Avoiding Live Vaccines
One of the most important things to avoid while taking Dupixent is live vaccines. A live vaccine contains a weakened version of a virus or bacterium that prompts an immune response without causing disease. However, Dupixent can affect certain parts of your immune system, which may increase the risk of getting an infection from the weakened virus or bacteria in the vaccine.
Examples of live vaccines to avoid while on Dupixent include:
- Measles, mumps, and rubella (MMR)
- Chickenpox (Varicella)
- Nasal spray flu vaccine (FluMist)
- Yellow fever
- Rotavirus
Before starting treatment with Dupixent, it is essential to discuss your vaccination history and future vaccination needs with your healthcare provider. The Centers for Disease Control and Prevention (CDC) generally recommends administering live vaccines at least four weeks prior to initiating immunosuppressive or immunomodulatory therapy. In contrast, inactivated (non-live) vaccines are generally considered safe while on Dupixent, and treatment does not need to be interrupted for their administration.
Avoiding Abrupt Cessation of Corticosteroids
For many patients, Dupixent is used as an add-on therapy alongside other medications, such as corticosteroids, to manage severe inflammatory conditions like asthma or atopic dermatitis. It is critical not to abruptly discontinue systemic, inhaled, or topical corticosteroids when you start Dupixent treatment.
Discontinuing corticosteroids too quickly can lead to several problems:
- Corticosteroid withdrawal symptoms: Your body can become dependent on corticosteroids, and sudden cessation can cause fatigue, nausea, and vomiting.
- Relapse of underlying conditions: Symptoms previously controlled by the corticosteroid may return or worsen.
- Unmasking other conditions: In rare cases, a serious systemic eosinophilia (increase in a type of white blood cell) presenting with features of eosinophilic pneumonia or vasculitis can occur, especially when oral steroids are being reduced.
Any reduction in corticosteroid dosage should be gradual and performed under the direct supervision of your healthcare provider.
Avoiding Over-the-Counter and Prescription Drug Interactions
While Dupixent is not known to have many drug-to-drug interactions, it's vital to inform your doctor about all medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements. Dupixent's effect on inflammation can potentially alter the activity of liver enzymes that metabolize certain other drugs, especially those with a narrow therapeutic index.
| Type of Drug | Specific Examples | Potential Interaction with Dupixent | Healthcare Provider's Action |
|---|---|---|---|
| Certain Seizure Medications | Phenytoin, Carbamazepine | Can increase side effects or reduce effectiveness | May adjust dosage or monitor blood levels |
| Warfarin | (e.g., Jantoven) | Can alter blood clotting time (INR) | Requires more frequent blood tests to monitor INR |
| Lithium | (e.g., Lithobid) | Can alter lithium blood levels | May check lithium blood levels more frequently |
| Live Vaccines | MMR, Chickenpox, Nasal Flu Spray | Increased risk of infection from the live agent | Avoid use while on Dupixent |
| Other Biologics | (e.g., Adalimumab) | Increased risk of adverse effects | Careful consideration and monitoring |
Managing Other Considerations
Alcohol Consumption
There is no known direct interaction between Dupixent and alcohol. However, patients should be cautious for two reasons:
- Worsening symptoms: Alcohol can trigger or exacerbate symptoms of the condition being treated, such as asthma.
- Facial flushing: Some rare case reports have linked alcohol consumption with facial flushing while on Dupixent, although a direct causal link is not established.
Consult your doctor about alcohol consumption while on Dupixent to ensure it does not negatively affect your condition or treatment plan.
Pre-existing Eye Conditions
Dupixent can cause eye-related side effects, such as conjunctivitis (pink eye) and keratitis (inflammation of the cornea). If you have a history of these or other eye conditions, Dupixent could potentially worsen them. It is important to tell your doctor about any pre-existing eye issues and to report any new or worsening symptoms like itching, pain, or blurred vision immediately. Your doctor may recommend a full eye exam by an ophthalmologist.
Parasitic Infections
Patients with known or suspected parasitic (helminth) infections should be treated before starting Dupixent. The effect of Dupixent on the immune response against these infections is not fully understood, and clinical trials excluded patients with such conditions. If a patient develops a parasitic infection during treatment and it does not respond to standard anti-parasitic treatment, Dupixent may need to be discontinued until the infection resolves.
What to Do If You Experience Side Effects
While Dupixent is generally well-tolerated, some serious side effects are possible.
If you experience signs of a serious allergic reaction, seek emergency medical help immediately:
- Trouble breathing or wheezing
- Swelling of the face, lips, mouth, tongue, or throat
- Fainting, dizziness, or feeling lightheaded
- Fast pulse
- Hives or severe skin rash
Report any new or worsening symptoms to your doctor, including:
- Eye problems (pain, blurred vision)
- Joint aches and pain
- High levels of eosinophils (a type of white blood cell), which can indicate a more serious condition
- Signs of new-onset psoriasis
Your doctor will help you determine the best course of action, which may include further evaluation, treatment, or discontinuing Dupixent.
Best Practices for Injection
Improper injection techniques can lead to injection site reactions, which are one of the most common side effects. To minimize this, follow these best practices:
- Rotate injection sites with each dose.
- Do not inject into skin that is tender, damaged, bruised, or scarred.
- Do not rub the injection site after the injection.
For more detailed instructions, refer to the official FDA-approved patient information.
Conclusion
Navigating treatment for a chronic inflammatory condition with Dupixent involves being mindful of several key avoidance areas. The most critical include steering clear of live vaccines and never abruptly stopping prescribed corticosteroids. Patients should also maintain open communication with their healthcare provider about their alcohol consumption, any pre-existing or new eye and parasitic conditions, and other medications they are taking. By understanding and adhering to these precautions, patients can significantly enhance the safety and effectiveness of their Dupixent therapy, ultimately improving their quality of life. Always consult your doctor or pharmacist with any questions or concerns that arise during your treatment.
