How to Inject HEMLIBRA (emicizumab-kxwh)
Hi! I’m Michael, and today I’m going to demonstrate how to inject HEMLIBRA. Be sure to allow yourself enough time so your medication can reach room temperature and you can inject without interruption. Whether you’re injecting yourself or a person you care for, this video is a refresher of what you learned at your healthcare provider’s office or hemophilia treatment center.
You should not inject yourself unless you have been shown how to by your healthcare provider. I hope the video is helpful, but of course if you have any questions about your treatment, always ask your healthcare provider and be sure you read and understand the Instructions for Use that came with your HEMLIBRA before you inject it.
Alright, let’s get started. First, you’ll need to collect all the necessary injection supplies. Some may be different than what you’re used to, and you may need 2 of some items, depending on the dose that your healthcare provider prescribed.
Be sure to follow your healthcare provider’s instructions for your dose and only use the syringes and needles that he or she prescribes, being careful to only use them once and to discard everything in a sharps container right after you use it. It’s also good to mention that if your healthcare provider prescribes a dose that is more than 2 mL, you’ll need to administer more than 1 subcutaneous injection, so check with your healthcare provider for instructions.
You will need:
- Vial containing the medicine
- Alcohol wipes
- A cotton ball
- A syringe
- An 18 gauge transfer needle with 5 micron filter
- A 25, 26, or 27 gauge injection needle with a safety shield
- Sharps disposal container
Please refer to the Instructions for Use for proper storage instructions.
If you’re not sure if you have everything you need, be sure to always check out the Instructions for Use pamphlet that came in the box with HEMLIBRA and is available at HEMLIBRA.com.
Connects Patient Resource Center logo
You also can speak with a Connect coordinator at 1-866-HEMLIBRA.
Remember to inspect all supplies before you start, including the box and vial label. If they are damaged, have dropped or expired, don’t use them and get another set of supplies.
Also, check your medication to be sure it is the right strength, isn’t damaged, and hasn’t expired. Double check to make sure the name HEMLIBRA appears on the box and vial label too.
Vial for illustrative purposes only
You’ll also want to check the appearance of your medication. HEMLIBRA is a colorless to slightly yellow liquid. Don’t use it if it is damaged, looks cloudy, hazy or colored, is missing the cap covering the stopper, or has particles.
- Place supplies on a clean, well-lit surface away from direct sunlight.
- Do not try to warm up the vial by any other way.
Okay, I have everything I need. I have inspected the vial and, since I took my vial out of the refrigerator 15 minutes ago in order to bring it to room temperature, the vial is ready to use.
I’ll grab my injection log so I can track the date of my dose, how much I injected, and the injection site. And now I just need to wash my hands (with soap and water of course) and dry them thoroughly.
Let’s start by getting the HEMLIBRA vial ready.
First, take off the cap. Clean the vial stopper with an alcohol wipe and throw it away.
Attach syringe to transfer needle with filter.
Next, we need to prepare the syringe by attaching it to the transfer needle. To do this, push and twist the transfer needle clockwise until it’s fully attached.
Now, I’m going to slowly pull back the plunger to draw air into the syringe. Take your time here as you’ll want to pull back to the same amount as your prescribed dose.
As you know, your healthcare provider prescribed your dose based on your weight, and will tell you your specific dose. For me, I have a 105-mg vial and there will be a little left over, which I have to discard in a puncture-proof container.
- Do not save unused medicine in the vial for later use.
- The medicine in the syringe must be injected immediately.
- If your prescribed dose is more than 2 mL, you will need to administer more than 1 subcutaneous injection; contact your healthcare provider for the appropriate injection instructions.
Do not save unused medicine in the vial for later use, as the medicine in the syringe must be injected immediately. If your prescribed dose is more than 2 milliliters, you will need to administer more than 1 subcutaneous injection. Instructions on how to administer a second vial will be shown later in this video.
Once that’s done, uncap the transfer needle by holding the syringe at the bottom with the needle pointing up and pull the cap straight off.
- Place the transfer needle cap down on a flat surface.
- Do not touch the needle or place it on a surface after the cap has been removed.
When you’re doing this be careful not to touch the needle or place it on a surface after the cap has been removed. And don’t throw the cap away, because you’ll need it again. If you do touch the needle by accident, or it touches anything else, just throw it away and start with another one.
Next, you’ll need to inject air into the vial. With the vial on a flat surface, insert the needle and syringe straight down into the center of the vial stopper. Then, once the needle’s in the vial, turn it upside down.
With the needle above the medicine, now push that plunger to inject air out of the syringe and above the medicine.
- Do not inject air into the medicine as this could create air bubbles in the medicine.
Make sure to keep your finger pressed down on the plunger.
Next, slide the tip of the needle down so that it’s in the medicine and slowly pull back the plunger to fill the syringe.
You’ll want to fill it with more than your prescribed dose to make sure that you get the correct amount.
- Be careful not to pull the plunger out of the syringe.
- If your prescribed dose is more than is in the vial, withdraw all of the medicine and refer to the Instructions for Use on how to combine vials.
- HEMLIBRA comes in 4 strengths. Depending on your dose, you may need to use more than 1 vial to give your total prescribed dose. Your healthcare provider will determine your dose in milliliters (mL) that you will need to give based on your body weight. Do not combine HEMLIBRA vials of different concentrations in 1 injection to give the prescribed dose.
Be careful not to pull the plunger out of the syringe. If your prescribed dose is more than is in the vial, withdraw all of the medicine and refer to the Instructions for Use on how to combine vials. HEMLIBRA comes in 4 strengths. Depending on your dose, you may need to use more than 1 vial to give your total prescribed dose. Your healthcare provider will determine your dose in milliliters that you will need to give based on your body weight. Do not combine HEMLIBRA vials of different concentrations in 1 injection to give the prescribed dose.
Before we move on, we’ll also need to remove any large air bubbles in the medicine.
Just gently tap the syringe with your fingers—like this—until the air bubbles rise to the top.
Next, move the tip of the needle above the medicine and slowly push the plunger to get the air bubbles out of the syringe.
If the medicine is now at or below your prescribed dose, move that needle back into the medication and slowly pull the plunger until you have more than you need.
- Repeat these steps until you have removed all larger air bubbles.
- Ensure you have enough medicine in the syringe to complete your dose before moving on.
- If you can’t remove all medicine, turn the vial upright to reach the remaining amount.
Repeat these steps until you have removed all larger air bubbles. Ensure you have enough medicine in the syringe to complete your dose before moving on. If you can’t remove all medicine, turn the vial upright to reach the remaining amount.
When the air bubbles are gone, it’s time to recap the needle. First, remove the syringe and transfer needle from the vial.
Then, using only 1 hand, slide the needle into the cap in an upward scooping motion. You may want to use a clean, hard surface to help you—like your injection mat. Push the cap down to fully attach it.
Using 1 hand may feel awkward at first, but it helps to make sure you don’t accidentally stick yourself with the needle.
If you need to use more than 1 vial to get your total prescribed dose, follow these steps after you have prepared the vials:
- Remove the previous transfer needle
- Attach a new transfer needle
- Uncap new transfer needle
- With the new vial on a flat surface, insert the needle straight down into the center of the vial
- Turn the vial and needle upside down
- Slide the tip of the needle down so it is within the medicine, then pull the plunger back to your dose
- Recap the transfer needle
For further instructions on combining vials, please reach out to your healthcare provider.
Now it’s time to choose your injection site. You can use the front or middle of your thigh, your stomach area (abdomen), except for a 2-inch section around your belly button, or, if you are injecting someone else, you can use the outer area of the upper arm.
Today, I’ve chosen my stomach, but it’s important to choose a different location each time you take your medication. As long as the site is at least 1 inch away from the area you used last time, you’re good.
Then you’ll need to clean the injection site with an alcohol wipe and wait for about 10 seconds while it dries.
- Do not inject into areas that could be irritated by a belt or waistband.
- Do not inject into moles, scars, bruises, or areas where the skin is tender, red, hard, or the skin is broken.
- Do not touch, fan, or blow on the cleaned area before your injection.
Do not inject into areas that could be irritated by a belt or waistband. Do not inject into moles, scars, bruises, or areas where the skin is tender, red, hard, or the skin is broken. Do not touch, fan, or blow on the cleaned area before your injection.
Now, I’m ready to inject HEMLIBRA.
- Remove the transfer needle with filter.
First, remove the transfer needle from the syringe by twisting it counter-clockwise and gently pulling. Then throw away the transfer needle in a sharps container.
Don’t use the transfer needle to inject medicine as this may cause harm such as pain and bleeding.
Next, you’ll need to attach the injection needle to the syringe by pushing the needle clockwise until it is fully attached and moving the safety shield away toward the syringe barrel.
- Do not touch the needle or allow it to touch any surface.
- After the injection needle cap has been removed, the medicine must be injected immediately.
And finally, carefully pull the injection needle cap away from the syringe and throw away the cap into your sharps disposal container.
Now you’ll want to slowly push the plunger to your prescribed dose.
Next, pinch the skin on the spot you chose for your injection. You don’t need a lot of skin—just enough to hold with two fingers.
- Do not hold or push on the plunger while inserting the needle.
- Do not rub the injection site after injection.
Then fully insert the needle quickly and firmly at a 45- to 90-degree angle to your skin. Hold the syringe and let go of the pinched skin.
Now slowly push the plunger all the way down to inject the medication, then remove the needle and syringe at the same angle. Remember, do not inject the medicine intravenously—the injection goes just under the skin, not into your veins.
For safety, cover the needle with the safety shield. To do this, move the safety shield forward 90 degrees and then press down firmly against a flat surface until you hear a click.
- Keep your fingers behind the safety shield and away from the needle.
Ok, that’s it—we’re done.
- If bleeding does not stop, contact your healthcare provider.
After the injection, you may see a few drops of blood. If you do, just press a cotton ball or gauze on it to stop the bleeding. If you experience any bruising, you can also use an ice pack.
Since you can only use your needles and syringes 1 time, you can now throw them away in a sharps container. Just remember to not throw away any loose needles or syringes in your trash can.
- Only use the vial 1 time.
- Throw away any unused medicine in the vial.
- Do not save unused medicine for later use.
- Always keep the sharps disposal container out of reach of children.
Only use the vial 1 time. Throw away any unused medicine in the vial. Do not save unused medicine for later use. Always keep the sharps disposal container out of reach of children.
When I’m done, I like to write down the spot I just used in my injection log so I don’t forget. I also write down the date, time, and vial lot information in case I need it for my healthcare provider at some point in the future.
- Set a calendar reminder to help remember the next injection.
That’s it! I’ve set a calendar reminder in my phone to help me remember my next injection. You may use your phone or a paper calendar—whatever works best for you.
I know that a new routine can sometimes take a little bit of time to get used to, but keep it up and refer back to this video anytime you need a refresher.
Remember, if you have any questions, always talk to your healthcare provider.
- For a copy of the full Instructions for Use and Medication Guide, visit HEMLIBRA.com and the link to the full Prescribing Information.
Summary of injection tips for people with hemophilia A
Here are important injection tips to remember when taking HEMLIBRA:
- Leave your HEMLIBRA out for at least 15 minutes to bring it to room temperature before injecting
- If you are nervous about your first injection, it may be helpful to use some relaxation techniques or video chat with a friend for support
- Make sure to rotate injection sites each time you treat. They should be at least 1 inch from the previous injection site
- After using an alcohol swab to clean the injection site, let the skin dry for at least 10 seconds before injecting
- Pinch the skin to avoid muscle when injecting
- The medication should be injected slowly after the needle has penetrated the skin
- After the injection, do not rub the injection site
- If there is bruising, an ice pack can be applied with gentle pressure
- Always talk to your doctor if you have questions about how to administer HEMLIBRA, including any other injection tips
What is HEMLIBRA?
HEMLIBRA is a prescription medicine used for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children, ages newborn and older, with hemophilia A with or without factor VIII inhibitors.
What is the most important information I should know about HEMLIBRA?
HEMLIBRA increases the potential for your blood to clot. People who use activated prothrombin complex concentrate (aPCC; Feiba®) to treat breakthrough bleeds while taking HEMLIBRA may be at risk of serious side effects related to blood clots.
These serious side effects include:
- Thrombotic microangiopathy (TMA), a condition involving blood clots and injury to small blood vessels that may cause harm to your kidneys, brain, and other organs
- Blood clots (thrombotic events), which may form in blood vessels in your arm, leg, lung, or head
Talk to your doctor about the signs and symptoms of these serious side effects, which can include:
- Stomach, chest, or back pain
- Nausea or vomiting
- Swelling, pain, or redness
- Feeling sick or faint
- Decreased urination
- Swelling of arms and legs
- Yellowing of skin and eyes
- Eye pain, swelling, or trouble seeing
- Fast heart rate
- Numbness in your face
- Shortness of breath
- Coughing up blood
If you experience any of these symptoms during or after treatment with HEMLIBRA, get medical help right away.
Carefully follow your healthcare provider’s instructions regarding when to use an on-demand bypassing agent or factor VIII, and the dose and schedule to use for breakthrough bleed treatment. If aPCC (Feiba®) is needed, talk to your healthcare provider in case you feel you need more than 100 U/kg of aPCC (Feiba®) total.
Your body may make antibodies against HEMLIBRA, which may stop HEMLIBRA from working properly. Contact your healthcare provider immediately if you notice that HEMLIBRA has stopped working for you (eg, increase in bleeds).
The most common side effects of HEMLIBRA include: injection site reactions (redness, tenderness, warmth, or itching at the site of injection), headache, and joint pain. These are not all of the possible side effects of HEMLIBRA. You can speak with your healthcare provider for more information.
What else should I know about HEMLIBRA?
See the detailed “Instructions for Use” that comes with your HEMLIBRA for information on how to prepare and inject a dose of HEMLIBRA, and how to properly throw away (dispose of) used needles and syringes.
- Stop taking your prophylactic bypassing therapy the day before you start HEMLIBRA
- You may continue taking your prophylactic factor VIII for the first week of HEMLIBRA
HEMLIBRA may interfere with laboratory tests that measure how well your blood is clotting and create an inaccurate result. Speak with your healthcare provider about how this may affect your care.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Only use HEMLIBRA for the condition it was prescribed. Do not give HEMLIBRA to other people, even if they have the same symptoms that you have. It may harm them.
Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, or herbal supplements. Keep a list of them to show your healthcare provider and pharmacist.
Before using HEMLIBRA, tell your healthcare provider about all of your medical conditions, including if you are pregnant, plan to become pregnant, are breastfeeding, or plan to breastfeed.
Since HEMLIBRA was tested in males, there is no information on whether HEMLIBRA may impact your unborn baby or breast milk. Females who are able to become pregnant should use birth control during treatment.
Side effects may be reported to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.
Please see Important Safety Information, including Serious Side Effects, as well as the HEMLIBRA full Prescribing Information and Medication Guide.