ravulizumab at a glance
Medicine class
Monoclonal antibody and terminal complement C5 inhibitor
Licensed uses
Selected patients with PNH, aHUS, AChR-antibody-positive generalised myasthenia gravis or AQP4-antibody-positive NMOSD
Administration
Diluted and given into a vein by a healthcare professional
Key safety issue
Increased susceptibility to meningococcal infection despite vaccination
What is ravulizumab used for?
UK-licensed uses represented by the selected intravenous product include:
Paroxysmal nocturnal haemoglobinuria (PNH) in eligible adults and children who meet the SmPC disease-activity or previous eculizumab criteria.
Atypical haemolytic uraemic syndrome (aHUS) in eligible adults and children who are complement-inhibitor naïve or have responded to eculizumab.
Add-on treatment for adults with generalised myasthenia gravis who are anti-acetylcholine-receptor antibody positive.
Treatment of adults with neuromyelitis optica spectrum disorder who are anti-aquaporin-4 antibody positive.
How does ravulizumab work?
Ravulizumab binds complement protein C5 and prevents it splitting into C5a and C5b. This reduces inflammation and formation of the membrane attack complex while preserving earlier complement functions involved in immune-complex clearance and marking microorganisms for removal.
How to take ravulizumab
Ravulizumab is administered by a healthcare professional under specialist supervision. The concentrate is diluted with sodium chloride solution and given through an intravenous infusion pump and filter; it must not be given as an intravenous push or bolus.
Tell the infusion team promptly about pain, chills, dizziness, breathing difficulty or other symptoms during administration.
Carry the supplied patient alert card and show it to healthcare professionals.
ravulizumab side effects
Common or expected effects
- Headache or dizziness
- Upper respiratory infection, common-cold symptoms or urinary infection
- Diarrhoea, nausea or abdominal pain
- Fever or fatigue
- Back or joint pain
- Rash, itching or hives
- Muscle pain, spasms, chills or an infusion-related reaction
Get urgent medical advice
- Meningococcal infection, meningitis, encephalitis or sepsis
- Anaphylaxis or another severe infusion-related allergic reaction
- Disseminated gonococcal infection
ravulizumab in pregnancy
Ravulizumab may be considered in pregnancy only after specialist assessment of maternal benefit and fetal risk. Human evidence remains limited, although a retrospective series of 19 ravulizumab-exposed PNH pregnancies reported live births in all cases; this small study does not remove uncertainty. Discuss pregnancy planning or a suspected pregnancy promptly with the specialist team rather than stopping treatment independently.
ravulizumab while breastfeeding
The UK SmPC advises stopping breastfeeding during ravulizumab treatment and for 8 months afterwards because risk to the infant cannot be excluded. Emerging reports describe very low milk transfer and no observed harm in a small number of infants, but this has not changed current product advice; specialist review is essential.
ravulizumab interactions
Formal interaction studies are limited. The specialist team should review all medicines and procedures, particularly:
Rituximab
C5 blockade may reduce rituximab's complement-dependent cytotoxic effect.
Chronic intravenous immunoglobulin
May increase ravulizumab clearance and lower its blood concentration.
Plasma exchange or plasmapheresis
Can reduce ravulizumab exposure, so administration must be coordinated by the specialist team.
Common questions about ravulizumab
Answers are fully visible for fast scanning and source review.
Why does ravulizumab increase the risk of meningitis?
C5 blockade weakens terminal complement activity, an important defence against meningococcal and other Neisseria bacteria.
Can meningococcal infection occur after vaccination while taking ravulizumab?
Yes. Vaccination reduces but does not remove the risk, so suspected symptoms still require immediate medical assessment.
Why must I carry a patient alert card?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.