What are the infusion guidelines for Vyepti (Eptinezumab)?

Vyepti (Eptinezumab) Infusion Guidelines

Vyepti should be administered as an intravenous infusion at a dose of 100 mg or 300 mg every 12 weeks (quarterly), delivered over approximately 30 minutes, with no routine premedication required unless the patient has a history of prior infusion reactions. 1, 2, 3

Dosing and Administration

• Standard dosing: 100 mg intravenously every 3 months (12 weeks) for migraine prevention 2, 3
• Alternative dosing: 300 mg intravenously every 3 months may be used, though 100 mg has demonstrated efficacy 2, 3
• Acute treatment dosing: 100 mg can be administered during an active moderate to severe migraine attack, with efficacy beginning within 1-6 hours of infusion start 4
• Chronic cluster headache: 400 mg intravenously every 12 weeks has been studied in this population 5

Infusion Protocol

• Infusion duration: Administer over approximately 30 minutes 3
• No routine premedication: Premedication with antipyretics or antihistamines is not routinely recommended 6
• Consider premedication only if: Patient has history of prior infusion reactions, multiple drug allergies, or history of asthma 7
• If premedication used: Administer acetaminophen 1000 mg and diphenhydramine 50 mg 30-60 minutes before infusion 7

Management of Infusion Reactions

Mild to Moderate Reactions (Grade 1/2)

• Immediate action: Stop or slow the infusion rate immediately 6, 8
• Symptomatic treatment: Administer antihistamines (diphenhydramine 25-50 mg IV) and antipyretics (acetaminophen 650-1000 mg) as needed 7
• Monitor: Observe for 15 minutes until symptoms resolve 7
• Restart protocol: Resume infusion at 50% of the previous rate after complete symptom resolution 8, 7
• Gradual escalation: If well tolerated for 15 minutes, gradually increase rate 7

Severe Reactions (Grade 3/4)

• Immediate cessation: Stop the infusion immediately 6, 8
• Aggressive treatment: Provide aggressive symptomatic therapy including corticosteroids if needed 8
• Do not rechallenge: Permanently discontinue eptinezumab after severe reactions including bronchospasm, severe hypotension, angioedema, or anaphylaxis 7

Post-Infusion Monitoring

• Observation period: Monitor patients for a minimum of 1-2 hours after infusion completion 8, 7
• Patient education: Counsel about potential delayed reactions up to 24 hours post-infusion, including flu-like symptoms, arthralgias, myalgias, and fever 7
• Delayed symptom management: Recommend NSAIDs for symptomatic relief of delayed symptoms 7

Safety Profile

• Common adverse events: Nasopharyngitis, upper respiratory tract infections, sinusitis, fatigue, and nausea—typically mild in severity 2, 3
• Hypersensitivity reactions: Occur in approximately 2.1% of patients, most commonly on the first day of infusion 4, 5
• Treatment-emergent adverse events: Reported in 81% of chronic cluster headache patients over 60 weeks, but rarely led to treatment withdrawal (3%) or infusion interruption (<1%) 5
• No drug interactions: Eptinezumab shows no significant drug interactions 2

Critical Pitfalls to Avoid

• Never restart at full rate: Always resume at 50% of previous rate after any reaction resolution 7
• Do not rechallenge after severe reactions: Permanent discontinuation is required after Grade 3/4 reactions 6, 7
• Monitor vital signs continuously: During any rechallenge attempt, as reactions can occur at any time despite prior tolerance 7
• Do not assume premedication prevents reactions: Premedication may not prevent infusion reactions in all patients 6

Onset of Efficacy

• Preventive effect: Begins on day 1 after infusion, with sustained efficacy throughout the 12-week dosing interval 2, 3
• Acute treatment: When administered during a migraine attack, median time to headache pain freedom is 4 hours, with 23.5% achieving pain freedom at 2 hours 4
• Most bothersome symptom: Median time to absence is 2 hours, with 55.5% achieving absence at 2 hours post-infusion 4