Elrexfio (Elranatamab)
Complete patient guide for uses, dosage, side effects, and safety information
Prescription RequiredQuick Facts
What Is Elrexfio Used For?
Elrexfio is a specialized cancer medicine that contains the active ingredient elranatamab. It’s designed to treat a specific type of blood cancer called multiple myeloma.
Primary Uses
Elrexfio is used to treat adults with multiple myeloma, a cancer of the bone marrow. It’s specifically for patients who have already tried at least three other types of treatment that either didn’t work or stopped working.
How It Works
Elrexfio is an antibody that targets two specific proteins: BCMA (found on multiple myeloma cancer cells) and CD3 (found on your immune system’s T cells). By attaching to these proteins, it helps your immune system recognize and destroy the cancer cells.
How to Take Elrexfio
Elrexfio is always given by an experienced healthcare professional as an injection under your skin, usually in your stomach area or thigh. You cannot take this medication at home.
Dosage Instructions
The full treatment dose is 76 mg, but you’ll start with smaller doses: Step-up dose 1 is 12 mg on Week 1 Day 1, Step-up dose 2 is 32 mg on Week 1 Day 4, then full dose of 76 mg starting Week 2 Day 1. From Week 3-24, you’ll get weekly doses. From Week 25-48, you’ll get doses every other week. From Week 49 onwards, you’ll get doses every 4 weeks. You’ll also receive pre-medications 1 hour before your first three doses to help prevent side effects.
What If You Miss a Dose?
If you miss your scheduled appointment, contact your doctor right away to reschedule as soon as possible. The dose should be given as soon as possible, and your dosing schedule will be adjusted to maintain the proper intervals.
Important: Hospitalization is recommended for 48 hours after your first dose and 24 hours after your second dose due to the risk of serious side effects.
Available Tablet Strengths
Side Effects
Like all medications, this medicine can cause side effects. Most are mild and temporary, but some require medical attention.
Common Side Effects
These side effects occur relatively frequently and usually don’t require emergency care:
- Bleeding or bruising more easily
- Low white blood cell, red blood cell, or platelet counts
- High liver enzymes
- Low potassium and/or phosphate levels
- Nausea, diarrhea, or vomiting
- Loss of appetite
- Dry skin or skin rash
- Injection site reactions (rash, itching, swelling, pain, bruising)
- Fatigue, tiredness, lack of energy
- Headache
- Fever
- Muscle weakness and joint pain
Seek immediate medical attention if you experience:
- Allergic reactions (chest tightness, shortness of breath, swelling, hives)
- Cytokine release syndrome (fever, difficulty breathing, chills, dizziness, fast heartbeat)
- Neurological problems including ICANS (confusion, difficulty speaking/writing, pins and needles feeling, muscle spasms, tremors, burning/throbbing pain)
- Infections (fever, chills, chest discomfort, urinary symptoms, herpes virus symptoms)
- Blood abnormalities (persistent fever, easy bruising/bleeding, paleness)
- Severe diarrhea
Important Warnings
Elrexfio can cause serious, life-threatening, or fatal side effects including allergic reactions, cytokine release syndrome (CRS), infections, and neurological problems.
Who Should Not Take Elrexfio
Do not use Elrexfio if you are allergic to elranatamab or any of the ingredients. Signs of allergic reaction include shortness of breath, wheezing, swelling of face/lips/tongue, rash, itching, or hives.
Medical Conditions to Discuss
Tell your doctor if you have: fever, chills, or signs of infection; abnormal blood test results; kidney problems; liver problems; recent vaccination or scheduled vaccination; or if you take any other medicines.
Pregnancy and Breastfeeding
Elrexfio may harm your unborn baby. You’ll need a pregnancy test before starting treatment if you’re of childbearing age. Use effective contraception during treatment and for 4 months after your last dose. Do not breastfeed during treatment and for 4 months after your last dose.
Boxed Warning: Elrexfio may cause cytokine release syndrome (CRS) and neurological toxicity including immune effector cell-associated neurotoxicity syndrome (ICANS). Call your healthcare provider immediately if you develop fever, chills, nausea, headache, fast heartbeat, dizziness, difficulty breathing, numbness, tingling, confusion, trouble speaking, muscle spasms, tremor, or changes in handwriting.
Drug Interactions
When you start Elrexfio, your body releases proteins called cytokines that may affect how other medicines work. The highest risk for interactions is during the step-up dosing schedule and after cytokine release syndrome.
- Live vaccines (avoid within 4 weeks before and during treatment)
- Other medicines may be affected by cytokine release during step-up dosing
- Medicines may need monitoring and adjustment during CRS episodes
Alcohol & Driving
Special precautions are needed regarding driving and machinery operation while taking Elrexfio.
Alcohol
Tell your doctor if you drink alcohol. The interaction between Elrexfio and alcohol should be discussed with your healthcare provider.
Driving and Operating Machinery
Do not drive, use tools, or operate heavy or dangerous machinery during treatment and for at least 48 hours after each of your first 2 step-up doses. Elrexfio may cause neurological problems that make you feel tired, less alert, dizzy, or confused. If you develop new neurological symptoms, do not drive or operate machinery until symptoms resolve.
Storage
Elrexfio will be stored and handled by healthcare professionals at the hospital or clinic. It should be stored in a refrigerator at 2°C to 8°C, kept in the original carton to protect from light, and should not be frozen or shaken.
Overdose Information
Since Elrexfio is given by healthcare professionals, overdose is unlikely. In the rare event of an overdose, your healthcare team will monitor you closely for side effects and provide appropriate treatment.
Frequently Asked Questions
Elrexfio works by helping your immune system recognize and destroy cancer cells. The treatment follows a specific schedule starting with step-up doses, and you’ll continue treatment as long as you’re getting benefit from it.
No, Elrexfio is not addictive. It’s a cancer treatment medication that works with your immune system.
Contact your doctor right away to reschedule your appointment as soon as possible. The dose should be given as soon as possible, and your dosing schedule will be adjusted to maintain proper intervals.
You should not receive live vaccines within 4 weeks before starting treatment and during treatment with Elrexfio. If you’re unsure about a vaccine type, ask your healthcare provider.
Hospitalization is recommended for 48 hours after your first dose and 24 hours after your second dose because of the risk of serious side effects like cytokine release syndrome and neurological problems.
You’ll receive an Elrexfio Patient Card that lists symptoms of serious side effects like CRS and neurological problems. Always carry it with you and show it to any healthcare professionals involved in your care or if you go to the Emergency Department.
Elrexfio is not recommended for children or young people below 18 years of age. For adult patients of any age, your doctor will monitor you closely for side effects and adjust treatment as needed based on your individual medical condition.
Important Disclaimer
This information is intended for general educational purposes only and should not be considered medical advice. Always consult your healthcare provider or pharmacist before starting, stopping, or changing any medication.
If you think you may have a medical emergency, call your doctor or emergency services immediately.