How to Prescribe MS Interferon Beta-1b: Extavia®
James Bowen, MD
Medical Director, Multiple Sclerosis Center
Swedish Neuroscience Institute
Generic name: interferon beta-1b
How supplied: ExtaviaÒ comes in prepackaged kits containing all needed supplies. It comes in single dose vials with 0.3mg of lyophilized powder each. There are 15 vials per pack.
Initial dose: ExtaviaÒ should be started at 1/4 dose and tapered upwards as tolerated. Most patients tolerate an increase of ¼ dose every two weeks. These doses are obtained by drawing up only a partial dose into the injection syringe. The time of day does not matter, though most patients find that the flu-like side effects are better tolerated if the medication is given at bedtime.
Maintenance dose: 0.25mg subcutaneously every other day.
Antipyretics: Antipyretics should be prescribed for every patient starting ExtaviaÒ. Flu-like side effects usually begin about an hour after the injection, so the antipyretics can be administered at the time of the injection. Typical medications include: acetaminophen 650mg qid, aspirin 650mg qid, ibuprofen 600mg tid, or naproxen 250mg bid. In cases with refractory flu-like side effects, acetaminophen can be combined with either aspirin, ibuprofen, or naproxen. Flu-like side effects may also be decreased with pentoxifylline 400mg tid, or with prednisone 20mg po given with each injection. Antipyretics may be needed only at the time of the injection or they may also be needed the following day. Over time, antipyretics may be tapered or discontinued as tolerated.
Sharps container: Sharps containers for needle disposal should be prescribed.
Autoinjector: Autoinjectors are available through the pharmacy.
Initial training: Patients access to a support program including a nurse helpline, one-on-one injection training and reimbursement support services provided by the manufacturer (Novartis Pharmaceuticals Corporation). This may be arranged by contacting Extavia Patient Services at 1-866-925-2333. Larger centers may perform their own training.
Laboratory testing: Basic chemistry panels, transaminases, and CBCs should be monitored. These should be checked before initiating treatment, and at 1, 3, and 6 months after starting treatment. After 6 months they should be checked periodically. Thyroid function tests are recommended every 6 months for those with thyroid dysfunction.
Company Support: Extavia Patient Services - 1-866-925-2333
Last Updated: November 2009