siRNA targeting ALAS1
Givosiran
Brand names: Givlaari
Adult dose
Dose: 2.5 mg/kg SC monthly
Route: SC
Frequency: monthly
Clinical pearls
- Acute hepatic porphyria with recurrent attacks; specialist porphyria service
- Reduces ALA and PBG via knockdown of ALAS1
Contraindications
- Hypersensitivity
Side effects
- Injection site reactions
- Hepatotoxicity
- Nephrotoxicity (rise in creatinine)
- Anaphylaxis (rare)
- Homocysteine rise
Interactions
- CYP1A2 substrates
- CYP2D6 substrates
Monitoring
- LFTs
- U&E
- Homocysteine
Reference: BNF; NICE TA836 (Givosiran); SmPC; https://bnf.nice.org.uk/drugs/givosiran/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO