Copaxone: Indications, Contraindications, Precautions, Interactions and Dosage

It is a drug indicated for multiple sclerosis whose active substance is glatiramer.

This injectable drug reduces recurrences of the disease, since it alters the specific autoimmune responses of myelin, a substance whose deficiency in cells is the cause of multiple sclerosis.

Glatiramer belongs to a group of medicines known as immunomodulators. Immunomodulators modify the way our body’s defense system works.

Glatiramer is used to treat relapsing-remitting form of multiple sclerosis (MS). This drug is also used to delay the onset of MS in people who have experienced a single flare of symptoms and have changes that suggest MS on their magnetic resonance imaging (MRI).

MS is a disease that affects the way the nerves in our body work. It is an autoimmune disease (the immune system attacks the body) and cannot be spread from person to person.

In MS, the myelin sheath, a protective layer that wraps around a nerve, like insulation around electrical wiring, is damaged. Typically this sleeve allows electrical messages to be sent quickly and efficiently.

If this insulation is damaged, the electrical signals in the central nervous system will not be sent correctly. For unknown reasons, in MS, the immune system sees the myelin as foreign and attacks it.

Glatiramer is believed to work by altering the immune system to reduce its harmful effects on the myelin sheath. It does not cure multiple sclerosis, but it can decrease the frequency of relapses and reduce the number of damaged areas of the brain as seen on MRI scans.

Copaxone indications

Recurrent remissive multiple sclerosis.

Contraindications

Risk pregnancy; breastfeeding women; Hypersensitivity to any component of the formula.

Inform the doctor

Before receiving Copaxone, tell your doctor:

  • If you are allergic to Copaxone or any other medicine.
  • If you have kidney disease.
  • Yes you are pregnant.
  • If you are breastfeeding.

Are there any other precautions or warnings for this drug?

Breathing problems: This drug can cause shortness of breath, which worsens the symptoms of lung disease.

Cardiovascular effects: This drug may have effects on the heart and circulatory (blood vessels) system.

Chronic progressive multiple sclerosis (CMS): The safety and efficacy of the use of this medicine by people with chronic progressive MS have not been established. Currently, glatiramer is only recommended for people with relapsing-remitting form of MS.

Immunosuppression (weak immune system): Glatiramer can modify the immune response and could interfere with useful immune function.

Kidney disease: Glatiramer has not been studied in people with reduced kidney function.

Post-injection reaction : Some people have a rare reaction that begins immediately after the injection and consists of redness, tightness in the chest with a fast or fast heartbeat, anxiety, and shortness of breath.

The symptoms of this reaction usually last about 15 minutes and disappear without further problems. However, if you experience dizziness, hives and itching, sweating, chest pain, or shortness of breath, you should contact a doctor immediately.

Vaccination: Glatiramer can modify the immune response and could interfere with useful immune function. People who receive a vaccine should inform their doctor that they are taking this medicine.

Pregnancy: Glatiramer has not been adequately studied for use by pregnant women.

Lactation: It is not known whether glatiramer passes into breast milk.

Interactions

There may be an interaction between glatiramer and any of the following:

  • BCG.
  • Denosumab.
  • Echinacea.
  • Fingolimod.
  • Leflunomide.
  • Natalizumab.
  • Pimecrolimus.
  • Roflumilast.
  • Tacrolimus.
  • Tofacitinib.
  • Trastuzumab.
  • Vaccines.

Copaxone dosage

The recommended dose of Copaxone for the treatment of relapsing-remitting multiple sclerosis is:

  • 20 mg once daily injected subcutaneously (into the fatty layer under the skin).
  • 40 mg, three times a week injected subcutaneously (into the fatty layer under the skin).

Overdose

If you take too much Copaxone, call your local Poison Control Center or seek emergency medical attention right away.

Copaxone Administration

Look at the medicine in the pre-filled syringe. If the medicine is cloudy or has particles in it, do not use it.

Each pre-filled syringe should be used for one injection only. Do not reuse the pre-filled syringe. After use, please throw it away properly.

There are 3 basic steps to injecting Copaxone pre-filled syringes.

Step 1 – gather your supplies

First, place each of the items you will need on a clean, flat surface in a well-lit area:

  • 1 blister with Copaxone pre-filled syringe.
  • Remove only 1 blister from the Copaxone pre-filled syringe box. Store all unused syringes in the pre-filled syringe box and store in the refrigerator.
  • Alcohol preparation.
  • Dry cotton ball (not included).
  • Allow the blister with the syringe inside to warm to room temperature for 20 minutes.
  • To prevent infection, wash and dry your hands. Do not touch your hair or skin after washing.
  • There may be small air bubbles in the syringe. To avoid loss of medicine when using Copaxone pre-filled syringes, do not push out (or try to push out) the air bubble from the syringe before injecting the medicine.

Step 2 – choose the injection site

  • There are 7 possible injection sites on your body: arms, thighs, hips, and lower stomach (abdomen) area.
  • Every day, choose a different injection site from one of the 7 areas. Do not inject into the same area more than once a week.
  • Within each injection area there are multiple injection sites. Have a plan to rotate your injection sites. Keep track of your injection sites, so you know where you injected yourself.
  • There are some places on your body that can be difficult to reach to inject yourself (such as the back of your arm) and you may need help.
  • Do not inject into sites where skin depression has occurred, as additional injections at these sites can deepen the depression.

Step 3 – Injection

  • Remove the syringe from its protective blister by removing the label from the paper. Before use, look at the liquid in the syringe. If it is cloudy or contains particles, do not use it. If the liquid is clean, place the syringe on the clean, flat surface.
  • Choose an injection site on your body. Clean the injection site with a new alcohol preparation and allow the site to air dry to reduce the sting.
  • Pick up the syringe as you would a pencil. Remove the needle guard.
  • With the other hand, pinch a 2-inch fold of skin between your thumb and index finger.
  • Insert the needle at a 90 degree (straight) angle, resting the heel of your hand against your body. When the needle is fully open, it releases the fold of skin.
  • To inject the medicine, hold the syringe steady and push down on the plunger.
  • When you have injected all of the medicine, pull the needle straight out.
  • Press a dry cotton ball on the injection site for a few seconds. Do not rub the injection site.
  • Dispose of the syringe in a safe, hard-walled plastic container.

Side effects

Along with its necessary effects, glatiramer (the active ingredient contained in Copaxone) can cause some unwanted effects.

See your doctor if you have:

More common

  • Anxiety.
  • Bleeding, hard lump, hives or welts, itching, pain, redness, or swelling at the injection site.
  • Chest pain.
  • Tos.
  • Excessive muscle tone.
  • Fast, irregular, pounding, or racing pulse.
  • Redness
  • Joint pain
  • Low back or side pain.
  • Neck Pain.
  • Pain or difficulty urinating
  • Acne.
  • Swelling of the face
  • Swollen lymph glands.
  • Swollen, painful, or tender lymph glands in the neck, armpit, or groin.
  • Difficulty breathing.

Less common

  • Agitation.
  • A cold.
  • Confusion.
  • Difficulty to swallow.
  • Feeling weak, dizzy, or lightheaded.
  • Fever.
  • Headache, severe and throbbing.
  • Itching of the vagina or external genitalia.
  • Muscle pains.
  • Pain during sexual intercourse.
  • Purple spots under the skin.
  • Quick weight gain.
  • Red streaks on the skin.
  • Tremors in the legs, arms, hands, or feet.
  • Small bumps under the skin.
  • Throat spasm.
  • Strong urge to urinate.
  • Perspiration.
  • Swelling of the fingers, arms, feet, or legs.
  • Thick, curd-white vaginal discharge that is odorless or has a mild odor.
  • Chest tightness.
  • Tingling of the hands or feet
  • Trembling of the hands or feet.
  • Unusual weight gain or loss.

Rare

  • Back pain.
  • Blood in the urine.
  • Burning or stinging of the skin.
  • Continuous, uncontrolled eye movements from side to side.
  • Decreased sexual ability.
  • Diarrhea.
  • Difficulty with movement.
  • Earache.
  • Fast breathing.
  • Irritation of the mouth and tongue (thrush).
  • Loss of appetite
  • Period pain or changes.
  • Muscle pain.
  • Painful sores or blisters on the lips, nose, eyes, or genitals.
  • Sensation of movement, usually spinning, either from oneself or from surroundings.
  • Speech problems
  • Eye sight problems.

Some side effects of glatiramer can occur and generally do not require medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

Also, your healthcare professional can educate you on ways to prevent or reduce some of these side effects.