Donanemab
Anti-amyloid monoclonal antibodies
Anti-amyloid monoclonal antibodies
Intravenous anti-amyloid antibody for early Alzheimer disease. It lowers plaques and slows decline; ARIA and headache are its main effects.
Also called: Donanemab-azbt
Quick facts
- Group
- Anti-amyloid monoclonal antibodies
- Target
- Amyloid beta (Aβ) in amyloid plaques
- Key effects
- Headache · Infusion-related reactions
- Monitor
- ApoE ε4 status before starting
- ATC
- N06DX05
No doses: the clinician sets them by the current guideline.
Mechanism of action
Donanemab is a monoclonal antibody that binds amyloid beta in plaques and reduces the plaque burden in the brain. In its pivotal trial, patients with early symptomatic Alzheimer disease and confirmed amyloid had less clinical decline than with placebo. It controls the disease but does not cure it, and treatment may be paused or stopped according to response and adverse effects.
- The antibody binds amyloid beta deposited in plaques
- Plaque burden in the brain falls
- Clinical decline is slowed in early disease
- Reaction around vessel amyloid can cause oedema or microbleeds (ARIA)
Indications
- Alzheimer disease at the mild cognitive impairment or mild dementia stage, with confirmed amyloid pathology Alzheimer disease →
Adverse effects
Common
- Headache
- Infusion-related reactions: flu-like symptoms, nausea, vomiting, changes in blood pressure, chills, sweating, skin redness
Contraindications
- Known serious hypersensitivity to donanemab or to any of its ingredients
Key interactions
- Aspirin and other drugs that may cause bleeding
- Listed as interacting; bleeding risk is weighed because ARIA includes small brain haemorrhages.
What is monitored
- ApoE ε4 status before starting, to estimate the risk of ARIA
- MRI before starting and during treatment
- Neurological symptoms suggesting ARIA (headache, confusion, dizziness, visual change, gait trouble, seizures)
- Observation for infusion and allergic reactions
Administration and safety
- Given by intravenous infusion by a doctor or nurse in a hospital or clinic, with the patient watched during and after it.
- Medicines may be given to prevent or treat infusion reactions.
- The patient carries identification stating that they receive donanemab.
- Missed appointments are rescheduled as soon as possible.
Pregnancy and breastfeeding
It is used in older adults with Alzheimer disease; pregnancy or breastfeeding is reported to the treating doctor.
Nursing care
- Confirm that the planned MRI and ApoE testing were done and reviewed.
- During the infusion, watch for chills, sweating, nausea, vomiting, chest pain, breathlessness and blood pressure changes.
- Teach patient and carers the warning signs of ARIA.
- Ask at every visit about new drugs that may cause bleeding.
Pharmacokinetics
- Absorption
- Given only by intravenous infusion in a hospital or clinic; the dose is started low and increased.
Test yourself
Think of the answer, then tap the question to see it.
By what route is donanemab given?
Intravenous infusion in a hospital or clinic, under observation.
What are the two most common adverse effects of donanemab?
ARIA and headache.
Why is ApoE ε4 status tested before donanemab?
Homozygotes have a higher incidence of ARIA, including symptomatic and serious ARIA.
Connections
← Back to the class: Anti-amyloid monoclonal antibodies
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Donanemab-azbt injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); FDA approves treatment for adults with Alzheimer’s disease (U.S. Food and Drug Administration, 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.