amount of medication your doctor told you to use. (If your dose is more than 1.25 mL, you will fill the syringe with half the amount of medication your doctor told you to use and then prepare a second syringe containing the other half of your dose.) Line up the plunger with the right number on the side of the syringe to fill the syringe with the right amount of medication.
• Remove the needle and syringe from the vial. Place the needle cap on a flat surface and slide the needle into the cap. Push the cap all the way down over the needle.
• Hold the syringe upright and tap it to push any air bubbles to the top. Gently push in the plunger to push the air bubbles out.
• Check that the syringe contains the right amount of medication. If the amount of liquid in the syringe goes past the line that matches your dose, push the plunger up slowly to release the extra medication.
• Twist the capped needle off of the syringe and throw it away in a puncture-resistant container.
• Hold the plastic cover of the second needle and remove the needle from the package. Be careful not to touch the uncovered end of the needle.
• Place the capped needle on the syringe tip and twist it in place. Put the syringe and needle on a flat surface.
• Wash your hands and the skin in the area where you plan to inject the medication with soap and warm water.
• Let the skin in the area where you will inject efalizumab air dry, then clean it with an alcohol pad or alcohol-soaked cotton ball using a circular motion. Allow the skin to air dry again and do not touch it with your fingers until after you are finished injecting your medication.
• Pick up the syringe and remove the needle cap by twisting and pulling it. Be careful not to touch the needle to your fingers or any surface.
• Hold the syringe firmly between your thumb and fingers with one hand and use your other hand to pinch a fold of skin in the area where you will inject your medication.
• Push the needle straight into your skin at a 90-degree angle.
• Let go of the pinched fold of skin and use that hand to slowly push down on the plunger until it stops.
• Remove the needle from your skin and throw it away in a puncture-resistant container. Do not recap the needle.
• Use a dry sterile gauze pad to press down on the spot where you injected efalizumab. Do not use an alcohol wipe. You may cover the spot with a small bandage if needed.

Other uses for this medicine

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

What storage conditions are needed for this medicine?

Keep this medication in the carton it came in, tightly closed, away from light, and out of reach of children. Store unopened blister trays of efalizumab in the refrigerator, but do not freeze them. You may store mixtures of efalizumab and sterile water for up to 8 hours at room temperature. Throw away mixtures of efalizumab and sterile water after 8 hours have passed and throw away any medication that is outdated or no longer needed. 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.

Symptoms of overdose may include:

• severe vomiting

What other information should I know?

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

Before having any laboratory tests, tell your doctor and the laboratory personnel that you are using efalizumab.

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

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