Biologics at Home

Some patients now have the choice to self-administer their biologic at home instead of receiving it at the doctor’s office on a regular basis. What do you need to know to self-administer a biologic medication at home?

How do you give biologic medication at home? 

Benralizumab, dupilumab, mepolizumab and omalizumab are all given via subcutaneous (under the skin, similar to an insulin injection).  

** Note that tezepelumab is not approved for home use at this time. Resilzumab is only given via intravenous injection. It may be given at home, but by a nurse or other trained healthcare professional.

Do I need to measure out the medication into a syringe? 

You will not need to measure out the medication into a syringe. The medications come in the following forms:

  • Benralizumab (Fasenra®) – pre-filled pen
  • Dupilumab (Dupixent®) – pre-filled syringe or prefilled pen
  • Mepolizumab (Nucala®) – pre-filled autoinjector
  • Omalizumab (Xolair®) – pre-filled syringe
  • Reslizumab (Cinqair®) – this medication is mixed in a solution, then the correct weight-based dose is removed and the rest discarded. Unlike the other medications, reslizumab is given by infusion and can sometimes be administered by a nurse at home. You would not be responsible for measuring out the correct dose.

How do you give yourself an injection? 

Prior to starting home administration of your medication, you should receive training at your clinic and demonstrate proper technique. The medication manufacturers also have videos available showing how to give your medication.

At home, remove the medication from the refrigerator and let it warm to room temperature. Once at room temperature, you select the site for injection. You should not repeat sites or administer to damaged skin. Typical spots include the stomach, upper arms or legs. Clean the area with an alcohol prep pad and let it dry for a few seconds. Follow the directions for injection specific to your medication. You can dab the area with a cotton ball if bleeding slightly. Then dispose of the device in a sharps container.  

What should I do if I miss a dose?  

Each specific medication will have information on what to do if you miss a dose. The directions will vary based upon how often you should be receiving your medication and how overdo you are. So if you miss a dose, contact your healthcare provider for directions.  

How do I know what side effects to watch for? 

Common side effects include fatigue, headache, bruising, back pain, fever, and dry or itchy skin.  There may also be redness or irritation at the injection site. 

What would be a situation that would require emergency care? 

Any signs and symptoms of anaphylaxis require epinephrine and then seek emergency medical care. Anaphylaxis symptoms include: difficulty breathing or wheezing, skin hives, tight throat, nausea or diarrhea, lightheadedness, a racing heartbeat, cool or clammy skin, or even a loss of consciousness. If you experience these symptoms following a biologic injection, administer epinephrine and call 911.

How do you store your biologic medication at home?

Storage of your biologic may vary by medication. It is important that you read the instructions for use for your particular medication. All the medications must be stored in their carton (for protection from sunlight) in the refrigerator. They should not be frozen. They should not be exposed to high temperatures or direct sunlight. Specific storage instructions include:

  • Benralizumab (Fasenra®) – stored in the refrigerator. Prior to use, it should be brought to room temperature (takes about 30 minutes). It may be kept at room temperature for up to 14 days.
  • Dupilumab (Dupixent®) – stored in the refrigerator. it should be brought to room temperature (takes about 30 minutes). It may be kept in the carton at room temperature for up to 14 days.
  • Mepolizumab (Nucala®) – stored in the refrigerator. it should be brought to room temperature (takes about 30 minutes). It may be kept in the carton at room temperature for up to 7 days.
  • Omalizumab (Xolair®) – stored in the refrigerator. Prior to use, it should be brought to room temperature (takes about 30 minutes). It may be kept at room temperature for up to 2 days.
  • Reslizumab (Cinqair®) – stored in the refrigerator. It is removed from the refrigerator and mixed in a solution of saline.  If unused, the diluted medication may be placed back in the refrigerator for up to 16 hours.
  • Tezepelumab (Tezpire®) – stored in the refrigerator. Prior to use, it should be brought to room temperature (takes about 60 minutes). It may be kept at room temperature for up to 30 days.

Are biologics dangerous for other family members?  

Biologics pose no risk to your family members. If a family member is helping administer the medications, the biggest risk would be a needlestick. If that happens, contact your healthcare provider and the medication manufacturer for directions.