Ravulizumab
Complement inhibitors
Complement inhibitors
A longer-acting antibody against complement C5, related to eculizumab, for PNH, atypical HUS, myasthenia gravis and NMOSD; it raises meningococcal risk.
Also called: ravulizumab-cwvz
Quick facts
- Group
- Complement inhibitors
- Target
- Complement component C5 (plasma protein)
- Used for
- Paroxysmal nocturnal haemoglobinuria
- Key effects
- Diarrhoea · Headache · Joint or muscle pain
- Monitor
- Vaccination status before starting · After stopping
- ATC
- L04AJ02
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure with ravulizumab is available; the figure shows human C5 bound to the fragment of eculizumab, a closely related C5 antibody.
Ravulizumab binds complement C5 and prevents its cleavage, so the membrane attack complex cannot form. It works like eculizumab but lasts longer in the blood, so infusions are spaced further apart. Blocking C5 also weakens the defence against Neisseria meningitidis.
- Ravulizumab binds complement C5
- C5 is not cleaved into C5a and C5b
- No membrane attack complex forms on red cells or vessels
- Its longer action allows widely spaced doses
Indications
- Paroxysmal nocturnal haemoglobinuria, in adults and children Paroxysmal nocturnal haemoglobinuria →
- Atypical haemolytic uraemic syndrome, in adults and children Hemolytic uremic syndrome (HUS) →
- Generalised myasthenia gravis with acetylcholine-receptor antibodies (adults) Myasthenia gravis →
- Neuromyelitis optica spectrum disorder (adults) Neuromyelitis optica spectrum disorder →
Adverse effects
Common
- Diarrhoea, nausea, vomiting
- Headache, dizziness
- Joint or muscle pain
- Cough, decreased appetite
- Injection-site reactions (subcutaneous form)
Contraindications
- Active meningococcal infection
- Not vaccinated against meningococcus, unless antibiotic cover is given
- Hypersensitivity to ravulizumab (and, for the on-body device, to acrylic adhesives)
Key interactions
- Meningococcal vaccines
- Given at least 2 weeks before the first dose; boosters may be needed
- Eculizumab
- Same target: the two are not combined; one replaces the other
What is monitored
- Vaccination status before starting
- Blood tests during treatment
- After stopping: at least 16 weeks of follow-up in PNH and at least 12 months in aHUS
Administration and safety
- Intravenous infusion in a health facility, or a subcutaneous on-body injector after training
- Prescribed only through a risk-management (REMS) programme
- The patient is observed for reactions during and after an infusion
Pregnancy and breastfeeding
A pregnancy is reported to the treating team; breastfeeding is not recommended during treatment and for 8 months after the last dose.
Nursing care
- Confirm meningococcal vaccination or antibiotic cover
- Ask about fever or infection before each dose
- Teach the patient to carry the safety card during treatment and for 8 months after
- Teach warning signs of meningococcal infection and of haemolysis or clots after stopping
Pharmacokinetics
- Absorption
- Intravenous infusion, or subcutaneous injection with an on-body device
- Elimination
- Broken down like other antibodies; designed to last longer than eculizumab
Test yourself
Think of the answer, then tap the question to see it.
How does ravulizumab differ from eculizumab?
Same target (C5) but longer acting, so doses are spaced further apart.
Which vaccine is needed before treatment?
Meningococcal vaccine.
How long is the safety card carried after the last dose?
8 months.
Connections
← Back to the class: Complement inhibitors
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Ravulizumab-cwvz Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.