C5 complement inhibitor (IV monoclonal)

Eculizumab

Brand names: Soliris

Adult dose

Dose: PNH: 600mg IV weekly ×4, then 900mg week 5, then 900mg q14d. aHUS / NMOSD / gMG: per NHS England commissioning

Route: IV

Frequency: q14d (maintenance)

Clinical pearls

NICE HSTs / NHS England commissioning: PNH, atypical HUS (aHUS), refractory generalised myasthenia gravis (anti-AChR), NMOSD
MenACWY + MenB vaccination ≥2 weeks before initiation; antibiotic prophylaxis (ciprofloxacin/penicillin) first 2 weeks
Specialist tertiary centres only (PNH National Service)

Contraindications

Unresolved Neisseria meningitidis infection
Unvaccinated against meningococcal disease
Hypersensitivity

Side effects

Meningococcal infection (boxed warning)
Other encapsulated bacterial infections
Headache
Hypertension
Infusion reactions

Interactions

Live vaccines
Other immunosuppressives

Monitoring

Hb / LDH (PNH)
Renal function (aHUS)
Infections (especially meningococcal)
Disease-specific scores (MG-ADL, EDSS)

Reference: BNF; NICE HST1 (PNH); NICE HST20 (NMOSD); NICE HST evaluations; SmPC; https://bnf.nice.org.uk/drugs/eculizumab/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways