How to Inject Xolair, Plus 4 Other Tips for Administering This Injectable Biologic

If you or a loved one are living with asthma, you know how bothersome symptoms can be. And if standard asthma treatments aren’t cutting it, a newer group of medications, called biologics, are another option to consider. Asthma biologics address specific molecules that are responsible for causing moderate-to-severe respiratory symptoms.

The first FDA-approved asthma biologic is Xolair (omalizumab). Xolair targets an antibody called immunoglobulin E (IgE), which is a common culprit behind allergic asthma. Xolair binds to IgE and blocks it from triggering an allergic reaction. IgE is responsible for other types of allergic reactions too, such as food allergies.

You can self-administer Xolair as an under-the-skin injection. But to do your injections at home, you have to be cleared by your healthcare professional after a few doses in their office. Here, we’ll go through tips to make your Xolair injections go as smoothly as possible.

1. Xolair has several approved uses

Xolair isn’t usually a first-choice treatment option. It’s prescribed when other go-to medications aren’t doing enough on their own.

Xolair is approved to treat:

• Moderate-to-severe allergic asthma in adults and children ages 6 and older

• Chronic urticaria (hives) in adults and children ages 12 and older

• Chronic rhinosinusitis (sinus inflammation) with nasal polyps in adults

• Food allergy risk reduction in adults and kids ages 1 year and older

Of these, Xolair’s recent approval for food allergies is noteworthy. It’s the first approval of its kind. Xolair can now be used to lower the risk of allergic reactions if you’re accidentally exposed to a food or drink that you’re allergic to. It can help make exposure to small amounts of allergens less serious, but you should still avoid foods that you’re allergic to.

Keep in mind: Xolair is a preventive medication. If you or your loved one are exposed to an allergen and start to have an allergic reaction, follow the usual emergency protocol. This includes using your epinephrine (EpiPen, Auvi-Q) injection and calling 911. Do not use Xolair for the emergency treatment of any allergic reactions, including anaphylaxis, hives, or sudden breathing problems.

EXPERT PICKS: WHAT TO READ NEXT

• At-home medication: Here’s what three people say about their self-injection experiences.

• A brand-new use: In February 2024, Xolair was FDA approved for a new one-of-a-kind indication.

• Risks to keep in mind: Xolair can cause side effects, such as injection site reactions and joint pain. Learn how you can manage them.

2. You can inject Xolair in a few quick, strategic steps

Xolair is usually given as an injection under the skin (subcutaneously) every 2 to 4 weeks. Your specific Xolair dosage will depend on your measured IgE levels, age, and body weight.

You’ll likely receive your first three Xolair doses from your healthcare professional. This way, they can monitor and treat you in case of a severe allergic reaction (anaphylaxis) to the medication, which is rare. If everything goes smoothly with these starter doses, your healthcare professional will likely let you administer future injections at home.

Xolair is available in two formulations for at-home use: a prefilled syringe and an autoinjector. The autoinjector should be used only by people over age 12. Children ages 1 to 12 can receive the prefilled syringe, but a parent should help with the injection. Both formulations should be injected in the stomach (at least 2 inches from the belly button) or upper thigh. If someone is helping you with the injection, it can also be injected in the upper arm.

This guide will provide step-by-step instructions on how to use each formulation.

Preparing for the injection

Before you administer Xolair, take a few minutes to set up.

• Gather your materials: Find a clean workspace, and place your materials on it. This includes your Xolair prefilled syringe or autoinjector, alcohol swab, small bandage, and sharps container.

• Wash your hands: Use soap and water to wash your hands. If you don’t have access to a sink, you can use hand sanitizer.

• Examine your prefilled syringe or autoinjector: Take the medication out of its carton in an upright position, and check the expiration date. Look for visible damage on the device, and make sure the liquid in the medication is clear. If it is cloudy or has any particles in it, don’t use it. Ask your pharmacy about getting a replacement product.

• Prepare the injection site: Use the alcohol swab to sanitize your preferred injection site. Let it air-dry for at least 10 seconds.

Administering the injection

After you’ve prepared for the injection, follow these steps based on which device you have. Both the prefilled syringe and autoinjector are available in three doses: 75 mg (blue device), 150 mg (purple device), and 300 mg (gray device).

Good to know: You may need more than one injection to make up your full dose. Your healthcare professional will tell you how many syringes or autoinjectors you should inject per dose (if more than one). In this case, you can inject your doses one after another. Just make sure each injection is given at least 1 inch apart from each other.

Option 1: Prefilled syringe

To inject the prefilled syringe, first take the prefilled syringe out of the blister pack. Hold the middle part of the syringe firmly when you do this. Use your other hand to pull the needle cap straight off, without twisting it. You may see small air bubbles in the prefilled syringe or a drop of liquid at the end of the needle — this is normal.

Then pinch together a 2-inch area of skin that you wiped with an alcohol swab. Inject the syringe in that spot in a quick motion at a 45- to 90-degree angle, while keeping your skin pinched. Slowly inject all the medication by pushing the plunger down until the needle-shield wings are pushed apart. The needle-shield wings should cover the needle when the plunger is released. Place your used prefilled syringe in a sharps container right away.

Option 2: Autoinjector

To use the autoinjector, hold it firmly in an upright position. Use your other hand to pull the cap straight off without twisting it. Throw the cap away in the regular trash, and do not put it back on the autoinjector.

Hold the autoinjector directly on the area of skin that you wiped with an alcohol swab. Press straight down at a 90-degree angle while holding the autoinjector firmly against the skin. You will listen for a few clicks. The first click means the injection has started, so keep the autoinjector in that same position. Keep holding the autoinjector against your skin while the green indicator moves. The second click means the injection is almost done. The injection will finish when the green indicator stops moving, which will likely take 10 to 15 seconds from start to finish.

At this point, remove the autoinjector from the skin. The needle guard will lock over the needle. Place your entire autoinjector in a sharps container right away.

3. It’s best to store Xolair in the refrigerator

Xolair should be stored in the refrigerator. Keeping it at a temperature of 36°F to 46°F will help ensure it lasts until its labeled expiration date.

If the prefilled syringe or autoinjector are taken out of the fridge, they can be put back if needed. But they should not be out of the fridge for more than 2 days total.

Why the strict storage parameters? If Xolair has been left at a temperature above 77°F, it could be damaged, unsafe, or less effective. In this case, discard it and avoid using it. Xolair should always be kept in its original packaging to protect it from light. The medication should never be frozen either.

4. Xolair injections don’t always have to be painful

Injecting a room temperature medication is less painful than a cold one. You can remove your Xolair device from the refrigerator (about 15 to 30 minutes for the prefilled syringe or 30 to 45 minutes for the autoinjector) before your injection. Let the medication warm up to room temperature. Do not microwave it or run it under warm water.

You should also rotate the spot where you inject your medication. This helps prevent and ease injection site reactions, which includes pain, bruising, or stinging at the site of injection. This is a common side effect of Xolair that can happen within an hour of your dose. But it should ease over time and with subsequent injections. Do not rub the injection site either.

As an added measure, you can use ice packs or over-the-counter pain relievers, such as ibuprofen (Advil, Motrin), to help minimize more intense injection site discomfort.

5. Several Xolair alternatives are available for use

Xolair is only one biologic to consider. There are multiple biologic treatments for asthma and other allergic conditions. They work in different ways by targeting different molecules. Some biologics may be self-injected at home every 4 or 8 weeks, while others can be given only by intravenous infusion in a healthcare setting.

One biologic is not considered better than the others. The safest and most effective one for you will likely differ for someone else. Your healthcare professional will help you choose the right biologic depending on the type of allergic condition you have, your medical history, and your preferences. Your health insurance coverage will likely be a factor too.

How to save on Xolair

There are ways to save on Xolair, which is available only as a reference (“brand name”) medication. GoodRx can help you navigate between copay savings cards and patient assistance programs to save money on your prescription.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $0 for Xolair using a savings card from the manufacturer.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Xolair’s patient assistance program, which offers the medication free of charge.

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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