Nucala
Nucala (mepolizumab) is an injection medication used to treat severe asthma that's not controlled by other medications. It can also help with other inflammatory (swelling) conditions. Side effects of Nucala (mepolizumab) include headache, injection-site reactions, and throat, back, or joint pain. You can get the injection at your provider's office. But with training, you can give yourself the injection at home. Nucala (mepolizumab) is available as a prefilled autoinjector and prefilled syringe for easier administration.
What is Nucala (mepolizumab)?
What is Nucala (mepolizumab) used for?
Add-on maintenance treatment for severe asthma
Add-on maintenance treatment for chronic rhinosinusitis with nasal polyps
Eosinophilic granulomatosis with polyangiitis (EGPA; swelling of the blood vessels)
Hypereosinophilic syndrome (HES; high eosinophils in the blood)
How Nucala (mepolizumab) works
Nucala (mepolizumab) is an interleukin antagonist. It blocks interleukin-5 (IL-5), which is a protein that normally makes immune cells called eosinophils. High levels of eosinophils in the body cause inflammation. And, inflammation plays a role in asthma and certain other conditions. By blocking IL-5, Nucala (mepolizumab) lowers eosinophil levels in the body. This is thought to lower inflammation to help with symptoms, such as pain, swelling, or difficulty breathing (for people with asthma).
Drug Facts
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What are the side effects of Nucala (mepolizumab)?
Common Side Effects
- Headache (19%)
- Injection-site reactions (pain, redness, swelling, itching, burning; 8%)
- Back pain (5%)
- Fatigue (5%)
- Throat pain (8%)
- Joint pain (6%)
- Injection-site reactions (pain, redness, swelling, itching, burning; up to 15%)
Other Side Effects
- Stomach pain
- Muscle spasms
- Itching
- Red or itchy skin (eczema)
- Flu infection
- Urinary tract infection (UTI)
- Stomach pain
- Diarrhea
- Fever
- Dry nose
- Rash
- Injection site reactions (itching, redness)
- Rash
- Itching
- Flushed skin
- Fatigue
- Warm sensation in torso and neck
- Cold arms and legs
- Difficulty breathing or wheezing
Serious Side Effects
- Allergic reactions: hives; wheezing; difficulty breathing; swelling of face, mouth, tongue, or throat
Source: DailyMed
More on Nucala (mepolizumab) 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 or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Back pain
- Fatigue
- Headache
- Joint pain
- Pain, redness, or irritation at injection site
- Sore throat
Pros and cons of Nucala (mepolizumab)
Pros
Only needs to be given once per month
Don't need to draw up the medication; it's available as a prefilled autoinjector and syringe
Can store unopened packages of medication at room temperature for up to 7 days
Cons
Doesn't replace your current asthma medications
Might be difficult for some people to administer properly
Doses higher than 100 mg require multiple injections
Pharmacist tips for Nucala (mepolizumab)
If your provider says it's safe for you to administer Nucala (mepolizumab) at home, follow their directions carefully to inject the medication safely. Depending on which Nucala (mepolizumab) product you have, review the prefilled autoinjector instructions for use or the prefilled syringe instructions for use. You can also watch the instructional videos on how to take the medication. Contact your provider or pharmacist if you have any questions on how to use Nucala (mepolizumab).
Keep Nucala (mepolizumab) in the original carton to protect it from light. Use the medication within 8 hours once you take it out of the carton. If it's not used within 8 hours, throw the medication away in a sharps container.
Keep Nucala (mepolizumab) in the refrigerator. When you're ready to give yourself the injection, take it out of the carton from the refrigerator, and lay it on a flat surface to warm up. This will take about 30 minutes. Don't try to warm up the medication any other way. If you're traveling or don't have access to a refrigerator, you can keep an unopened carton at room temperature for up to 7 days.
Always check the medication solution to make sure it's clear or a pale yellow to pale brown color before using it. If it's cloudy, discolored, or has particles (solid parts), don't use it. Contact your provider or pharmacist about giving you a replacement.
Don't remove the needle cap until you're ready to inject the medication. This is because you'll need to inject the medication within 5 minutes after removing the needle cap. Otherwise, the medication will dry in the needle, and you won't get your full dose.
Inject Nucala (mepolizumab) under the skin in your thigh, stomach, or back of the upper arms. Avoid injecting the medication within 2 inches of your belly button. If your dose is higher than 100 mg, you'll need to give yourself multiple injections. Make sure to leave at least 2 inches between each injection site. Don't inject into skin that's bruised, tender, red, or hard to avoid pain or skin damage.
Don't save any leftover medication that's still in the syringe after you use it because the medication doesn't contain any preservatives. This means it can grow bacteria and become contaminated if it's saved.
After giving yourself the medication, throw the needle and syringe away in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle. This helps lower the risk of needle-stick injuries. Don't throw away needles or syringes in your trash can. For more information on how to throw away your sharps container safely and guidance for your specific state, visit the FDA's website.
Don't use Nucala (mepolizumab) to treat an asthma attack. If you're having trouble breathing, use your albuterol (ProAir, Ventolin) rescue inhaler. If your asthma doesn't get better or is getting worse, contact your provider or get medical attention right away.
Don't stop taking any of your steroid medications for the condition you're using Nucala (mepolizumab) for without talking to your provider first, even if you feel better. Doing so can worsen your symptoms and raise your risk for steroid withdrawal symptoms.
More on Nucala (mepolizumab) tips
Frequently asked questions about Nucala (mepolizumab)
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What are the risks and warnings for Nucala (mepolizumab)?
Nucala (mepolizumab) 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.
Allergic reactions
Nucala (mepolizumab) can cause allergic reactions, including hives, wheezing, difficulty breathing, or swelling of the face, mouth, tongue, or throat (anaphylaxis). These reactions can happen within a few hours after the Nucala (mepolizumab) dose. But, in some cases, it could be a few days after your dose until an allergic reaction occurs. Because of this risk, you'll receive treatment only under direct medical supervision when starting treatment with Nucala (mepolizumab). Your provider will probably observe you closely for an appropriate period of time after receiving the dose to make sure you don't have a serious allergic reaction to the medication. If you experience any signs or symptoms of an allergic reaction outside of a healthcare setting, call 911 right away.
Not for an asthma attack
Nucala (mepolizumab) is meant to be used for asthma as an add-on maintenance medication only. This means it's added to other asthma medications to help control your symptoms in the long term. Don't use Nucala (mepolizumab) to treat an asthma attack because it isn't a rescue medication like albuterol (ProAir, Ventolin) inhaler. If you experience difficulty breathing from an asthma attack, use your albuterol inhaler.
Caution when using corticosteroids
If you're taking oral or inhaled corticosteroids for your condition, don't suddenly stop taking them without talking to your provider first, even if you feel better after using Nucala (mepolizumab). Doing so could result in dangerous withdrawal symptoms, such as lightheadedness, severe tiredness, body aches, and vomiting. If you need to stop your corticosteroid medication or lower your corticosteroid medication dose, your provider will give you directions on how to do so safely.
Risk of infections
While unclear, Nucala (mepolizumab) might affect your body's ability to fight infections from parasites. Because of this, you'll need to be tested for a parasitic infection before starting Nucala (mepolizumab) and get treatment if you test positive (meaning you have a parasitic infection). If you get any symptoms of a parasitic infection (e.g., stomach cramps or pain, nausea, vomiting, skin rash, muscle or joint pain) while taking Nucala (mepolizumab), contact your provider. If you don't respond to treatment for the infection, you'll have to stop taking Nucala (mepolizumab) until the parasitic infection goes away.
Nucala (mepolizumab) dosage forms
Typical dosing for Nucala (mepolizumab)
This medication is injected under the skin in your thigh, stomach, or back of the upper arms. The dose depends on what condition you're using Nucala (mepolizumab) for and your age.
Severe asthma
People 12 years and older: The typical dose is 100 mg injected under the skin once every month.
Children 6 to 11 years old: The typical dose is 40 mg injected under the skin once every month.
Chronic rhinosinusitis with nasal polyps
People 18 years and older: The typical dose is 100 mg injected under the skin once every month.
EGPA (adults only) or HES (people 12 years and older)
The typical dose is 300 mg injected under the skin once every month. The dose is given as three separate 100 mg injections, given one right after the other.
What are alternatives to Nucala (mepolizumab)?
Add-on maintenance treatment for severe asthma
Add-on maintenance treatment for chronic rhinosinusitis with nasal polyps
Eosinophilic granulomatosis with polyangiitis (EGPA; swelling of the blood vessels)
Hypereosinophilic syndrome (HES; high eosinophils in the blood)
Moderate-to-severe allergic asthma
Chronic spontaneous urticaria (CSU) (chronic hives of unknown cause)
Lower risk of severe allergic reactions after accidental exposure to food triggers
What is the latest news about Nucala (mepolizumab)?
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References
Best studies we foundAmerican Academy of Allergy, Asthma and Immunology. (2020). Hypereosinophilic syndrome.
American Academy of Allergy, Asthma and Immunology. (2020). Immunosuppressive medication for the treatment of autoimmune disease.
American College of Allergy, Asthma, and Immunology. (2021). Chronic rhinosinusitis with nasal polyps.
American Lung Association. (2022). Learn about eosinophilic granulomatosis with polyangiitis (EGPA).
Drugs and Lactation Database (LactMed). (2023). Mepolizumab. National Institute of Child Health and Human Development.
GlaxoSmithKline LLC. (2023). Nucala (mepolizumab) for injection, for subcutaneous use; injection, for subcutaneous use [package insert].
GlaxoSmithKline LLC. (2023). Nucala- mepolizumab injection, powder, for solution; mepolizumab injection, solution [package insert]. DailyMed.
GSK. (n.d.). How to inject NUCALA at home.
GSK. (2023). Nucala (mepolizumab) injection 100 mg/mL prefilled autoinjector: Instructions for use.
Lombardi, C., et al. (2022). The emerging roles of eosinophils: Implications for the targeted treatment of eosinophilic-associated inflammatory conditions. Current Research in Immunology.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
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