Version July 2025
Hypersensitivity reactions, including anaphylaxis
Patients treated with enzyme replacement therapies have experienced life-threatening hypersensitivity reactions, including anaphylaxis. Anaphylaxis has occurred during the early course of enzyme replacement and after extended duration of therapy. Initiate imiglucerase in a healthcare setting with appropriate medical monitoring and support measures, including access to cardiopulmonary resuscitation equipment. If a severe hypersensitivity reaction (eg, anaphylaxis) occurs, discontinue imiglucerase and immediately initiate appropriate medical treatment, including use of epinephrine. Inform patients of the symptoms of life-threatening hypersensitivity reactions, including anaphylaxis and to seek immediate medical care should symptoms occur.
Dosage guidance:
Clinical considerations: Pretreatment with antihistamines and/or corticosteroids can be considered for prevention of subsequent infusion reactions in patients with previous hypersensitivity reactions to imiglucerase or other enzyme-replacement therapies. Initiate in a health care setting with appropriate medical monitoring and support measures, including CPR equipment, readily available during administration.
Gaucher disease, type 1: IV: Initial range: 2.5 units/kg 3 times weekly, up to 60 units/kg every 2 weeks. Note: Dosage adjustments are made based on assessment and therapeutic goals. Most benefits observed with doses of 30 to 60 units/kg every 2 weeks (Ref).
Gaucher disease, type 3 (Canadian labeling; not in US labeling): IV: Initial range: 2.5 units/kg 3 times weekly, up to 60 units/kg every 2 weeks. Doses up to 120 units/kg every 2 weeks have been safely administered.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Imiglucerase (glucocerebrosidase): Pediatric drug information")
Dosage guidance:
Clinical considerations: Pretreatment with antihistamines and/or corticosteroids can be considered for prevention of subsequent infusion reactions in patients with previous hypersensitivity reactions to imiglucerase or other enzyme replacement therapies. Initiate in a health care setting with appropriate medical monitoring and support measures, including CPR equipment, readily available during administration.
Gaucher disease, type 1:
Children and Adolescents: Limited data available for children <2 years:
Initial: IV: 30 to 60 units/kg/dose every 2 weeks; consider starting on higher end of range in patients with severe disease or at high risk for complications (Ref); may increase dose in patients initiated at lower end of range if response inadequate (Ref); doses >60 units/kg/dose are rarely needed (Ref).
Maintenance: Limited data available: IV: Assess calculated dose and patient growth (weight) frequently to maintain consistent dosage per kg body weight (Ref). The appropriate dose to prevent long-term complications in pediatric patients is unknown; after therapeutic goals are achieved, any dose reduction should be considered with extreme caution and at intervals no more frequent than every 6 months; minimum dose: 30 units/kg/dose every 2 weeks (Ref).
Gaucher disease, type 3: Limited data available: Note: In the management of type 3 Gaucher disease, enzyme replacement therapy is recommended to ameliorate visceral, skeletal, and hematologic manifestations; it has not been demonstrated to impact neurological manifestations.
Children and Adolescents: IV: Initial: 60 units/kg/dose every 2 weeks (Ref). Individualize dose based on patient response; doses up to 120 units/kg every 2 weeks have been described (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Immunologic: Development of IgG antibodies (15%)
Frequency not defined:
Cardiovascular: Tachycardia
Dermatologic: Skin rash
Gastrointestinal: Abdominal pain, diarrhea, nausea, vomiting
Hypersensitivity: Hypersensitivity reaction (including anaphylaxis, angioedema, severe hypersensitivity reaction), infusion-related reaction
Local: Burning sensation at injection site, discomfort at injection site, swelling at injection site
Nervous system: Chills, dizziness, fatigue, headache
Neuromuscular & skeletal: Back pain
Respiratory: Pneumonia, pulmonary hypertension
Miscellaneous: Fever
There are no known contraindications listed in the US manufacturer's labeling.
Canadian labeling: Severe hypersensitivity to imiglucerase or any component of the formulation
Concerns related to adverse effects:
• Antibody formation: Development of IgG antibodies has been reported in ~15% of patients and has been observed within 6 months from the onset of therapy; antibody formation is rare after 12 months of therapy; may increase risk of hypersensitivity reactions.
• Hypersensitivity reactions: Imiglucerase may cause severe hypersensitivity reactions, including anaphylaxis (sometimes life-threatening). Other reactions have included angioedema, chest discomfort, cough, cyanosis, dyspnea, flushing, hypotension, pruritus, tachycardia, and urticaria. Incidence is increased in patients with antibodies to imiglucerase. Discontinue treatment and institute appropriate therapy if hypersensitivity occurs. When retreating patients with prior hypersensitivity, administer antihistamine and/or corticosteroid premedications and decrease infusion rate.
• Infusion-related reactions: Imiglucerase may cause infusion-related reactions, including angioedema, chest discomfort, chills, fatigue, fever, hypertension, infusion-site burning/discomfort/swelling, pruritus, rash, and urticaria. Consider decreasing the infusion rate, temporarily withholding the infusion, and/or administering antihistamines, and/or antipyretics if infusion-related reactions occur.
Dosage form specific issues:
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.
Other warnings/precautions:
• Registry: A registry has been established and all patients with Gaucher disease, and physicians who treat Gaucher disease are encouraged to participate. Information on the International Collaborative Gaucher Group (ICGG) Gaucher Registry may be obtained at https://www.registrynxt.com, or by calling 1-800-745-4447 (ext.15500).
Based on postmarketing reporting, the most common reported adverse events in children 2 to 12 years include dyspnea, fever, nausea, flushing, vomiting, and coughing; for children ≥12 years and adolescents, the most common reported adverse events include headache, pruritus, and rash.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous [preservative free]:
Cerezyme: 400 units (1 ea) [contains polysorbate 80]
No
Solution (reconstituted) (Cerezyme Intravenous)
400 unit (per each): $2,080.96
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous:
Cerezyme: 400 units (20 mL) [contains polysorbate 80]
IV: Infuse over 1 to 2 hours; may filter diluted solution through an in-line, low protein-binding 0.2-micron filter during administration. The Canadian labeling recommends a maximum infusion rate of 1 unit/kg/minute. Infusion times <1 hour are not recommended (Ref). For patients who experience infusion-related reactions, reduce rate of infusion and premedicate with an antihistamine and/or corticosteroid.
Note: Monitor patients closely for infusion-related or hypersensitivity reactions. Initiate infusion in a health care setting that includes cardiopulmonary monitoring and can provide resuscitation if necessary.
Parenteral: IV: Infusion rate depends on weight; infuse diluted solution over 2 hours for patients <18 kg, and over 1 to 2 hours for patients ≥18 kg. A maximum infusion rate of 1 unit/kg/minute is described in Canadian labeling; infusion times <1 hour are not recommended (Ref). May filter diluted solution through an in-line low-protein-binding 0.2 micron filter during administration.
Rate adjustment for infusion-related reactions or hypersensitivity:
Infusion-related reactions or mild/moderate hypersensitivity reactions: Treatment should be based on the severity of the reaction and may include temporarily interrupting the infusion, decreasing the infusion rate, and/or administration of antihistamines, antipyretics, and/or corticosteroids (Ref). Consider pretreatment with antihistamines and/or corticosteroids for prevention of subsequent infusion reactions in patients with previous hypersensitivity reactions to imiglucerase or other enzyme replacement therapies; closely monitor when readministering.
Anaphylaxis or severe hypersensitivity: Discontinue therapy immediately and treat appropriately. If the decision is made to readminister after anaphylaxis, consider premedication with antihistamines and/or corticosteroids for subsequent infusions and reduction of infusion rate; appropriately trained personnel and emergency medications should be immediately available. Monitor patient closely for recurrence.
Gaucher disease:
US labeling: Treatment of pediatric patients ≥2 years and adults with type 1 Gaucher disease that results in at least one of the following: anemia, bone disease, hepatomegaly or splenomegaly, and thrombocytopenia.
Canadian labeling: Long-term enzyme replacement therapy for patients with type 1 Gaucher disease or patients with type 3 Gaucher disease who display non-neurological manifestations (anemia, bone disease, hepatomegaly or splenomegaly, and thrombocytopenia) of the disease.
Cerezyme may be confused with Cerebyx, Ceredase
None known.
There are no known significant interactions.
Patients requiring treatment for type 1 Gaucher disease should continue imiglucerase while attempting to become pregnant to stabilize disease and achieve optimal health prior to pregnancy. Imiglucerase does not need to be initiated prior to conception in asymptomatic patients (Granovsky-Grisaru 2011).
An increased risk of adverse pregnancy outcomes has not been associated with maternal use of imiglucerase (Raynor 2019; Zimran 2009).
Pregnancy may exacerbate existing type 1 Gaucher disease or result in new symptoms. Patients with type 1 Gaucher disease have an increased risk of spontaneous abortion if disease is not well-controlled. Adverse events, including anemia, hepatosplenomegaly, and thrombocytopenia, may be exacerbated during pregnancy (Granovsky-Grisaru 2011). Based on available information, treatment with imiglucerase can reduce the risk of adverse pregnancy outcomes (Zimran 2009).
Patients requiring treatment for type 1 Gaucher disease should continue imiglucerase during pregnancy. Treatment may be initiated during pregnancy for symptomatic patients. Dosing should be based on prepregnancy weight and adjusted if clinically indicated (Granovsky-Grisaru 2011).
Data collection to monitor pregnancy and infant outcomes following exposure to imiglucerase is ongoing. Health care providers are encouraged to enroll patients exposed to imiglucerase during pregnancy in the Gaucher Patient Registry (1-800-745-4447, extension 15500 or https://www.registrynxt.com). Patients may also enroll themselves.
Imiglucerase is present in breast milk.
A case report describes the presence of β-glucocerebrosidase activity in breast milk. The mother was treated with imiglucerase throughout pregnancy and postpartum over the course of 2 pregnancies. Breast milk samples were obtained 6 months after delivery of the first child, prior to and for 24 hours after the maternal dose. Enzyme activity was lower than what was observed in the breast milk of patients not diagnosed with type 1 Gaucher disease. Enzyme activity was highest in breast milk collected 1 hour after the infusion, then decreased to pre-infusion levels. Adverse events were not observed in either breastfed infant (Sekijima 2010). Enzyme ingested by a breastfed infant would likely degrade in their digestive system (Zimran 2009).
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Breastfeeding patients requiring treatment for type 1 Gaucher disease can continue imiglucerase postpartum. Treatment may be initiated for symptomatic patients who are breastfeeding. Although imiglucerase is not expected to adversely affect the breastfed infant, evaluate the maternal risk of bone complications associated with breastfeeding; limiting breastfeeding to ~6 months or supplementing with formula for patients at high risk may be considered (Granovsky-Grisaru 2011; Zimran 2009).
Lactating patients are encouraged to enroll in the Gaucher Patient Registry (1-800-745-4447, extension 15500 or https://www.registrynxt.com).
CBC, platelets, liver function tests, IgG antibody formation periodically during the first year of treatment (Canadian labeling recommends antibody testing approximately every 3 months during the first year and at ~18 months), chitotriosidase, angiotensin-converting enzyme (ACE), acid phosphatase (AP), iron, iron-binding capacity, ferritin, vitamin B12; MRI or CT scan (liver and spleen volume), skeletal x-rays, DXA; pulmonary function tests; ECG/echocardiography; growth in pediatric patients; signs and symptoms of hypersensitivity or infusion-related reactions.
Imiglucerase is an analogue of glucocerebrosidase; it is produced by recombinant DNA technology using mammalian cell culture. Glucocerebrosidase is an enzyme deficient in Gaucher's disease. It is needed to catalyze the hydrolysis of glucocerebroside to glucose and ceramide.
Distribution: Vd: 0.09 to 0.15 L/kg
Half-life elimination: 3.6 to 10.4 minutes
Clearance: 9.8 to 20.3 mL/minute/kg
