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Travelling with Monoclonal Antibodies

Home Medications Travelling with Monoclonal Antibodies

Monoclonal antibodies (MAbs) are effective therapies used for severe asthma.

These medicines reduce the rate of severe attacks requiring oral corticosteroid tablets, and can improve other aspects of asthma control.

In Australia there are currently four of these MAbs approved for the treatment of patients with severe allergic or eosinophilic asthma, who despite optimised standard treatment remain uncontrolled. These therapies are given via subcutaneous injection in either a pre-filled syringe or pre-filled pen (Auto injector) at specific intervals between two, four and eight weekly depending on the product. They are generally very well tolerated, and most people using them are taught to self-administer. The medications are PBS funded and require authority scripts from an asthma specialist.

Because these medicines are effective, people using them often feel sufficiently well to travel. This requires some planning and in this article you will find guidance on how to manage, store and dispose of the medication and ensure there are no breaks in provision.

  • The introduction of monoclonal antibody (MAb) therapy has allowed many people with severe asthma the freedom to travel.
  • These specialist medicines require authority scripts, and must be stored, used and disposed of in accordance with specific guidance.
  • We recommend that before prolonged travel, people on MAbs:
    • Notify their specialist to arrange a review and ensure they have appropriate plans, scripts and paperwork.
    • Contact their pharmacy to arrange provision of their required amount of medication.
    • Contact their airline, cruiseline or similar to discuss access to fridge or cool bricks during travel.

General Travel information

This guidance assumes that specialist healthcare providers have considered whether self-administration of monoclonal anti-bodies is appropriate for the patient, and if so, provide training to show the patient or caregiver the correct way to use the treatment and confirm the patient/ caregiver is confident and accurate in administration.

Before Travel
During Travel
Before Travel
  • The general advice for people travelling with asthma is to be as well as possible, and to be well-prepared.
  • Being as well as possible means taking steps such as:
    • Taking every prescribed dose of regular preventer inhalers and tablets
    • Smoking cessation
    • Having the treatment reviewed by the specialist, including for other ailments like rhinitis, reflux, etc that can impact symptoms
  • Being well-prepared means taking steps such as:
    • Having appropriate vaccinations for respiratory and (if applicable) other communicable diseases
    • Ensuring there is appropriate health insurance
    • Reviewing the need for a rescue pack of prednisolone with the specialist
    • Potentially having a “high altitude simulation test” in cases of breathlessness on daily activities (the specialist will advise)
    • Ensuring there is sufficient medicine (antibody and inhalers) for the whole trip and they won’t expire while away. Consider extra medication, in case of a delay or unexpected circumstances (making sure the quantity is within the law)
  • Ensure there is a letter from the prescriber, detailing any prescription medicines. The letter should include the name of the medicine, how much is being taken, and that it is for their personal use.
  • To ensure there is sufficient medicine for the trip (limited to 6 months maximum) the specialist may need  to complete Regulation 49 form to allow original and repeat scripts to be supplied at the same time. It may not be possible to have the monoclonal antibody dispensed in another country you are visiting (PBS Regulation 49 details can be found here).
  • Customs clearance is required for some medicines before entering some countries. Patients should check the Embassy or Consulate of the countries they are travelling to in relation to the specific medications. Visit the Australian Department of Foreign Affairs Foreign Embassies and Consulates page here.
During Travel
  • All medications should be transported in carry-on baggage.
  • Monoclonal antibodies (and all medications) should be stored & transported in the original packaging, including the original box, and clearly labelled with the patients name and contact information.
  • Pack alcohol swabs, band-aids/cotton balls, and a small sharps container in checked baggage.
  • Ensure medications are not accessible to children whilst travelling.

Keeping things cool

  • Travellers can contact their airline to check whether there is access to a fridge to store medication in-flight, or alternatively, whether the airline can provide cool bricks or ice to maintain the cold-chain.
  • The pharmacy may be able to supply cold-chain resources (i.e. ice-box/bag etc) for the purposes of travel.
  • For long flights (or other locations where no fridge is available), patients can bring a supply of plastic zip lock bags, to allow ice-replenishment by the cabin staff (or other businesses at destination, e.g. café, hotel, petrol station) if required. The ice-box/bag will need to be of good quality and large enough for the entire medication supply and several ice packs.
  • For hotel room fridge storage – it is important to make sure the fridge is adjusted properly so that it is cold enough but will not cause medication to freeze. Travellers should be aware of fridges that turn off when leaving the room – in some countries it is standard practice to turn the power to a hotel room off when the room is not occupied.

Storage temperatures – refer to specific monoclonal antibody information, below.

Disposal – Discard pen device or pre-filled syringe into a sharps container. Once the sharps container is full, it must be sealed and disposed of into a community sharps disposal facility. Within Australia many hospitals, local councils and pharmacies can provide this.  When travelling outside of Australia, check the advice of your local area, or alternatively seal your container and dispose of it on return to Australia.

Specific storage/ administration information for monoclonal antibodies

Benralizumab (FASENRA)
Format: Prefilled syringe

Special Precautions for Storage:

  • Store at 2°C to 8°C (Refrigerate. Do not freeze).
  • Do not expose to heat.
  • Do not shake.
  • Store Benralizumab (FASENRA) in the original package in order to protect from light.
  • Benralizumab (FASENRA) may be kept at room temperature up to 25°C for a maximum of 14 days. After removal from the refrigerator, Benralizumab (FASENRA) must be used within 14 days or discarded.

Preparation and administration

  • Do not use if the syringe has been frozen.
  • Prior to administration, allow Benralizumab (FASENRA) to reach room temperature (approximately 30 minutes). Keep Benralizumab (FASENRA) in the carton until ready to administer to protect it from light.
  • Administer within 24 hours after taking the syringe out of the refrigerator or discard into sharps container.
  • For more information see Benralizumab Clinical Recommendations.
Dupilumab (DUPIXENT)
Format:  Single-dose pre-filled syringe with needle shield or as a pre-filled pen

Special Precautions for Storage:

  • Store at 2°C to 8°C (Refrigerate. Do not freeze).
  • Do not expose to heat. Do not store above 25°C.
  • Do not shake.
  • Store Dupilumab (DUPIXENT) in the original package in order to protect from light
  • If necessary, Dupilumab (DUPIXENT) may be kept at room temperature up to 25°C for a maximum of 14 days. After removal from the refrigerator, Dupilumab (DUPIXENT) must be used within 14 days or discarded.

Preparation and administration

  • Do not use if the syringe has been frozen.
  • Prior to administration, allow Dupilumab (DUPIXENT) reach room temperature (approximately 30 minutes). Keep Dupilumab (DUPIXENT) in the carton until ready to administer to protect it from light.
  • For more information, see Duplimab clinical recommendations
Mepolizumab (NUCALA)
Format: Auto-injector or Pre-filled Pen

Powder for injection

Unopened vial: Refer to the product carton for storage conditions which will state either: Store at 2°C – 8°C (Refrigerate. Do not freeze)” OR “Store below 25°C (Do not freeze)”.

Protect from light. Store in the original carton until use.

Reconstituted solution

After reconstitution with Water for Injection, the product is stable for up to 6 hours when stored below 25°C. Do not freeze. During administration, protection from light is not necessary.

 Special Precautions for Storage

 Store at 2°C – 8°C (Refrigerate. Do not freeze).

  • Store Mepolizumab (NUCALA) in the original package in order to protect from light.
  • If necessary Mepolizumab (NUCALA) can be removed from the refrigerator and kept in the unopened carton for up to 7 days at room temperature (up to 30°C), when protected from light. Discard if left out of the refrigerator for more than 7 days. To ensure temperature remains under 30°C, it is advisable to keep the pen/syringe insulated (not directly on ice).

Preparation and administration

  • Do not use if the Mepolizumab (NUCALA) pen/syringe has been frozen.
  • The Mepolizumab (NUCALA) pen / syringe must be administered within 8 hours once the pack is opened. Discard if not administered within 8 hours.

For more information see Mepolizumab Clinical Recommendations.

Omalizumab (XOLAIR)
Doctor’s Letter template for Omalizumab (XOLAIR)

Format: Pre-filled syringe

Special Precautions for Storage

  • Store at 2°C – 8°C (Refrigerate. Do not freeze).
  • Protect from light. Store in the original carton until use.
  • Omalizumab (XOLAIR) prefilled syringe can be removed from and placed back in the refrigerator if needed. The total combined time out of the refrigerator may not exceed 2 days.

Preparation and administration

  • Do not use if the syringe has been frozen OR exposed to temperatures above 25°C.
  • Prior to administration, allow to Omalizumab (XOLAIR) reach room temperature (Approximately 30 minutes). Keep Omalizumab (XOLAIR) in the carton until ready to administer to protect it from light
  • For further information, see Omalizumab clinical recommendations.

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