Nucala (mepolizumab)

Nucala contains mepolizumab, which is a biologic medication. It’s not available as a biosimilar. (Biosimilars are like a generic version of a biologic medication.)

Nucala can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Nucala. These lists do not include all possible side effects.

For more information on the possible side effects of Nucala, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.

Note: In addition to the information below, you can refer to this article for details about Nucala’s side effects.

More common side effects

Side effects of Nucala can vary depending on the condition you’re taking the drug for.

In clinical trials of people with eosinophilic asthma, eosinophilic granulomatosis with polyangiitis, or hypereosinophilic syndrome, more common side effects included:

• headaches
• injection site reactions, such as pain, redness or deepening of skin color, itching, swelling, or burning in the injection area
• back pain
• fatigue

In clinical trials of people with rhinosinusitis, more common side effects included:

• pain in the mouth and throat
• joint pain

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Nucala aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects, explained in more detail below in “Side effect details,” can include the following:

• allergic reaction, including anaphylaxis
• herpes zoster infection (shingles)

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on some of the side effects this drug may or may not cause.

Allergic reaction, including anaphylaxis

As with most drugs, some people can have a mild allergic reaction after taking Nucala. In clinical trials, most of these reactions were mild, but some were serious. Most happened within a few hours after a Nucala injection was given. But some allergic reactions occurred a few days later.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Anaphylaxis is a very serious type of allergic reaction that can be life threatening. Symptoms of a severe allergic reaction can include:

• angioedema (swelling under your skin, typically in your eyelids, lips, hands, or feet)
• swelling of your tongue, mouth, or throat
• difficulty swallowing
• trouble breathing
• feeling faint or dizzy

Call your doctor right away if you have a severe allergic reaction to Nucala. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Herpes zoster infection (shingles)

In clinical trials, some people taking Nucala for severe asthma reported having a herpes zoster infection, also known as shingles. The virus that causes shingles is the same one that causes chickenpox.

It’s not fully known whether taking Nucala increases the risk of developing shingles.

Your doctor might have you get the shingles vaccine before you start treatment with Nucala. This may help reduce your risk of developing shingles.

If you’re receiving Nucala and notice symptoms of shingles, tell your doctor right away. Symptoms of shingles can include:

• blistering rash
• fever
• tingling or burning feeling
• shooting pain in the area of the rash

Your doctor can recommend treatments to ease your symptoms and shorten how long shingles lasts.

Long-term side effects

Cases of shingles were reported in clinical trials of Nucala. Shingles infection may sometimes cause long lasting symptoms or complications.

It isn’t known for sure whether taking Nucala increases the risk of developing shingles. As a precaution, your doctor might have you get the shingles vaccine before you start treatment with Nucala. This may reduce your risk of having shingles.

No other long-term side effects were reported in clinical trials of Nucala.

If you’re concerned about how Nucala may affect you long term, talk with your doctor.

Weight gain (not a side effect)

Weight gain wasn’t reported in clinical trials of Nucala.

However, oral corticosteroid (steroid) medications are often used to treat the same conditions that Nucala treats. And steroids are known to cause weight gain. Nucala is not a steroid.

If you’re concerned about weight gain, discuss it with your doctor. They can suggest helpful diet, exercise, and lifestyle tips or recommend a dietitian.

Weight loss (not a side effect)

Weight loss wasn’t reported as a side effect in clinical trials of Nucala.

People taking oral corticosteroids for long periods of time can often gain weight. If you’re able to take a lower amount of steroids due to your Nucala treatment, it’s possible that you may lose weight. However, this hasn’t been specifically studied.

If you’re concerned about weight loss, talk with your doctor. They can suggest helpful diet tips or recommend a dietitian to help make sure you get the proper nutrition.

Hair loss (not a side effect)

Hair loss wasn’t reported in clinical trials of Nucala.

But some other medications that help treat EGPA may cause hair loss. These include:

• methotrexate (Otrexup, Rasuvo, Xatmep)
• cyclophosphamide
• azathioprine (Azasan, Imuran)
• rituximab (Rituxan)

If you’re concerned about hair loss, talk with your doctor.

Other drugs are available that can treat your condition. Some may be better suited for you than others. If you’re interested in finding an alternative to Nucala, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are prescribed off-label. Off-label drug use means prescribing a drug for a purpose other than what it’s been approved for by the FDA.

Alternatives for eosinophilic asthma

Examples of other drugs that may be used to treat severe eosinophilic asthma include:

• benralizumab (Fasenra)
• dupilumab (Dupixent)
• reslizumab (Cinqair)
• omalizumab (Xolair)

Alternatives for eosinophilic granulomatosis with polyangiitis (EGPA)

Examples of other drugs that may be used to treat EGPA include:

• methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• cyclophosphamide (Cytoxan)
• azathioprine (Azasan, Imuran)
• mycophenolate (CellCept, Myfortic)
• rituximab (Rituxan)

Alternatives for chronic rhinosinusitis with nasal polyps

Examples of other drugs that may be used to treat chronic rhinosinusitis with nasal polyps include:

• beclomethasone (Beconase AQ)
• ciclesonide (Omnaris, Zetonna)
• fluticasone (Flonase, Xhance)
• mometasone (Nasonex)

Alternatives for hypereosinophilic syndrome (HES)

Examples of other drugs that may be used to treat HES include:

• corticosteroids, such as methylprednisolone (Solu-Medrol)
• cyclophosphamide (Cytoxan)
• hydroxyurea (Hydrea)
• imatinib (Gleevec)

You may wonder how Nucala compares to other medications that are prescribed for similar uses. Here we look at how Nucala and Fasenra are alike and different.

General

Nucala and Fasenra are both biologic drugs, which are made from parts of living cells rather than from chemicals. Both medications work to reduce the number of eosinophils in your body. These are a type of white blood cell that’s involved in causing inflammation.

Nucala contains the drug mepolizumab. Fasenra contains the drug benralizumab.

Uses

The Food and Drug Administration (FDA) has approved both Nucala and Fasenra to treat severe eosinophilic asthma. Fasenra is approved for use in adults and children ages 12 years and older. Nucala is approved for use in adults and children ages 6 years and older.

These medications are used as add-ons to your existing asthma treatment. This means that you take Nucala or Fasenra in addition to your other asthma medications.

Nucala is also FDA-approved to treat:

• eosinophilic granulomatosis with polyangiitis in adults
• chronic rhinosinusitis with nasal polyps in adults
• hypereosinophilic syndrome in adults and children ages 12 years and older

Drug forms and administration

Nucala and Fasenra are both given as subcutaneous injections. Nucala comes in three forms:

• a single-dose vial of powder that’s mixed with sterile water to form a solution, which is injected with a syringe by a healthcare professional
• a single-dose prefilled autoinjector pen
• a single-dose prefilled syringe

Fasenra comes as a single-dose prefilled syringe and a single-dose prefilled autoinjector pen.

Nucala is given once every four weeks. Fasenra is given once every four weeks for the first three doses. After that, Fasenra is given once every eight weeks.

Side effects and risks

Nucala and Fasenra can cause some similar side effects and some different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Nucala, with Fasenra, or with both drugs (when taken individually).

• Can occur with Nucala:
  • injection site reactions such as redness or deepening of skin color, itching, swelling, or burning in the injection area
  • back pain
  • fatigue
• Can occur with Fasenra:
  • fever
  • allergic skin rashes, including urticaria (an itchy skin rash also known as hives)
• Can occur with both Nucala and Fasenra:
  • headaches
  • pain in the mouth or throat

Serious side effects

These lists contain examples of serious side effects that can occur with Nucala or with both drugs (when taken individually).

• Can occur with Nucala:
  • herpes zoster infection (shingles)
• Can occur with both Nucala and Fasenra:
  • severe allergic reactions, including anaphylaxis

Effectiveness

The only condition that both Nucala and Fasenra are used to treat is severe eosinophilic asthma.

These drugs haven’t been directly compared in clinical studies, but studies have found both Nucala and Fasenra to be effective for helping to treat this type of severe asthma.

Costs

Nucala and Fasenra are both brand-name drugs. There are currently no generic or biosimilar versions of either drug. (Biosimilars are like generic versions of a biologic medication.) Brand-name medications usually cost more than generics or biosimilars.

The actual price you’ll pay for either drug depends on your insurance plan and your location.

Xolair is another drug that’s similar to Nucala. Here we look at how Nucala and Xolair are alike and different.

General

Nucala and Xolair are both biologic drugs, which are made from parts of living cells rather than from chemicals. Nucala works to reduce the number of eosinophils in your body. These are a type of white blood cell that’s involved in causing inflammation.

Xolair targets a substance called immunoglobulin E (IgE), which is involved in causing allergic reactions. By blocking IgE, Xolair helps reduce inflammation and lowers the number of eosinophils in your body.

Nucala contains the drug mepolizumab. Xolair contains the drug omalizumab.

Uses

The Food and Drug Administration (FDA) has approved Nucala and Xolair to treat:

• Chronic rhinosinusitis with nasal polyps in adults.
• Asthma in certain situations, specifically:
  • Nucala is approved to treat severe eosinophilic asthma in adults and children ages 6 years and older.
  • Xolair is approved to treat moderate to severe persistent allergic asthma in adults and children ages 6 years and older.

For these uses, Xolair and Nucala are prescribed in addition to other treatments.

Nucala is also approved to treat eosinophilic granulomatosis with polyangiitis in adults, and hypereosinophilic syndrome in adults and children 12 years and older.

Additionally, Xolair is approved to treat chronic spontaneous urticaria (long-term hives) in adults and children ages 12 years and older.

Drug forms and administration

Nucala and Xolair are each given as subcutaneous injections. Both drugs come in three forms:

• a single-dose vial of powder that’s mixed with sterile water to form a solution, which is injected with a syringe by a healthcare professional
• a single-dose prefilled autoinjector pen
• a single-dose prefilled syringe

Nucala is given once every four weeks. Xolair may be given once every two weeks or once every four weeks. The dosage depends on your age, body weight, and IgE level before starting treatment.

Side effects and risks

Nucala and Xolair have some similar side effects and some different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Nucala, with Xolair, or with both drugs (when taken individually).

• Can occur with Nucala:
  • back pain
  • headaches
• Can occur with Xolair:
  • pain, particularly in your arms, legs, or joints
  • dizziness
  • earache
  • skin rash
• Can occur with both Nucala and Xolair:
  • fatigue
  • injection site reactions such as redness or deepening of skin color, itching, or burning in the injection area

Serious side effects

These lists contain examples of serious side effects that can occur with Nucala, with Xolair, or with both drugs (when taken individually).

• Can occur with Nucala:
  • herpes zoster infections (shingles)
• Can occur with Xolair:
  • symptoms similar to serum sickness (a type of allergic reaction), including fever, joint pain, rash, and swollen glands
  • possible risk of cancer
• Can occur with both Nucala and Xolair:
  • severe allergic reactions, including anaphylaxis*

* Xolair has a boxed warning about the risk of anaphylaxis. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Nucala and Xolair have slightly different FDA-approved uses. Nucala is FDA-approved to treat severe eosinophilic asthma. Xolair is FDA-approved to treat severe allergic asthma. If you have severe allergic asthma, you’ll have high levels of eosinophils and IgE.

These drugs haven’t been directly compared in clinical studies, but studies have found both Nucala and Xolair to be effective for treating severe asthma. The choice between them depends on what is causing your asthma. Your doctor can determine this from the results of blood tests.

Costs

There are currently no generic or biosimilar versions of either drug. (Biosimilars are like a generic version of a biologic medication.) Brand-name medications usually cost more than generics or biosimilars.

The actual price you’ll pay for either drug will depend on your insurance plan and your location.

The Nucala dosage your doctor prescribes depends on the condition you’re taking Nucala to treat. The following information describes dosages that are commonly used or recommended.

Drug forms and strengths

Nucala is given as a subcutaneous injection. The drug comes in three forms and strengths, described below. Strength is given in milligrams (mg) and mg per milliliter (mL).

Your doctor or a healthcare professional may show you (or a caregiver) how to inject Nucala at home, using the prefilled syringe or prefilled autoinjector.

Dosage for asthma

Nucala’s recommended dosage for eosinophilic asthma in adults and children ages 12 years and older is 100 mg (one injection) every four weeks.

For children ages 6–11 years, Nucala’s recommended dosage is 40 mg (one injection) every four weeks.

Dosage for eosinophilic granulomatosis with polyangiitis

The recommended Nucala dosage for eosinophilic granulomatosis with polyangiitis is 300 mg (three injections) on the same day, once every four weeks.

Dosage for chronic rhinosinusitis

The recommended Nucala dosage for chronic rhinosinusitis with nasal polyps is 100 mg (one injection) every four weeks.

Dosage for hypereosinophilic syndrome

The recommended Nucala dosage for hypereosinophilic syndrome is 300 mg (three injections) on the same day, once every four weeks.

What if I miss a dose?

If you miss giving yourself a dose, give yourself an injection as soon as possible. Then get back on track with your normal schedule. But if you miss a dose and it’s almost time for your next one, follow your normal schedule. Call your doctor or a pharmacist if you’re not sure whether to give your missed injection right away or wait.

If your healthcare professional gives you injections of Nucala and you miss an appointment, call your healthcare professional as soon as possible. They can make a new appointment and adjust the timing of other visits if needed.

It’s important to keep having your injections as scheduled, even if your symptoms start to go away. It’s a good idea to note your injection schedule on your calendar. You can also set a reminder on your phone so that you don’t miss a dose or an appointment. Other medication reminders can help, too.

Will I need to use this drug long term?

Nucala is meant to be used as a long-term treatment. If you and your doctor determine that Nucala is safe and effective for you, you’ll likely take it long term.

In addition to the information above, you can refer to this article for details about Nucala’s dosages.

The Food and Drug Administration (FDA) approves prescription drugs such as Nucala to treat certain conditions.

Nucala for eosinophilic asthma

Nucala is FDA-approved to treat severe eosinophilic asthma in adults and children ages 6 years and older. For this use, Nucala is an add-on treatment. This means you take it in addition to your other asthma medications, typically corticosteroids (steroids).*

With severe eosinophilic asthma, you have high levels of eosinophils (a type of white blood cell) in your body. Eosinophils are important cells in helping fight infections. However, too many eosinophils can cause inflammation in your airways. The higher the level of eosinophils, the greater the inflammation. This results in asthma symptoms that are more serious and harder to control.

Symptoms can include wheezing, being short of breath, coughing, and chest tightness. These symptoms can greatly affect your day-to-day life. You can refer to our asthma and allergies hub to learn more.

If you and your doctor are considering Nucala, your doctor will test your blood to check your level of eosinophils. If your level is higher than 150 cells per microliter, you may benefit from Nucala treatment. People with higher levels of eosinophils are more likely to respond to Nucala.

Keep in mind that Nucala injections do not work to treat asthma attacks or sudden breathing problems. You should instead use a rescue inhaler for this purpose.

* In clinical trials, some people were able to have their steroid dosage lowered after starting Nucala treatment. However, it’s important to keep taking any steroid medications that your doctor has prescribed unless they tell you otherwise. Not everyone who is treated with Nucala will be able to reduce their use of steroids.

Nucala for eosinophilic granulomatosis with polyangiitis

Nucala is FDA-approved to treat a rare condition called eosinophilic granulomatosis with polyangiitis (EGPA) in adults. This condition used to be called Churg-Strauss syndrome.

With EGPA, high levels of eosinophils cause inflammation in various tissues in the body and small blood vessels. Over time, inflammation in the blood vessels results in problems with blood flow through these vessels. This poor blood flow can lead to damage in vital organs, such as the lungs.

Some of the first symptoms of EGPA include asthma, hay fever (nasal allergies), and sinusitis (sinus infection).

EGPA can have many other symptoms, depending on what part of the body it affects. EGPA can also impact your:

• nose
• digestive system
• nerves
• kidneys
• heart
• skin

By reducing the number of eosinophils in your body, Nucala reduces inflammation. This can help ease the symptoms of EGPA. In Nucala’s clinical trials, some conditions went into remission, meaning people had no symptoms or symptoms that were mild enough to not affect their daily lives. People also had fewer relapses (symptom flare-ups) after starting Nucala.

Nucala for rhinosinusitis

Nucala is FDA-approved to treat chronic rhinosinusitis with nasal polyps in adults. It’s prescribed as an add-on treatment, meaning you take it in addition to your other rhinosinusitis medications, typically nasal corticosteroids (steroids). Nucala is prescribed for rhinosinusitis that isn’t responding well to nasal corticosteroid treatment.

Chronic (long-term) rhinosinusitis causes long-term inflammation in your nose and sinuses. This condition can involve nasal polyps. These are benign (noncancerous) growths in your nose.

Possible symptoms of chronic rhinosinusitis with nasal polyps include:

• reduced sense of smell or loss of smell
• nose and sinus congestion
• mucus draining from the nose
• facial pain or pressure

Nucala for hypereosinophilic syndrome

Nucala is FDA-approved to treat hypereosinophilic syndrome (HES) in adults and children ages 12 years and older. It’s prescribed for HES that’s been present for at least 6 months and isn’t known to be caused by a blood condition such as cancer.

With HES, you have a very high level of eosinophils. Over time, the eosinophils spread into tissues throughout your body. This often affects the heart, skin, lungs, and nervous system. Symptoms vary depending on which part of the body is affected, and may include:

• rash
• shortness of breath
• dizziness
• fatigue
• cough
• mouth sores
• confusion or memory problems

Nucala for COPD (not an appropriate use)

Nucala isn’t FDA-approved for treating chronic obstructive pulmonary disease (COPD). In March 2019, the FDA voted against approving Nucala for this use. The FDA decided there wasn’t enough evidence from clinical studies to prove that Nucala was effective in treating COPD.

The FDA also decided that it would be hard to define who with COPD would most likely benefit from Nucala. This is because it’s not clear how eosinophils, a type of white blood cell, cause lung inflammation in COPD. Specialists don’t currently agree on the level of eosinophils that should be used to diagnose someone with eosinophilic COPD.

That’s not to say that Nucala won’t be approved for COPD in the future. The manufacturer of the drug will have to provide evidence that Nucala is effective and address any other concerns the FDA has.

Nucala and children

Nucala is approved to treat severe eosinophilic asthma in children ages 6 years and older. It’s also approved to treat HES in children ages 12 years and older.

Nucala isn’t currently approved to treat EGPA or rhinosinusitis in children.

If your doctor prescribes Nucala, you’ll take it with your current treatment for severe eosinophilic asthma, eosinophilic granulomatosis with polyangiitis (EGPA), or chronic rhinosinusitis.

Keep using all your current asthma, EGPA, or rhinosinusitis medications while taking Nucala, even if you start to feel better. In some cases, if you’re taking corticosteroids, your doctor might gradually lower your corticosteroid dosage while you’re taking Nucala. However, do not stop taking your medications or reduce your doses unless your doctor tells you to. Stopping your other medications could make your symptoms come back or get worse.

This is especially important for any steroid medications. If you’ve been taking high dose steroids for a long time, your body may rely on them. This means that if you suddenly stop taking the steroids, you may develop extra side effects.

For severe eosinophilic asthma

If you have severe eosinophilic asthma, below are examples of drugs you may take with Nucala:

• a corticosteroid inhaler such as:
  • beclomethasone (Qvar)
  • budesonide (Pulmicort)
  • fluticasone (Flovent)
  • ciclesonide (Alvesco)
  • mometasone (Asmanex)
• corticosteroid tablets such as:
  • prednisone (Rayos)
  • prednisolone
• a long-acting beta-agonist (LABA) inhaler such as:
  • salmeterol (Serevent)
  • formoterol (Perforomist)
• a combined steroid and bronchodilator inhaler such as:
  • fluticasone and salmeterol (Advair Diskus, Advair HFA)
  • budesonide and formoterol (Symbicort)
  • fluticasone and vilanterol (Breo Ellipta)
  • fluticasone, vilanterol, and umeclidinium (Trelegy Ellipta)
  • mometasone and formoterol (Dulera)
• a short-acting beta-agonist such as:
  • albuterol (ProAir, Proventil, Ventolin HFA)
  • terbutaline
  • ipratropium bromide inhalation (Atrovent HFA)
  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • theophylline

For EGPA

If you have EGPA, below are examples of drugs you may take with Nucala:

• corticosteroids such as:
  • prednisone (Rayos)
  • prednisolone
• immunosuppressants such as:
  • azathioprine (Azasan, Imuran)
  • methotrexate (Rasuvo, Otrexup, Trexall)
  • mycophenolic acid (CellCept, Myfortic)

For rhinosinusitis

If you have chronic rhinosinusitis with nasal polyps, below are examples of drugs you may take with Nucala:

• beclomethasone (Beconase AQ)
• ciclesonide (Omnaris, Zetonna)
• fluticasone (Flonase, Xhance)
• mometasone (Nasonex)
• triamcinolone (Nasacort)

There aren’t any warnings about avoiding alcohol while you’re receiving Nucala. Alcohol doesn’t affect the medication itself. However, if you find that the Nucala injections give you a headache, drinking alcohol could worsen this side effect.

If you drink alcohol and are concerned about how it might interact with Nucala, talk with your doctor. They can tell you how much is safe for you to drink during your treatment.

No drug interaction studies have been done with Nucala. However, based on what’s known about how Nucala works in the body, the drug is unlikely to interact with other medications.

Before taking Nucala, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Nucala and herbs and supplements

No herbs or supplements are known to interact with Nucala. To be on the safe side, always check with your doctor or pharmacist before using treatments like these with Nucala.

As with all medications, the cost of Nucala can vary. The actual price you’ll pay depends on your insurance plan and your location.

Financial and insurance assistance

If you need financial support to pay for Nucala, or if you need help understanding your insurance coverage, help is available.

A program called Gateway to Nucala is available. For more information and to find out if you’re eligible for support, call 844‐4‐NUCALA (844‐468‐2252) or visit the program website.

You can refer to this article for details about Nucala’s cost.

Nucala comes as a subcutaneous injection in three forms: an injection given by your healthcare professional, a prefilled autoinjector pen, and a prefilled syringe. You can use the autoinjector pen or syringe to give yourself injections.

Depending on the condition you’re taking Nucala for, you might have one or three Nucala injections. For multiple injections, the injection sites need to be at least 2 inches apart.

Healthcare professional injection

Your healthcare professional can give you Nucala doses at their office or clinic. You may be given the injection in your upper arm, thigh, or abdomen.

Autoinjector pen and syringe

Nucala also comes as a prefilled autoinjector pen and a prefilled syringe, which you can use to give yourself an injection. You’ll give yourself the injection in your thigh or abdomen. If a caregiver (such as a family member or friend) gives you the injection, they can give it in your upper arm, as well.

Your healthcare professional will teach you how to give yourself an injection using the autoinjector pen or syringe. Once you’re at home, you can refer to the “Instructions for Use” that come with your autoinjector pen or syringe. Nucala’s website also has video instructions and written instructions. And you can get help by calling your healthcare professional or the MyNucala Support Line at 844‐4‐NUCALA (844‐468‐2252).

When Nucala is given

Nucala injections are usually given once every four weeks.

It’s a good idea to note your injection schedule on a calendar. You can also set a reminder on your phone so that you don’t miss a dose or an appointment. Other medication reminders can help, too.

The conditions Nucala treats are all thought to be caused by having high levels of eosinophils. These are a type of white blood cell that cause inflammation. Having too many eosinophils leads to too much inflammation in the body, which can cause symptoms such as trouble breathing, nasal polyps, and more.

Nucala contains the active ingredient mepolizumab, which is designed to specifically target eosinophils. It’s a type of biologic drug called a monoclonal antibody.

Nucala is designed to recognize and bind (attach) to a substance called interleukin 5 (IL-5), which is involved in making eosinophils. When Nucala binds to IL-5, the IL-5 stops making eosinophils. As a result, the number of eosinophils decreases.

Having fewer eosinophils lessens inflammation. This may help reduce your symptoms or make symptoms go away. For example, if you have asthma, Nucala should make it easier to breathe.

How long does it take to work?

Nucala doesn’t start to work right away. The drug gradually builds up an effect over time. The length of time it takes for symptoms to ease will vary from person to person.

In clinical trials, Nucala reduced people’s levels of eosinophils within four weeks.

If your symptoms don’t ease or if they get worse after starting Nucala treatment, see your doctor.

At the moment, there’s not enough data to say whether Nucala is safe to use in pregnancy. Animal studies didn’t show that the drug harmed the fetus. However, animal studies don’t always predict what will happen in humans.

If you have asthma, it’s very important for your condition to be managed well during pregnancy. Having asthma that’s poorly managed during pregnancy means you have a higher risk of developing problems such as preeclampsia (high blood pressure). It also increases the risk of the baby being born prematurely (too early) or with a low birth weight.

If you’re pregnant or planning a pregnancy while receiving Nucala, talk with your doctor. They can discuss the risks and benefits.

It’s not known whether Nucala passes into human breast milk. It’s also not known whether it affects milk production. Nucala did pass into breast milk when given to lactating animals in animal studies. But animal studies don’t always predict what might happen in humans.

If you want to breastfeed while you’re receiving Nucala, talk with your doctor. They can discuss the pros and cons with you.

Here are answers to some frequently asked questions about Nucala.

Is Nucala a steroid?

No, Nucala isn’t a steroid.

Steroids are medications that are used to reduce inflammation with many different conditions. These drugs work in a number of ways. Nucala also reduces inflammation, but in a different and more specific way than steroids do. Nucala targets eosinophils, which are blood cells that cause inflammation in the conditions Nucala is approved to treat.

If you’re currently on steroid treatment, you’ll likely take Nucala along with your steroid. The two drugs help reduce inflammation in different ways. If your condition improves after you start taking Nucala, your doctor may reduce your dose of steroids. This may benefit you if you have a lot of side effects from your steroids.

If you have questions about steroids or Nucala, talk with your doctor.

Can Nucala cause cancer?

No, clinical studies haven’t found cancer to be a side effect of taking Nucala. And post-marketing reports of Nucala haven’t mentioned cancer. (These reports contain feedback from people who used Nucala after the Food and Drug Administration [FDA] approved the drug.)

Interestingly, Nucala is currently being investigated as a potential treatment for a rare type of cancer. This cancer is called chronic eosinophilic leukemia.

Does Nucala treat COPD?

No. The FDA hasn’t approved Nucala to treat chronic obstructive pulmonary disease (COPD). COPD is a group of lung diseases that include emphysema and chronic bronchitis.

Eosinophils, a type of white blood cell, are involved in causing the conditions Nucala is approved to treat. It’s not clear whether eosinophils also play a role in lung inflammation with COPD. And COPD specialists don’t agree on how high the level of eosinophils should be to diagnose someone with eosinophilic COPD.

Can Nucala treat other types of asthma?

No, Nucala is only used to treat severe asthma that involves increased levels of eosinophils, a type of white blood cell. The drug won’t help treat asthma symptoms that aren’t related to lung inflammation caused by a large amount of eosinophils. Nucala also isn’t used to treat asthma that’s mild or moderate.

Do I need to keep using other asthma drugs while receiving Nucala?

Yes. Nucala is an add-on treatment for your asthma. You must keep using the other asthma medications your doctor prescribes along with Nucala. This includes any steroid medications that you take with an inhaler or as tablets.

People with severe asthma often need high doses of steroids, but these drugs can cause some serious side effects.

If your asthma symptoms ease and you have fewer severe asthma attacks after you start taking Nucala, your doctor may reduce your dose of steroids. However, don’t change your dose unless your doctor tells you to, or else your asthma could get worse.

It’s also important to note that Nucala does not work to treat asthma attacks or sudden breathing problems. You should instead use your rescue inhaler as needed.

Before taking Nucala, talk with your doctor about your health history. Nucala may not be right for you if you have certain medical conditions. These include:

• Allergic reaction. If you’ve had an allergic reaction to Nucala or any of its ingredients, such as mepolizumab, you shouldn’t take the drug. If you’re unsure whether you’ve had an allergic reaction to Nucala or any of its ingredients in the past, talk with your doctor before you take Nucala.
• Helminth infection. If you have or recently had a helminth infection (a parasitic infection caused by worms), tell your doctor. The infection may need to be treated before you can start taking Nucala.

Note: For more information about the potential negative effects of Nucala, see the “Nucala side effects” section above.

Avoid injecting more than the dosage of Nucala prescribed by your doctor. Using more Nucala than your doctor recommends could increase the risk or severity of side effects.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

If you’re using a Nucala prefilled autoinjector or prefilled syringe, the expiration date will be printed on the packaging. The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. Do not use the syringe or autoinjector if the expiration date has already passed.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Keep Nucala prefilled autoinjector pens and prefilled syringes in your refrigerator at 36°F to 46°F (2°C to 8°C) until you need to use them. Don’t freeze Nucala. And don’t use the drug if it has been frozen. Keep the injection in its original box to protect it from light. Don’t shake the box.

If you need to, you can keep autoinjector pens or syringes out of the refrigerator for up to seven days. However, you must keep them unopened in the box at a temperature below 86°F (30°C). Don’t use the injection if it has gotten too hot or if it has been out of the refrigerator for more than seven days.

Only take Nucala autoinjector or syringe out of its box when you’re ready to use it. Don’t use the injection if it has been out of its box for more than eight hours.

Disposal

Carefully dispose of Nucala autoinjector pens and syringes in a sharps bin, whether you have used the injection or not.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.