Dupixent How to Inject Using the Pen or the Syringe?

Dupixent How to Inject: Dupixent (Dupilumab) is a biological medicine. It is neither an immune suppressant nor a corticosteroid. Biological medicines are specifically made to target a single receptor in our body.

Dupixent is a human monoclonal antibody of the IgG4 subclass. It targets IL4Rα resulting in the inhibition of IL-4 and IL-13. Both IL-4 and IL-13 execute their inflammatory processes by binding first to IL4Rα.

Dupixent is indicated in the treatment of patients with:

• Eosinophilic or allergic asthma
• Eczema (Atopic dermatitis)
• Chronic rhinosinusitis with nasal polyps
• Eosinophilic esophagitis.

Dupilumab is administered as a subcutaneous injection via Dupixent Pen or Syringe into the skin of the stomach, thighs, or arms.

How to Inject Dupixent via a Syringe?

Dupixent administration via a syringe is intended for children younger than 12 years of age. It should be administered by a doctor or a caregiver.

Before injecting Dupixent, you need:

• Dupixent pre-filled syringe
• an alcohol wipe to clean the skin
• A sterile gauze piece or a cotton ball in case there is bleeding at the injection site
• and a sharps disposal container to dispose of all the sharps. If you do not have a sharps disposal container, ask the “Dupixent MyWay” representative to provide one. It is complementary.

Before the injection, Dupixent is kept for some time at room temperature to lower its temperature. We know, that Dupixent injection (both pen and syringe) should be stored in the refrigerator at 4 C to 8 C (36 F to 46 F).

For how long should you keep Dupixent at room temperature before injecting it?

The time duration to keep Dupixent injection at room temperature varies according to the dose of the injection.

• For 100 mg and 200 mg Dupixent injections: Keep the injection at room temperature for at least 30 minutes.
• For the 300 mg injection, keep it for at least 45 minutes before injecting it

Although it is best to keep the Dupixent injection inside your refrigerator, however, if it is left at room temperature, it can be used provided the temperature has not exceeded 25 C (77 F) and no more than 14 days have passed.

So you can use Dupixent injection for up to 14 days if it is kept out of the refrigerator and at room temperature (not exceeding 25 C)

The Carton contains two injections, you should take one out by holding it from the middle.

Next check the label, dose, and expiry date. If the dose is not right or the expiry date has passed, do not inject it and inform your pharmacy.

Also, you should avoid injecting Dupixent if the solution inside seems turbid or discolored. Normally, it should be clear white or slightly yellow.

If the injection is damaged or if it falls down on a hard surface or if the needle cap is missing, do not use it.

Other “DO NOTs” when using Dupixent injections:

• Do not heat the injection using any external warmers or microwaves.
• Do not freeze the injection
• Do not shake the syringe or the pen
• Do not keep the injection in direct sunlight.

Next, wash your hands and get seated in a comfortable place.

Choose the site where to inject Dupixent:

The three recommended skin sites where Dupixent can be injected are:

• The stomach, 5 cm (2 inches) away from the belly button
• The thighs, and
• The upper arms.

The stomach is the preferred site and most people stated that the skin of the stomach is where it hurts the least.

The thighs may be used to inject as well. However, injection into the arms is only recommended if the caregiver is injecting it.

The skin of the upper arms should not be used to self-inject Dupixent. Self-injecting Dupixent into the upper arms is not recommended.

The injection should be administered at a different site each time. For example, if you inject Dupixent onto the right side of your tummy, you should inject it on the left next time or into the thighs.

Do not inject Dupixent into the skin if it is bruised, tender, red, has a rash, scar, visible veins, or any evidence of infection. Also, never inject Dupixent through your clothes.

How to clean the skin where the injection is administered?

Using the alcohol wipe or swab, rub the skin in a circular motion. Start from the point where the injection is to be administered and move outwards in a circular motion.

The Dupixent website states to move from outwards to inwards which is not the correct way or the best practice.

If you start from outwards to inwards, you are going to bring in germs from outside to the point of injection.

On the other hand, if you clean the point of injection first and move outwards, you keep the area and the surroundings clean.

After cleaning the area, let it dry. Do not touch it or blow air to dry it.

Finally, Get the Injection:

Now, pick up the syringe and hold it from the middle in your hand with the needle pointing away from you.

Pull the needle cap off once you are ready to inject it.

• Do not twist the needle cap.
• Do not recap the needle
• Do not touch the needle

Next, Pinch your skin, holding it with your index and thumb. Do not touch the center of the injection area.

Insert the needle, keeping the needle at 45 degrees.

After inserting the needle, push the plunger down until the whole medicine is injected and the syringe is empty. If you feel a little resistance, do not get scared, it’s normal.

Once the injection is administered, lift your finger off the plunger and let the needle shield covers the needle.

It is important not to pull the plunger at any time either during the injection, before the injection, or even after the injection.

Also, do not cover the needle with the needle cap after administering the injection.

If you see any blood spots at the site of the injection, apply the cotton or sterile gauze piece for a few seconds and let it dry. You can leave the skin as such or apply a bandage.

Do not rub the skin if it hurts or if you see blood spots. Do not rub it if you see a bump after the Dupixent injection.

Lastly, put the sharps and the needle cover in a sharp-resistant disposal container.

• Do not reuse the syringe.
• Do not dispose of the prefilled syringe in your household trash

How to Inject Dupixent via the Dupixent Pre-filled Pen?

Dupixent Pre-filled pen is only indicated in adults and children who are at least 12 years of age. It is not recommended for children younger than 12 years of age.

To inject Dupixent (Dupilumab) via the pre-filled pen, you need to have:

• Dupixent pre-filled pen device
• an alcohol wipe to clean the skin
• A sterile gauze piece or a cotton ball in case there is bleeding at the injection site
• and a sharps disposal container to dispose of all the sharps. If you do not have a sharps disposal container, ask the “Dupixent MyWay” representative to provide one. It is complementary.

Before the injection, Dupixent is kept for some time at room temperature to lower its temperature. We know, that Dupixent injection (both pen and syringe) should be stored in the refrigerator at 4 C to 8 C (36 F to 46 F).

The method of injecting the 200 mg and 300 mg pen is the same except for the warming time. The 200 mg pen is kept at room temperature for about 30 minutes before administering the injection.

The 300 mg pen is kept for at least 45 minutes before injecting it.

Although it is best to keep the Dupixent prefilled pen inside your refrigerator, however, if it is left at room temperature, it can be used provided the temperature has not exceeded 25 C (77 F) and no more than 14 days have passed.

So you can use Dupixent injection for up to 14 days if it is kept out of the refrigerator and at room temperature (not exceeding 25 C).

Before injecting Dupixent Pen, familiarize yourself with the pen device:

The Dupixent prefilled pen device is like a pen with the following parts:

• A needle cover
• A cap
• A window

The Carton contains two injections, you should take one out by holding it from the middle.

Next check the label, dose, and expiry date. If the dose is not right or the expiry date has passed, do not inject it and inform your pharmacy.

Also, you should avoid injecting Dupixent if the solution inside seems turbid, solid yellow, or discolored. Normally, it should be clear white or slightly yellow. Do not use it if the cap is missing.

If the injection is damaged or if it falls down on a hard surface or if the needle cap is missing, do not use it. An air bubble in the solution is totally normal.

Other “DO NOTs” when using Dupixent injections:

• Do not heat the prefilled pen device using any external warmers or microwaves.
• Do not freeze the injection
• Do not shake the syringe or the pen
• Do not keep the injection in direct sunlight.

Next, wash your hands and get seated in a comfortable place.

Choose the site where to inject Dupixent:

The three recommended skin sites where Dupixent can be injected are:

• The stomach, 5 cm (2 inches) away from the belly button
• The thighs, and
• The upper arms.

The stomach is the preferred site and most people stated that the skin of the stomach is where it hurts the least.

The thighs may be used to inject as well. However, injection into the arms is only recommended if the caregiver is injecting it.

The skin of the upper arms should not be used to self-inject Dupixent. Self-injecting Dupixent into the upper arms is not recommended.

The injection should be administered at a different site each time. For example, if you inject Dupixent onto the right side of your tummy, you should inject it on the left next time or into the thighs.

Do not inject Dupixent into the skin if it is bruised, tender, red, has a rash, scar, visible veins, or any evidence of infection. Also, never inject Dupixent through your clothes.

How to clean the skin where the injection is administered?

Using the alcohol wipe or swab, rub the skin in a circular motion. Start from the point where the injection is to be administered and move outwards in a circular motion.

The Dupixent website states to move from outwards to inwards which is not the correct way or the best practice.

If you start from outwards to inwards, you are going to bring in germs from outside to the point of injection.

On the other hand, if you clean the point of injection first and move outwards, you keep the area and the surroundings clean.

After cleaning the area, let it dry. Do not touch it or blow air to dry it.

Finally, Get the Injection:

Now, pick up the Dupixent Prefilled pen device and hold it from the middle in your hand. Pull the needle cap off once you are ready to inject it.

Next, Pinch your skin if you are skinny holding it with your index and thumb. If you have an adequate amount of fat, you can directly inject the prefilled pen device without holding the skin or making a fold.

Keep the prefilled Dupixent Pen device at 90 degrees, and press it against the skin firmly. Hold the pre-filled pen device in such a way that you can see the window. You’ll see the window turns yellow once the injection is administered.

Take a deep breath and push the pre-filled pen until the needle cover disappears. The needle cover will disappear and a “click” sound will be heard.

With the first “click”, the injection will begin. It may take up to 15 seconds for the whole injection to be administered.

At the same time, the window will turn completely yellow when the whole injection is administered. To make sure the whole medicine is injected, count up to 5 after the window is completely yellow.

Lift off the pen straight. You are all done. Great!

A few points to remember when Injecting Dupixent pre-filled pen:

If you press the pen and you feel a little resistance, do not get scared, it’s normal.

If you lift the pen before the window screen is completely yellow, you may not have injected the whole dose. In such cases, you may notice the medicine coming out of the syringe when you lift it off. Consult your healthcare provider. Do not administer a second dose.

If you see any blood spots at the site of the injection, apply the cotton or sterile gauze piece for a few seconds and let it dry. You can leave the skin as such or apply a bandage.

Do not rub the skin if it hurts or if you see blood spots. Do not rub it if you see a bump after the Dupixent injection.

Lastly, put the pre-filled pen device in a sharp-resistant disposal container.

• Do not dispose of the prefilled syringe in your household trash
• Do not reuse the prefilled pen
• Do not inject through the clothes
• Do not inject into the skin that is red, bruised, has a rash, visible veins, or a scar.
• Keep your sharps disposal container in a safe place away from children.

Dupixent important safety information:

Dupixent injection should be avoided or used with caution after your healthcare advisor if you have got any of the following conditions:

• If you are allergic to the drug:

If you have an allergy to Dupixent, you might notice a little lump/ bump after a Dupixent injection. Your skin at the injection site may become red, and itchy, and you may notice hives.

Sometimes, severe allergic reactions can occur that manifest with systemic symptoms including generalized rash, redness, hives/ urticaria, low blood pressure, facial redness and swelling, lips swelling, and difficulty breathing.

Other symptoms of allergic reactions include joint pains, feeling of being sick, nausea, vomiting, swelling of lymph nodes, and cramps in the stomach.

• If you have eye problems:

Dupixent use has been associated with eye redness, watery eyes, eye pain, burning, blurring of vision, and rash around the eyes and face.

if you experience eye problems with Dupixent, you should consult your healthcare provider before the next scheduled injection.

• If you have a worms infestation or a helminthic infection:

To clear worms or helminthic infections, the human body required properly functioning eosinophils. Since Dupilumab (Dupixent) impairs the eosinophilic response to helminthic infections, it may be difficult to get rid of the worms.

It is best to treat any worm infestation before initiating Dupilumab injections. However, if during Dupilumab treatment, a person gets infected, a trial of anthelmintic drugs without stopping Dupixent is a better option than totally discontinuing Dupixent.

In resistant cases of helminthic infections, Dupilumab injections may need to be stopped.

• If you are going to receive a live vaccine:

If you are planning to receive a live vaccine, it is better not to start Dupixent treatment at least 4 to 6 weeks after the last dose.

During Dupixent treatment, it is not recommended to administer any live vaccine.

“You can get the COVID vaccine and other non-live vaccines during Dupixent treatment”.

• If you are pregnant, planning to become pregnant, or breastfeeding:

Dupixent has not been studied in pregnant or breastfeeding mothers. It is not known whether Dupilumab use will harm the baby or not.

The manufacturer, therefore, recommends avoiding Dupilumab injections during pregnancy and breastfeeding.

• If you are using corticosteroids:

Also, inform your healthcare provider if you are using corticosteroids or any other immunosuppressants.

Discontinuing corticosteroids or immune suppressants abruptly is not recommended. Abrupt discontinuation or withdrawal of corticosteroids can result in acute exacerbation of the underlying disease.

• Dupixent and joint pains:

Rarely, people using Dupixent may develop severe pains. Joint pains and pain in the muscles are relatively common especially soon after Dupixent treatment initiation.

Most people who develop joint pains have abruptly discontinued their corticosteroids and immunosuppressants.

However, joint pains can occur at any time and sometimes may be the most terrible side effect of Dupixent.

Although most patients respond to Naproxen and other over-the-counter pain medicines, it is best to consult your healthcare provider.