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Xolair
Xolair Injection Dosage – Physician’s Quick Reference
Apr 23, 2025
Chronic allergies affect nearly one-third of U.S. adults, ranging from seasonal flare-ups to more severe immune responses. Standard antihistamines often fall short, prompting the need for advanced, long-term solutions.
Xolair (omalizumab), a monoclonal antibody that targets IgE, has become a key therapy for moderate to severe allergic asthma and chronic spontaneous urticaria. Administered by injection, its dosage depends on serum IgE levels and body weight, making precision essential.
This quick reference guide outlines Xolair’s dosage guidelines, helping physicians make informed, confident dosing decisions in clinical practice.
Key Takeaways
- Xolair (omalizumab) dosing varies by indication. Allergic asthma and nasal polyps require personalized dosing based on baseline IgE levels and body weight. Chronic spontaneous urticaria (CSU) uses a fixed dose of either 150 mg or 300 mg every 4 weeks.
- Typical Xolair injection ranges from 75 mg to 600 mg, administered subcutaneously every 2 or 4 weeks, depending on patient parameters.
- Physicians determine the doses for asthma and nasal polyps using manufacturer-supplied dosing charts, and they should confirm IgE levels and weight before starting treatment.
- Dosing adjustments are rare but may be necessary for missed doses, significant weight changes, or evolving clinical needs. Clinicians should not remeasure IgE levels once treatment has begun.
- Use official prescribing charts, online calculators, and EHR-integrated tools to ensure accurate, safe dosing across all indications.
- Regular patient monitoring improves safety and helps assess therapeutic response, particularly in long-term or high-dose cases.
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Dosage Guidelines for Xolair Injection in Allergic Asthma
The FDA has approved Xolair (omalizumab) for moderate to severe persistent allergic asthma in patients aged 6 years and older. Its dosage depends on both the patient’s body weight and baseline serum IgE levels, which must fall within specific ranges:
- Adults and adolescents (12+): IgE levels between 30–700 IU/mL
- Children (6–11 years): IgE levels between 30–1300 IU/mL
Typical Dosage Range
- 75 mg to 375 mg, administered subcutaneously every 2 or 4 weeks
Physicians must consult the official Xolair dosing chart found in the prescribing information to determine both dose and injection frequency.
If a patient’s IgE level falls outside the approved range, or if their asthma is non-allergic, Xolair may not be appropriate. Clinicians should reassess weight and clinical response if symptoms worsen or if the patient does not achieve long-term control.
Xolair Injection Dosage for Chronic Spontaneous Urticaria
Xolair is approved for chronic spontaneous urticaria (CSU) in patients aged 12 years and older who continue to experience hives despite H1 antihistamine therapy. Unlike asthma dosing, CSU does not require IgE or weight-based calculations, allowing for a more standardized approach.
Recommended Dosage
- 150 mg or 300 mg every 4 weeks
Most patients start at 300 mg, the dose shown to produce greater symptom relief in clinical trials. If symptoms become controlled over time, clinicians may reduce the dose to 150 mg at their discretion.
If no improvement occurs after 6 months, discontinuation should be considered. Xolair injections are given subcutaneously in a healthcare setting due to the rare risk of anaphylaxis, and patients should be observed briefly after each injection.
Determining Xolair Injection Dosage for Nasal Polyps
Xolair is also approved for nasal polyps in adults with an inadequate response to intranasal corticosteroids. The dosing strategy mirrors that of allergic asthma, requiring both baseline IgE levels and body weight to determine the correct regimen.
Typical Dosage Range
- 75 mg to 600 mg, administered subcutaneously every 2 or 4 weeks
Accurate dosing begins with referencing the nasal polyp-specific chart found in the prescribing information. Physicians should verify baseline IgE and weight before initiating treatment.
Knowing how to give Xolair injections is more than technique—it begins with correct dosing. As treatment progresses, patients should be monitored for clinical response and reassessed if symptoms persist or polyps recur.
Adjusting Xolair Injection Dosage Based on Patient Parameters
While Xolair dosing is largely fixed based on initial parameters, adjustments may be necessary under certain conditions. However, clinicians should not routinely remeasure IgE levels after initiating treatment.
Key Adjustment Considerations
- Missed Doses: Administer the missed dose as soon as possible, then return to the regular schedule.
- Significant Weight Change: Recalculate dose if a notable gain or loss occurs.
- IgE Fluctuations: Use baseline IgE only—new values are not used for dose adjustment.
- Liver/Kidney Impairment: No change is required for mild to moderate hepatic or renal impairment.
- Pediatric/Geriatric: No dosage changes are required, but monitor older adults closely due to limited safety data.
Throughout treatment, patients should be observed for both efficacy and adverse reactions, and clinicians should only adjust therapy when clinically justified.
Utilizing Dosing Tools for Xolair Injection
To ensure precision and consistency, clinicians are encouraged to use digital and printed dosing aids when prescribing or administering Xolair.
Useful resources include the following:
- Official Xolair Dosing Tables: Found in the full prescribing information (PDF and print).
- Online Xolair Dose Calculator: Provided on the manufacturer’s website.
- EHR-integrated Calculators: Many systems include Xolair-specific decision support tools.
- Printed Dose Cards: Useful in busy outpatient or allergy clinic settings.
- Clinical Prompts: Hospital systems often embed alerts and checks during order entry to minimize errors.
Confirm all calculations using at least two sources, especially when treating new or transitioning patients to avoid underdosing or overexposure.
Conclusion
Proper Xolair dosing is essential to achieve clinical efficacy and safety in treating allergic asthma, chronic spontaneous urticaria, and nasal polyps. While CSU follows a fixed dose, asthma and nasal polyps require personalized plans based on IgE levels and weight.
Giving Xolair injection requires careful attention to dosing guidelines, treatment response, and ongoing assessment. Leveraging official dosing tools and re-evaluating patients regularly helps ensure optimal outcomes across all indications.
FAQs
1. What is Xolair used for?
Xolair treats allergic asthma, chronic spontaneous urticaria, and nasal polyps that are unresponsive to other treatments.
2. How is Xolair administered?
Xolair is given as a subcutaneous injection, usually every 2 or 4 weeks in a healthcare setting.
3. Can Xolair cause side effects?
Yes. The most serious is anaphylaxis. Others include injection site reactions, headaches, and fatigue.
4. Is Xolair safe for children?
Yes, Xolair has approval for allergic asthma in children aged 6+ and for urticaria in patients aged 12+.
5. Can patients self-administer Xolair at home?
Currently, Xolair is administered in medical settings due to the risk of allergic reactions.
6. How long does it take for Xolair to work?
Some patients see improvement within a few weeks, but full benefits may take several months.
7. Does insurance cover Xolair?
Most insurance plans cover Xolair, but patients may need prior authorization due to its cost.
References
50 million Americans have allergies | ACAAI patient. American College of Allergy, Asthma, & Immunology. Published January 25, 2024. https://acaai.org/allergies/allergies-101/facts-stats/
Ng AE, Boersma P. Diagnosed allergic conditions in adults: United States, 2021. NCHS Data Brief. 2023;(460). Hyattsville, MD: National Center for Health Statistics. https://dx.doi.org/10.15620/cdc:122809