Dupixent (Dupilumab) 300mg/2mL Subcutaneous Solution Dosage
For adults with atopic dermatitis, administer an initial loading dose of 600 mg (two 300 mg injections) followed by 300 mg every 2 weeks. 1
Atopic Dermatitis Dosing by Age and Weight
Adults
Pediatric Patients (6 years and older)
Weight-tiered dosing is critical to achieve appropriate drug exposure: 1, 2
15 to <30 kg:
- Loading: 600 mg (two 300 mg injections)
- Maintenance: 300 mg every 4 weeks 1
30 to <60 kg:
- Loading: 400 mg (two 200 mg injections)
- Maintenance: 200 mg every 2 weeks 1
≥60 kg:
- Loading: 600 mg (two 300 mg injections)
- Maintenance: 300 mg every 2 weeks 1
Young Children (6 months to 5 years)
- 5 to <15 kg: 200 mg every 4 weeks (no loading dose) 1
- 15 to <30 kg: 300 mg every 4 weeks (no loading dose) 1
Other Approved Indications
Asthma (12 years and older)
- Standard dosing: 400 mg loading (two 200 mg injections), then 200 mg every 2 weeks 1
- Alternative: 600 mg loading (two 300 mg injections), then 300 mg every 2 weeks 1
- For oral corticosteroid-dependent asthma or co-morbid moderate-to-severe atopic dermatitis: Use the 600 mg/300 mg regimen 1
Chronic Rhinosinusitis with Nasal Polyps (12 years and older)
Eosinophilic Esophagitis (1 year and older, ≥15 kg)
Prurigo Nodularis (Adults)
Chronic Obstructive Pulmonary Disease (Adults)
- No loading dose: 300 mg every 2 weeks 1
Chronic Spontaneous Urticaria
- Adults: 600 mg loading, then 300 mg every 2 weeks 1
- Adolescents 30 to <60 kg: 400 mg loading, then 200 mg every 2 weeks 1
- Adolescents ≥60 kg: 600 mg loading, then 300 mg every 2 weeks 1
Bullous Pemphigoid (Adults)
- Loading dose: 600 mg (two 300 mg injections) 1
- Maintenance: 300 mg every 2 weeks 1
- Must be combined with a tapering course of oral corticosteroids 1
Critical Dosing Considerations
Concomitant Topical Therapy
Dupilumab can be used with or without topical corticosteroids depending on the indication. 1, 4 For atopic dermatitis, combining dupilumab with medium-potency topical corticosteroids significantly improved outcomes in patients with inadequate response to cyclosporine, with 59-63% achieving EASI-75 at week 16 versus 30% with placebo plus topicals. 4
Dose Interval Adjustments
Do not extend dosing intervals beyond the approved regimen. 5 A randomized trial demonstrated that extending dupilumab dosing from every 2 weeks to every 4 or 8 weeks resulted in dose-dependent worsening of disease control, with only 58% and 55% maintaining EASI-75 response at every 4 and 8 weeks respectively, compared to 72% with the approved every 2 weeks regimen. 5
Long-term Treatment
The approved 300 mg every 2 weeks regimen maintains efficacy and safety for up to 3 years of continuous treatment. 6 In an open-label extension study of 2,677 patients, sustained improvements were maintained with mean EASI scores of 1.4 (95.4% improvement from baseline) at week 148, with no new safety signals emerging. 6
Administration Technique
- Route: Subcutaneous injection 1
- Sites: Rotate injection sites; avoid areas with active skin lesions when possible 1
- Self-administration: Patients or caregivers can administer after proper training 1
Common Pitfalls to Avoid
- Do not use weight-based dosing in adults - all adults receive the same 600 mg loading/300 mg maintenance regimen regardless of weight 1
- Do not skip the loading dose in adults - the 600 mg initial dose is essential for rapid therapeutic effect 1
- Do not confuse the 300 mg/2mL concentration with dosing frequency - the concentration refers to the amount per vial, not the dosing schedule 1
- Monitor for conjunctivitis - this is the most common adverse event and typically responds to conservative management with artificial tears 3, 4