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Long-acting C5 complement inhibitor

Ravulizumab

Brand names: Ultomiris

Ravulizumab is a long-acting humanised monoclonal antibody complement C5 inhibitor used in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome, among other indications.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds complement protein C5, preventing its cleavage to C5a and C5b and thereby blocking formation of the terminal membrane attack complex and complement-mediated haemolysis.

Prescribing in practice

  • Complement inhibition markedly increases the risk of life-threatening meningococcal infection, so meningococcal vaccination is required before treatment, with antibiotic cover if treatment must begin sooner.
  • Its long duration of action allows infrequent maintenance dosing compared with eculizumab, and a patient safety card should be issued.
  • It is given by intravenous infusion at extended intervals under specialist supervision in line with the SPC.

Monitoring

Monitor markers of haemolysis such as lactate dehydrogenase and haemoglobin, and remain alert to early signs of meningococcal or other serious infection.

Counselling the patient

  • Stress that meningococcal and other recommended vaccinations are essential and that a safety card should be carried at all times.
  • Advise seeking urgent medical care for fever, headache with neck stiffness or other features of serious infection.

Evidence & guidelines

Pivotal trials demonstrated ravulizumab was non-inferior to eculizumab in paroxysmal nocturnal haemoglobinuria with less frequent dosing.

Reference: NICE TA698/TA710; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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