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Lemtrada

alemtuzumab
Used for Multiple Sclerosis
Used for Multiple Sclerosis

Lemtrada (alemtuzumab) is an anti-CD52 monoclonal antibody. It's used to treat relapsing forms of multiple sclerosis (MS) in adults, but only when other MS medications haven't worked well. Lemtrada (alemtuzumab) is given as an infusion through the veins once per year by a healthcare provider. Since this medication has many risks and side effects, it's only available through a Risk Evaluation and Mitigation Strategy (REMS) program) called the Lemtrada REMS program. Some common side effects of Lemtrada (alemtuzumab) include rash, headache, and fever.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Kristianne Hannemann, PharmD
Last reviewed on November 26, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Lemtrada (alemtuzumab)?

What is Lemtrada (alemtuzumab) used for?

How Lemtrada (alemtuzumab) works

People with multiple sclerosis (MS) have an immune system that attacks their own nervous system, such as the brain and spinal cord.

Lemtrada (alemtuzumab) is a CD52 monoclonal antibody. The exact way it treats MS isn't well-understood. But it's thought to dampen the immune system by attaching to a protein called CD52 found on certain immune cells. This temporarily lowers the amount of immune cells in the body, which can lessen inflammation and bring relief of MS symptoms.

Are you looking for information on Campath (alemtuzumab) for leukemia instead?

Drug Facts

Common BrandsLemtrada
Drug ClassAnti-CD52 monoclonal antibody
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Lemtrada (alemtuzumab)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Other Side Effects

  • Itching
  • Thyroid problems
  • Fungal infection
  • Joint pain
  • Pain in arms and legs
  • Back pain
  • Diarrhea
  • Sinus inflammation
  • Mouth and throat pain
  • "Pins and needles" feeling
  • Dizziness
  • Stomach pain
  • Flushing
  • Vomiting

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Autoimmune problems: see the risks and warnings section for more specific autoimmune problems and their associated signs and symptoms
  • Serious allergic and infusion reactions: low or high blood pressure, chest pain, low or high heart rate, headache, fever, rash, nausea, hives, difficulty sleeping, chills, flushing, fatigue, shortness of breath, dizziness
  • Stroke: sudden trouble speaking, droopy face, sudden confusion, numbness or weakness in the face, arm, or leg
  • Cancers: new lumps or swelling in your neck, pain in the front of the neck, changes in your voice, trouble swallowing or breathing, constant cough not due to an infection, changes in your skin
  • Inflammatory problems: see the risks and warnings section for more specific inflammatory problems and their associated signs and symptoms
  • Serious infections: fever, difficulty breathing, diarrhea, weakness, cough, stomach pain, sweating, chills, burning when you urinate, urinating more often

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

blood in the urine

chills

cough

diarrhea

dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position

fast heartbeat

fever

headache

itching, hives, skin rash

nausea

painful or difficult urination

pale skin

sore throat

sores, ulcers, or white spots on the lips or in the mouth

sweating

swollen glands

tightness in the chest

trouble breathing

unusual bleeding or bruising

unusual tiredness or weakness

vomiting

Less common

Bloating or swelling of the face, hands, lower legs, or feet

chest pain

hoarseness

lower back or side pain

muscle weakness

painful cold sores or blisters on the lips, nose, eyes, or genitals

pounding or irregular heartbeat or pulse

rapid weight gain

red or purple spots on the skin, varying in size and remaining after pushing the skin surface

tremor

unexplained nosebleeds

Rare

Bloody nose

flushing of the face or neck

swelling of the eyelids, face, or lips

white patches on the tongue, in the mouth, or in the folds of the skin, including the genitals

Incidence not known

Anxiety

back pain

blindness

blurred or double vision

chest pain or discomfort

confusion

dark urine

decreased urine output

decreased vision

difficulty in speaking

dilated neck veins

discouragement

double vision

drowsiness

extreme tiredness or weakness

eye pain

feeling of discomfort

feeling sad or empty

general feeling of tiredness and weakness

inability to move the arms, legs, or facial muscles

inability to speak

irregular breathing

irritability

joint pain, stiffness, or swelling

lack of appetite

light-colored stools

loss of interest or pleasure

muscle aches or pain

nightmares or unusually vivid dreams

numbness, pain, tingling, or weakness

pain or discomfort in the arms, jaw, back, or neck

painful or tender lymph glands in the neck, armpit, or groin

seizures

shakiness and unsteady walk

slow speech

spitting or coughing up blood

sudden numbness and weakness in the arms and legs

swelling of the face, fingers, feet, or lower legs

trouble concentrating

trouble sleeping

unsteadiness, trembling, or other problems with muscle control or coordination

upper right abdominal or stomach pain and fullness

yellow eyes and skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Fear or nervousness

Less common

Belching

bone pain

burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

heartburn

indigestion

lack or loss of strength

stomach discomfort, upset, or pain

swelling or inflammation of the mouth

weight loss

Rare

Constipation

sensation of temperature change

sleepiness

stuffy nose

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Lemtrada (alemtuzumab)

thumbs-up

Pros

Works well to treat relapsing forms of MS

Treatment courses are short and are only once per year

Not many known interactions with other medications

thumbs-down

Cons

A lot of potential risks and side effects, including serious allergic reaction, blood problems, and liver problems

Each treatment will take a least 6 hours at the clinic because of pre-treatment, infusion time, and monitoring time

Needs to be given as an IV injection by a healthcare professional

pharmacist-tips

Pharmacist tips for Lemtrada (alemtuzumab)

pharmacist

  • Before starting Lemtrada (alemtuzumab), check with your provider to see if you're up to date on your vaccines. You'll need to complete your vaccines at least 6 weeks before getting Lemtrada (alemtuzumab). If needed, your provider will postpone your Lemtrada (alemtuzumab) infusions.

    • On the day of treatment, your provider will give you IV corticosteroids right before Lemtrada (alemtuzumab) to help prevent infusion-related reactions. Please arrive early appointment so that you can receive the pre-treatment medications you need.

      • Each Lemtrada (alemtuzumab) infusion can take about 4 hours. You'll be monitored for at least 2 hours at the clinic after each infusion. Make sure to pack the things you need to help you stay hydrated and be more comfortable during the long stay.

        • Lemtrada (alemtuzumab) can raise your risk for stroke, especially within 1 to 3 days after the infusion. Call 911 if you get sudden neck or face pain, trouble speaking, droopy face, sudden confusion, or numbness or weakness in the face, arm, or leg.

          • Taking Lemtrada (alemtuzumab) can raise your risk for infections such as herpes. To prevent an infection, you'll need to take an antiviral medication starting the first day of each treatment course. You'll need to continue taking it for at least 2 months after Lemtrada (alemtuzumab) or until your provider says it's safe to stop taking it.

            • Lemtrada (alemtuzumab) can put you at risk for Listeria (a bacteria that grows in raw, undercooked, or unpasteurized foods) infection. You can protect yourself by avoiding foods like soft cheeses, raw foods, and cold cut lunch meats. Get medical help right away if your experience symptoms of Listeria such as fever, chills, diarrhea, and nausea.

              • Make sure to tell your provider about all the medications you're taking before starting Lemtrada (alemtuzumab), especially if you're taking medications that weaken your immune system. Don't start any new medications without talking to your provider first.

                • Lemtrada (alemtuzumab) can cause problems during pregnancy, including harm to unborn babies. If you're a female who's able to become pregnant, you should use birth control during the Lemtrada (alemtuzumab) treatment course and for 4 months after the treatment course is complete.

                  • Your provider will continue to monitor your health for 4 years after your last Lemtrada (alemtuzumab) infusion. You'll likely need monthly blood and urine tests, as well as yearly skin exams. These tests are to check for possible side effects Lemtrada (alemtuzumab), including kidney problems and risk of cancer. Talk with your provider if you're not sure where to go for your check ups.

                    faqs

                    Frequently asked questions about Lemtrada (alemtuzumab)

                    How well does Lemtrada (alemtuzumab) work?
                    In a 2-year clinical study, 65% of people who took Lemtrada (alemtuzumab) had no MS relapses. This is compared to about 50% of people who took Rebif (interferon beta-1a) (another MS medication). Talk with your provider if you have more questions about how well Lemtrada (alemtuzumab) works.
                    How is Lemtrada (alemtuzumab) administered?
                    Lemtrada (alemtuzumab) is given as an infusion into the veins (IV). The typical length of the infusion is 4 hours. But, your provider might slow the infusion if you get any infusion-related reactions.
                    How long does Lemtrada (alemtuzumab) stay in your system?
                    It takes over 2 months for most of Lemtrada (alemtuzumab) to leave your body after a single dose. This time frame is estimated based on the half-life of Lemtrada (alemtuzumab). If you're able to become pregnant, you still need to use effective birth control for 4 months after your last dose of Lemtrada (alemtuzumab) as a precaution. If you have more questions about how long Lemtrada (alemtuzumab) stays in your body, talk with your provider.
                    Is Lemtrada (alemtuzumab) chemotherapy?
                    No, Lemtrada (alemtuzumab) isn't a chemotherapy. Chemotherapy is a type of treatment that kills all fast-growing cells and is typically used to treat cancer. Instead, Lemtrada (alemtuzumab) is a monoclonal antibody that treats MS by specifically targeting immune cells. Please note that alemtuzumab goes by another brand name (Campath) that's FDA-approved to treat a certain type of blood cancer. Like Lemtrada, Campath is a monoclonal antibody.
                    Can Lemtrada (alemtuzumab) cure MS?
                    No, Lemtrada (alemtuzumab) doesn't cure MS; it only treats the symptoms of MS. Currently, there isn't a cure for MS available on the market.
                    What is the difference between Ocrevus (ocrelizumab) and Lemtrada (alemtuzumab)?
                    Both Ocrevus (ocrelizumab) and Lemtrada (alemtuzumab) are monoclonal antibodies that treat MS. One major difference is Ocrevus (ocrelizumab) can be used to treat all forms of MS, whereas Lemtrada (alemtuzumab) is only used to treat relapsing forms of MS (e.g., relapsing-remitting MS, secondary progressive MS). Secondly, Lemtrada (alemtuzumab) tends to have more side effects than Ocrevus (ocrelizumab), so it's typically used in people who don't respond well to at least two other MS medications. Thirdly, rounds of Lemtrada (alemtuzumab) infusions are given a year apart. But Ocrevus (ocrelizumab) is generally given every 6 months.
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                    warings-icon

                    What are the risks and warnings for Lemtrada (alemtuzumab)?

                    Lemtrada (alemtuzumab) 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.

                    risk-warning

                    Lemtrada REMS program

                    Lemtrada (alemtuzumab) is linked to many serious side effects, including autoimmune problems, infusion reactions, stroke, and cancers. Because of these risks, it's only available through a restricted Risk Evaluation and Mitigation Strategy (REMS) program called the Lemtrada REMS program. All providers who prescribe Lemtrada (alemtuzumab), pharmacies that dispense the medication, and people who need to use the injection must be registered with the REMS program. This program helps to make sure you and your providers are all aware of the risks with Lemtrada (alemtuzumab), and that you're familiar with the symptoms of serious health problems and know when it's time to get medical help.

                    risk-warning

                    Autoimmune problems

                    Lemtrada (alemtuzumab) can cause your body to make antibodies. These antibodies can attack different parts of your body, which can cause serious and life-threatening problems. As a precaution, your provider will regularly monitor your labs and organ health during and for 4 years or longer after your last dose of Lemtrada (alemtuzumab).

                    Some specific examples of autoimmune problems seen in people taking Lemtrada (alemtuzumab) include:

                    • Blood problems: Lemtrada (alemtuzumab) can lower your blood cell counts and raise your risk for bleeds and infections. Symptoms of blood problems include small, flat red spots under your skin, blood in urine or stool, easy bleeding or bruising, feeling tired, headache, pale skin, fast heart rate, and shortness of breath.

                      • Kidney problems: Lemtrada (alemtuzumab) can cause kidney problems. Symptoms include swelling, changes in urine color, urinating less, trouble breathing, coughing up blood, nausea, vomiting, and weakness.

                        • Thyroid problems: Lemtrada (alemtuzumab) can cause either too much or too little thyroid hormone, and other thyroid problems. Symptoms include changes in eating habits, changes in ability to tolerate cold or heat, and changes in weight.

                          • Liver problems: Lemtrada (alemtuzumab) can cause liver problems. Symptoms include nausea, vomiting, stomach pain, low appetite, dark urine, and yellowing of the skin or whites of the eyes.

                            Contact your provider immediately if you notice any of these symptoms.

                            risk-warning

                            Severe allergy and infusion reactions

                            It's possible for you to get severe allergic and infusion reactions with Lemtrada (alemtuzumab). These reactions typically happen within 3 days of your infusion. To lower your risk for these reactions, your provider will have you take corticosteroids for the first 3 days of each treatment course. Your provider will also monitor you for at least 2 hours after the Lemtrada (alemtuzumab) infusion to make sure you're not experiencing any symptoms. If you do experience symptoms of an allergic or infusion-related reaction such as swelling in the mouth or throat, trouble breathing, weakness, rash, or chest pain, get medical help right away.

                            risk-warning

                            Stroke

                            Lemtrada (alemtuzumab) can raise your risk of getting a stroke. This is most likely to happen within 3 days of receiving Lemtrada (alemtuzumab). Call 911 if you experience symptoms of stroke, such as sudden neck or face pain, trouble speaking, droopy face, sudden confusion, or numbness or weakness in the face, arm, or leg.

                            risk-warning

                            Risk of cancers

                            • Risk factors: History of cancer

                              Lemtrada (alemtuzumab) can raise your risk of certain cancers, such as thyroid cancer and skin cancer. Contact your provider if you notice signs of thyroid cancer, such as any new lumps or swelling in your neck, pain in the front of the neck, changes in your voice, trouble swallowing or breathing, constant cough not due to an infection, or changes in your skin.

                              Make sure you also schedule yearly screenings for skin cancer and let your provider know if you notice changes to your skin.

                              risk-warning

                              Inflammatory problems

                              Lemtrada (alemtuzumab) can cause several types of inflammatory problems. Specific examples of inflammatory problems seen in people taking Lemtrada (alemtuzumab) include:

                              • Overactive immune system: Lemtrada (alemtuzumab) can cause your immune system to become overly active. This is rare, but potentially deadly and side effects can appear 1 to 3 years after treatment. Get medical help right away if you notice symptoms including fever, swollen lymph nodes, changes in your mood or ability to think, seizures, and difficulty maintaining balance.

                                • Inflammation of the entire body: Lemtrada (alemtuzumab) can cause your whole body to become inflamed. Let your provider know if you experience symptoms such as joint pain, muscle pain, rash, high fever, and sore throat.

                                  • Inflammation of the gallbladder: Lemtrada (alemtuzumab) can cause inflammation in your gallbladder. Tell your provider if you feel stomach pain, have a fever, and experience nausea or vomiting.

                                    • Inflammation of the lungs: Lemtrada (alemtuzumab) can cause your lungs to become inflamed. Get medical attention if you experience shortness of breath, cough, wheezing, chest pain or tightness, or start to vomit blood.

                                      Contact your provider right away if you notice any of these symptoms.

                                      risk-warning

                                      Serious infections

                                      • Risk factors: Active, chronic, or recurrent infection | Having other conditions that raise your risk of infection | Living in or traveling to places with high rates of TB infections | Taking medications that weaken your immune system

                                        Lemtrada (alemtuzumab) can affect your body's ability to fight off infections, which can raise your risk of serious bacterial (e.g., Listeria, tuberculosis (TB)), viral (e.g., herpes, hepatitis, human papilloma virus (HPV)), or fungal infections. Your provider will routinely monitor you for infections before and during treatment with Lemtrada (alemtuzumab) and might give you antimicrobial medications to prevent or treat the infection(s).

                                        To lower your risk for Listeria (a bacteria that grows in raw, undercooked, or unpasteurized foods) infection, make sure to review which types of foods can potentially have Listeria. If you get an infection, you might have to stop taking Lemtrada (alemtuzumab) so your body can fight it off. Get medical help right away if you have fever, cough, difficulty breathing, diarrhea, weakness, sweating, or chills while taking Lemtrada (alemtuzumab).

                                        dosage

                                        Lemtrada (alemtuzumab) dosage forms

                                        Typical dosing for Lemtrada (alemtuzumab)

                                        A full treatment with Lemtrada (alemtuzumab) includes 2 treatment courses, given a year apart.

                                        • First treatment course: The typical dose is 12 mg infused into the veins (IV) once daily for 5 days by a healthcare provider.

                                        • Second treatment course: The second treatment course is given 1 year after the first treatment course. The typical dose is 12 mg infused IV once daily for 3 days by a healthcare provider.

                                        If needed, your provider might have you continue with additional treatment courses of Lemtrada (alemtuzumab). Each additional course can be given 1 year after your last course. The typical dose is 12 mg infused IV once daily for 3 days.

                                        interactions

                                        Interactions between Lemtrada (alemtuzumab) and other drugs

                                        Lemtrada (alemtuzumab) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Lemtrada (alemtuzumab). Please note that only the generic name of each medication is listed below.

                                        Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                                        Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                                        Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                                        contraindications-icon

                                        Lemtrada (alemtuzumab) contraindications

                                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Lemtrada (alemtuzumab) will not be safe for you to take.
                                        alternatives

                                        What are alternatives to Lemtrada (alemtuzumab)?

                                        There are a number of medications that your doctor can prescribe in place of Lemtrada (alemtuzumab). Compare a few possible alternatives below.
                                        Lemtrada (alemtuzumab)
                                        Used for:
                                        View Prices
                                        Ocrevus (ocrelizumab)
                                        Used for:

                                        • All types of multiple sclerosis (MS)

                                        View Prices
                                        Tysabri (natalizumab)
                                        Used for:
                                        View Prices

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                                        References

                                        Best studies we found

                                        American Cancer Society. (2019). What is thyroid cancer?

                                        Centers for Disease Control and Prevention. (n.d.). Fungal diseases.

                                        Centers for Disease Control and Prevention. (2023). Prevent Listeria.

                                        View All References (10)

                                        Coles, A. J., et al. (2012). Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: A randomised controlled phase 3 trial. Lancet.

                                        Genzyme Corporation. (n.d.). During treatment.

                                        Genzyme Corporation. (2022). Your guide to treatment: Step-by-step.

                                        Genzyme Corporation. (2023). Campath- alemtuzumab injection [package insert]. DailyMed.

                                        Genzyme Corporation. (2023). Lemtrada- alemtuzumab injection, solution, concentrate [package insert]. DailyMed.

                                        Janssen, B., et al. (2021). What is hypersensitivity pneumonitis? American Journal of Respiratory and Critical Care Medicine.

                                        Jones, M. W., et al. (2023). Acalculous cholecystitis. StatPearls.

                                        National Organization for Rare Disorders. (2018). Hemophagocytic lymphohistiocytosis.

                                        National Organization for Rare Disorders. (2021). Adult-onset Still’s disease.

                                        Whitley, R. J., et al. (1996). Chapter 68: Herpesviruses. Medical Microbiology, 4th edition.

                                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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