How to Prescribe Interferon Beta-1a: Rebif®
James Bowen, MD
Medical Director, Multiple Sclerosis Center
Swedish Neuroscience Institute
Generic name: interferon beta-1a
How supplied: RebifÒ comes in prepackaged kits containing all needed supplies. It comes in prefilled syringes. Two doses are available: 22 mcg/syringe, and 44 mcg/syringe. There are 12 syringes per pack. A titration pack for use during the first month is available.
Initial dose: RebifÒ is administered subcutaneously three times each week. Initially, the dose should be tapered upwards. A titration pack is available for use during this first month titration.
Maintenance dose: 44mcg subcutaneously three times per week. 22mcg subcutaneously three times per week is an alternative dose used in some patients.
Antipyretics: Antipyretics should be prescribed for every patient starting RebifÒ. 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: Initial training for patients is provided by the manufacturer (EMD Serono and Pfizer) through visiting nurse services. This may be arranged by contacting MS Pathways at 1-877-447-3243. 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.
Most common side effects:
Company Support: MS Lifelines - 1-877-447-3243
Last Updated: November 2009