Dupixent
Dupixent (dupilumab) is a injectable biologic medication that's used to treat certain inflammatory conditions, such as eczema, asthma, or swollen esophagus (eosinophilic esophagitis or EoE). Dupixent (dupilumab) is available as both a pre-filled pen and syringe. It's typically injected under the skin of the belly or thighs (or in the back of the upper arm, if injected by a caregiver). Most people will inject this medication every other week or monthly, depending on their medical condition. Common side effects of Dupixent (dupilumab) include injection site reactions and eye inflammation.
What is Dupixent (dupilumab)?
What is Dupixent (dupilumab) used for?
Moderate-to-severe eczema that isn't well-controlled by other topical medications - adults and children 6 months and older
Add-on treatment for moderate-to-severe asthma - adults and children 6 years and older
Long-term sinus congestion with nasal polyps - adults only
Swollen esophagus (eosinophilic esophagitis) - adults and children 1 year and older
Long-term itchy skin bumps (prurigo nodularis) - adults
How Dupixent (dupilumab) works
Dupixent (dupilumab) is a monoclonal antibody. It blocks proteins in your body that are responsible for inflammation (redness and swelling) in different parts of the body. By blocking these proteins, Dupixent (dupilumab) calms down the immune system. As a result, it can help ease symptoms of certain immune conditions, such as wheezing, cough, itchy skin, congestion, and skin redness.
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What are the side effects of Dupixent (dupilumab)?
Common Side Effects
- Injection site reaction (pain, swelling, bruising; 10%)
- Eye redness (10%)
- Cold sores (4%)
Other Side Effects
- Eyelid inflammation
- Corneal inflammation
- Itchy eye
- Dry eye
- Viral infections (e.g., genital herpes)
- Sore throat
- Joint pain
- Muscle pain
- Upper respiratory tract infections (e.g., trouble breathing, cough, fever)
- Dizziness
Serious Side Effects
- Serious allergic reactions: trouble breathing; rash; fever; swelling in your face, lips, or tongue; fast heartbeat, nausea, vomiting
Source: DailyMed
More on Dupixent (dupilumab) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Eye pain, redness, irritation, or discharge with blurry or decreased vision
- Unusual weakness or fatigue, fever, headache, skin rash, muscle or joint pain, loss of appetite, pain, tingling, or numbness in the hands or feet
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Cold sores
- Dry eyes
- Joint pain
- Pain, redness, or irritation at injection site
- Sore throat
- Trouble sleeping
Pros and cons of Dupixent (dupilumab)
Pros
Dosing for most conditions is every other week or monthly
Works well to treat many different inflammatory conditions, including asthma and eczema
Approved for children as young as 6 months old (for eczema only)
Available as pre-filled pens and syringes
Cons
Unknown if safe or works well in people who're pregnant or breastfeeding
Not safe for use in asthma attacks
Likely to cause injection reactions, such as pain, bruising, and swelling
No generic medication available
Pharmacist tips for Dupixent (dupilumab)
Don't give yourself or your child Dupixent (dupilumab) injections until you understand how to prepare and inject a dose. Dupixent (dupilumab) is available in a pre-filled syringe and pen. Your provider or pharmacist will show you how to do your first injection.
Double check your dose of Dupixent (dupilumab), particularly your first dose. For many people, the first dose will higher than the following doses. This means that you might have to inject 2 pens at different injection sites for your first dose.
Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start Dupixent (dupilumab). If you're taking corticosteroids (oral, topical, or inhaled) or other asthma medications, continue to take them according to your provider's treatment plan. Suddenly stopping or changing how you take these medications can cause serious steroid withdrawal symptoms or an asthma attack.
It's not clear whether Dupixent (dupilumab) is safe for people who're pregnant. If you become pregnant while receiving Dupixent (dupilumab), you’re encouraged to enroll in the Pregnancy Exposure Registry. This registry monitors and collects information about your and your baby’s health. Learn more about this registry by calling 1-877-311-8972.
Consider getting all your scheduled vaccines before starting treatment with Dupixent (dupilumab). Avoid live vaccines, such as the nasal spray flu vaccine, while you're using this medication. It's not known how Dupixent (dupilumab) impacts how well live vaccines work or their safety. If you're due for a vaccine or you're not sure which vaccines are safe for you, talk with your provider or pharmacist. They can let you know which ones are safe and help schedule them.
Throw away your used syringes and pens in a sharps disposal container after each use. Check out the FDA page for more information about disposing your sharps.
Store Dupixent (dupilumab) in the refrigerator in its original container, away from light. When it's time for your dose, take the medication out of the refrigerator and let it come to room temperature (30 to 45 minutes) before you inject it. If you accidentally left Dupixent (dupilumab) out of the refrigerator, you must use the medication within 14 days.
How to use Dupixent (dupilumab) syringes: 1) Wash your hands with soap and water before injection. 2) Pull the needle cap off the syringe, and inject the medication under the skin at a 45-degree angle. 3) Push the plunger down slowly until the syringe is emptied. You might experience some resistance. 4) Lift your thumb to release the plunger. The needle will retract into the needle shield. 5) Throw away the syringe (along with the used needle) and the needle cap in a sharps disposal container.
How to use Dupixent (dupilumab) pens: 1) Wash your hands with soap and water before injection. 2) Pull off the cap, place the needle cover of the pen straight against your or your child's skin, and press down. 3) Make sure to hold the pen at a 90-degree angle to get the whole injection. 4) When the injection starts, you'll hear a click and the window on the pen will start to turn yellow. 5) When the window turns completely yellow, you'll hear another click. Count 5 seconds while continuing to press the pen against your or your child's skin. 6) Pull the pen straight up after 5 seconds and throw it away in a sharps disposal container.
It's very important to receive Dupixent (dupilumab) regularly according to your provider's treatment plan. If you inject Dupixent (dupilumab) weekly and missed your dose, inject your missed dose immediately and start a new weekly schedule based on the timing of the last injection.
If you inject Dupixent (dupilumab) every other week or monthly and it's within 7 days of the usual time you receive it, inject your missed dose immediately. But if you missed the dose by more than 7 days, you need to either 1) Wait until your next scheduled dose (for every other week dosing); OR 2) Inject your missed dose immediately and start a new monthly schedule based on the timing of the last injection (for monthly dosing).
Frequently asked questions about Dupixent (dupilumab)
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What are the risks and warnings for Dupixent (dupilumab)?
Dupixent (dupilumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious allergic reactions
People who received Dupixent (dupilumab) have sometimes experienced life-threatening allergic reactions. Watch out for signs and symptoms of allergic reactions, such as rash, trouble breathing, swelling in your face, itching, redness, dizziness, and joint pain. Get medical attention right away if an allergic reaction occurs.
Eye inflammation
Risk factors: Receiving Dupixent (dupilumab) for eczema, long-term sinus congestion with nasal polyps, or long-term itchy skin bumps
People who receive Dupixent (dupilumab) can sometimes experience eye inflammation. If you have blurry vision, pink eye, itchy eye, more tearing from the eye, eye pain, or sensitivity to light, let your provider know. Your provider can prescribe you medications to help with your eye inflammation. In some cases, you might need to get an eye exam so your provider can make sure your cornea isn't also inflamed.
Inflammation of blood vessels
Risk factors: Asthma | Suddenly stopping or lowering the dose of oral steroid
Dupixent (dupilumab) can cause your white blood cell counts to rise, specifically eosinophils. Eosinophils are a part of your immune system and help your body fight off infections. But when your body makes too much of them, they can build up in your lungs, blood vessels, and other organs, which can cause dangerous health problems, such as inflammation of your blood vessels. The risk is higher if you're using Dupixent (dupilumab) to treat asthma or if you've recently stopped taking oral steroid therapy. Let your provider know if you experience rash, chest pain, worsening shortness of breath, a feeling of pins and needles, numbness of your arms or legs, or fever.
It's very important that you continue taking your steroid therapy according to your provider's treatment plan even if you're using Dupixent (dupilumab). Missing doses or stopping corticosteroids suddenly can cause withdrawal symptoms that can be dangerous.
Risk of worsening of asthma
Risk factor: Using Dupixent (dupilumab) during asthma attacks or severe episodes of asthma
Dupixent (dupilumab) shouldn't be used to treat asthma attacks or any severe episodes of asthma. You should only use a rescue inhaler, such as albuterol (ProAir), to treat asthma attacks. If your rescue inhaler isn't working well to control your symptoms of wheezing or shortness of breath, get medical attention right away. You might need additional medications, such as steroid pills to help with your symptoms.
Joint pain
People who use Dupixent (dupilumab) have experienced severe joint pain. This can happen anytime from a day to many months after starting the medication. For some people, the pain goes away as they continue to use the medication or after they stop treatment. If you experience any discomfort in your joints, speak to your provider right away.
Serious parasitic infections
Risk factor: Active, chronic (long-term), or recurrent infection
Dupixent (dupilumab) might lower your ability to fight infections. Serious infections, such as pinworm or roundworm infections, have happened in children receiving this medication. Don't use Dupixent (dupilumab) if you or your child has an infection or has infections that keep coming back since this medication can make these infections worse. Please let your provider know right away if you or your child has signs or symptoms of an infection, such as fever, restlessness, abnormal weight loss, or itching.
Interaction with vaccines
Risk factors: Receiving live vaccines
The effect Dupixent (dupilumab) has on vaccines isn't completely known, but it’s possible that it can interact with any vaccine you get. This is because similar medications that affect the immune system can make vaccines not work as well. These medications can also raise the risk of infections after receiving live vaccines. While using Dupixent (dupilumab), avoid getting any live vaccines, such as MMR (measles, mumps, and rubella vaccine). Before you or your child starts using Dupixent (dupilumab), talk with a provider or pharmacist about your or your child's vaccine history. Your provider can make sure all vaccines are up to date.
Dupixent (dupilumab) dosage forms
Typical dosing for Dupixent (dupilumab)
Dupixent (dupilumab) is available as a pre-filled pen (for people ages 2 years and older) and syringe (for people ages 6 months and older).
Adults and children ages 6 years or older (weighing 60 kg or more): The starting dose is 600 mg injected under the skin once. After that, the typical maintenance dose is 300 mg injected every other week.
Children ages 6 to 17 years old (weighing 30 kg to 59 kg): The starting dose is 400 mg injected under the skin once. After that, the typical maintenance dose is 200 mg injected every other week.
Children ages 6 to 17 years old (weighing 15 kg to 29 kg): The starting dose is 600 mg injected under the skin once. After that, the typical maintenance dose is 300 mg injected every 4 weeks.
Children ages 6 months to 5 years old: The typical dose ranges from 200 mg to 300 mg, depending on body weight, injected under the skin every 4 weeks.
Your provider will determine your dose of Dupixent (dupilumab) depending on what other medications you're taking and what other health conditions you have.
Adults and children age 12 years and older: The starting dose ranges from 400 mg to 600 mg injected under the skin once. After that, the typical maintenance dose ranges from 200 mg to 300 mg injected every other week.
Children ages 6 to 11 years old (weighing 30 kg or more): The typical dose is 200 mg injected under the skin every other week.
Children ages 6 to 11 years old (weighing 15 kg to 29 kg): The typical dose is 100 mg injected under the skin every other week or 300 mg injected every 4 weeks.
Sinus congestion with nasal polyps
Adults: The typical dose is 300 mg injected under the skin every other week.
Swollen esophagus (eosinophilic esophagitis)
Adults and children weighing at least 40 kg: The typical dose is 300 mg under the skin every week.
Adults and children weighing 30 kg to 40 kg: The typical dose is 300 mg under the skin every other week.
Children age 1 year and older weighing 15 kg to 30 kg: The typical dose is 200 mg under the skin every other week.
Itchy skin bumps (prurigo nodularis)
Adults: The starting dose is 600 mg injected under the skin once. After that, the typical maintenance dose is 300 mg injected every other week.
More on Dupixent (dupilumab) dosage forms
How much does Dupixent (dupilumab) cost?
What are alternatives to Dupixent (dupilumab)?
Moderate-to-severe eczema that isn't well-controlled by other topical medications - adults and children 6 months and older
Add-on treatment for moderate-to-severe asthma - adults and children 6 years and older
Long-term sinus congestion with nasal polyps - adults only
Swollen esophagus (eosinophilic esophagitis) - adults and children 1 year and older
Long-term itchy skin bumps (prurigo nodularis) - adults
Add-on treatment for severe eosinophilic asthma in people 6 years and older
Moderate-to-severe atopic dermatitis (eczema) in people age 12 years and older who didn't respond to other treatments
What is the latest news about Dupixent (dupilumab)?
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References
Best studies we foundAmerican Academy of Dermatology Association. (2021). Prurigo nodularis: Overview.
American College of Allergy, Asthma, & Immunology. (2021). Chronic rhinosinusitis with nasal polyps.
American College of Allergy, Asthma, & Immunology. (2023). Eosinophilic esophagitis.
Castro, M., et al. (2018). Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. The New England Journal of Medicine.
Harb, H., et al. (2020). Mechanisms of dupilumab. Clinical and Experimental Allergy.
MotherToBaby. (n.d.). Dupixent® (dupilumab).
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of adrenal insufficiency & Addison's disease.
Roussel, J. M., et al. (2023). Eosinophilic esophagitis. StatPearls.
Sanofi and Regeneron Pharmaceuticals, Inc. (2023). Dupixent dosing for asthma.
Sanofi and Regeneron Pharmaceuticals, Inc. (2023). Dupixent dosing for nasal polyps.
Sanofi and Regeneron Pharmaceuticals, Inc. (2023). How to inject Dupixent with a pre-filled pen.
Sanofi and Regeneron Pharmaceuticals, Inc. (2023). How to inject Dupixent with a pre-filled syringe.
Sanofi and Regeneron Pharmaceuticals, Inc. (2023). Injection support center.
Sanofi and Regeneron Pharmaceuticals, Inc. (2024). Dupixent dosing for eczema.
Sanofi and Regeneron Pharmaceuticals, Inc. (2024). Dupixent dosing for EoE.
Sanofi and Regeneron Pharmaceuticals, Inc. (2024). Dupixent dosing for prurigo nodularis.
sanofi-aventis U.S. LLC. (2024). Dupixent® (dupilumab) injection, for subcutaneous use [package insert]. DailyMed.
Simpson, E.L., et al. (2016). Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. The New England Journal of Medicine.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
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