Spinraza Dosage/Direction for Use

Treatment with Spinraza should only be initiated by a physician with experience in the management of spinal muscular atrophy (SMA).
The decision to treat should be based on an individualised expert evaluation of the expected benefits of treatment for that individual, balanced against the potential risk of treatment with Spinraza. Patients with profound hypotonia and respiratory failure at birth, where Spinraza has not been studied, may not experience a clinically meaningful benefit due to severe survival motor neuron (SMN) protein deficiency.
Posology: The recommended dosage is 12 mg (5 ml) per administration.
Spinraza treatment should be initiated as early as possible after diagnosis with 4 loading doses on Days 0, 14, 28 and 63. A maintenance dose should be administered once every 4 months thereafter.
Duration of treatment: Information on long term efficacy of this medicinal product is not available. The need for continuation of therapy should be reviewed regularly and considered on an individual basis depending on the patient's clinical presentation and response to the therapy.
Missed or delayed doses: If a loading or a maintenance dose is delayed or missed, Spinraza should be administered according to the schedule in Table 3 as follows. (See Table 3.)

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Special populations: Renal impairment: Nusinersen has not been studied in patients with renal impairment. The safety and efficacy in patients with renal impairment has not been established and they should be closely observed.
Hepatic impairment: Nusinersen has not been studied in patients with hepatic impairment. Nusinersen is not metabolised via the cytochrome P450 enzyme system in the liver, therefore dose adjustment is unlikely to be required in patients with hepatic impairment (see Interactions and Pharmacology: Pharmacokinetics under Actions).
Method of administration: Spinraza is for intrathecal use by lumbar puncture.
Treatment should be administered by health care professionals experienced in performing lumbar punctures.
Spinraza is administered as an intrathecal bolus injection over 1 to 3 minutes, using a spinal anaesthesia needle. The injection must not be administered in areas of the skin where there are signs of infection or inflammation. It is recommended that the volume of cerebral spinal fluid (CSF), equivalent to the volume of Spinraza to be injected, is removed prior to administration of Spinraza.
Sedation may be required to administer Spinraza, as indicated by the clinical condition of the patient. Ultrasound (or other imaging techniques) may be considered to guide intrathecal administration of Spinraza, particularly in younger patients and in patients with scoliosis; see instructions for use in Special precautions for disposal and other handling under Cautions for Usage.