Nemluvio (generic name: nemolizumab-ilto) is a recently approved medication designed to treat prurigo nodularis, a chronic skin condition that results in raised, itchy bumps on the skin.

Nemluvio: Precautions, Dosage, Side Effects, Instructions

This condition can severely affect a person’s quality of life, and effective treatments have been limited until the introduction of Nemluvio. Approved by the U.S. Food and Drug Administration (FDA) in 2024, this interleukin-31 (IL-31) receptor antagonist offers a promising new option for those suffering from persistent and painful itching.

In this article, we will explore the essential details about Nemluvio, including its precautions, recommended dosages, potential side effects, and usage instructions.

What is Nemluvio?

Nemluvio is a biologic medication that works by blocking IL-31, a cytokine known to be a major driver of the intense itching and skin inflammation in conditions like prurigo nodularis. IL-31 acts on specific receptors in the skin and nervous system to initiate the itch response. By inhibiting this pathway, Nemluvio helps alleviate the discomfort caused by pruritus (itching) and inflammation, leading to improved skin health.

Dosage and Administration

Nemluvio is administered via subcutaneous injection. The dosage depends on the patient's weight:

For adults weighing less than 90 kg, the recommended initial dose is 60 mg (administered as two 30 mg injections). Following this, the maintenance dose is 30 mg every 4 weeks.

For adults weighing 90 kg or more, the initial dose is still 60 mg, but the maintenance dose increases to 60 mg every 4 weeks.

Important Administration Guidelines:

Prior to administration, Nemluvio must be reconstituted from its powder form into a clear solution.

Injection sites should alternate between the front upper thighs or abdomen (avoiding the 2-inch area around the navel).

If a dose is missed, it should be administered as soon as possible, but thereafter, resume the regular schedule.

Patients are typically trained by healthcare providers to self-administer Nemluvio after proper training on injection techniques.

Precautions and Warnings

Before starting treatment with Nemluvio, patients should be aware of several precautions:

1. Hypersensitivity Reactions: 

Some patients may experience allergic reactions, including facial angioedema (swelling of the face or throat). If any signs of a hypersensitivity reaction occur, such as swelling, difficulty breathing, or rashes, medical attention should be sought immediately, and the treatment should be discontinued.

2. Vaccination Status: 

Patients should complete all age-appropriate vaccinations as recommended by immunization guidelines prior to initiating Nemluvio treatment. Use of live vaccines should be avoided during treatment as Nemluvio may alter immune responses.

3. Pregnancy and Lactation: 

The safety of Nemluvio during pregnancy or breastfeeding has not been well established. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the potential risks and benefits of using Nemluvio with their healthcare provider.

Side Effects

As with any medication, Nemluvio may cause side effects. While many of these are mild, it is important to be aware of potential adverse reactions:

Common Side Effects:

Headache

Atopic dermatitis (a form of eczema)

Eczema nummular (a specific type of eczema)

These side effects occur in a small percentage of patients and are typically temporary.

Serious Side Effects:

1. Hypersensitivity:

 As mentioned, allergic reactions such as swelling or difficulty breathing can be serious. If these symptoms occur, immediate medical attention is necessary.

2. Infection Risks: 

Like many biologic medications, Nemluvio can affect the immune system, increasing the risk of infections. Patients should inform their doctor if they have a history of frequent infections.

Instructions for Use

Nemluvio comes in a prefilled dual-chamber pen that contains both the lyophilized powder and the diluent (water for injection). The medication must be reconstituted before use. After reconstitution, the solution should be clear, colorless, or slightly yellow.

Do not use if the solution is discolored or contains visible particles.

Use the reconstituted solution within 4 hours. Any remaining solution should be discarded.

Patients should carefully follow all administration instructions provided with the medication, including those for site rotation and proper injection technique.

Nemluvio represents a significant advancement in the treatment of prurigo nodularis, providing relief from chronic itching and inflammation. By blocking IL-31, this medication targets the root cause of the condition rather than just treating its symptoms. However, it is essential for patients to follow the prescribed dosage and administration instructions and be aware of potential side effects and precautions. As with any medication, Nemluvio should be used under the guidance of a healthcare provider to ensure safe and effective treatment.