Frequent Adverse Reactions

  • Amyloid-Related Imaging Abnormalities (ARIA)
    • ARIA-Edema (ARIA-E): Temporary brain swelling (24% incidence), often asymptomatic but may cause headaches, dizziness, or confusion.
    • ARIA-Hemosiderin Deposition (ARIA-H): Microhemorrhages (25%) and superficial siderosis (15%).
  • Headache (13%).
  • Infusion-related reactions (e.g., chills, sweating, nausea, chest tightness, hypotension).

Serious but Less Common Effects

  • Hypersensitivity reactions, including anaphylaxis (swelling, hives, breathing difficulty).
  • Symptomatic ARIA: Confusion, vision changes, seizures, or difficulty walking—requiring immediate medical attention.
  • Increased bleeding risk in patients on antithrombotics.

Monitoring & Management

  • Baseline and serial MRIs (before 2nd, 3rd, 4th, and 7th infusions).
  • APOE ε4 testing (higher ARIA risk in homozygotes).
  • Post-infusion observation for ≥30 minutes due to allergic/infusion reaction risks.

Asymptomatic ARIA often resolves spontaneously, but symptomatic cases may require treatment suspension[2][5]. Patients should carry a medication alert card.

References:

[1] https://www.rxlist.com/donanemab/generic-drug.htm

[2] https://www.drugs.com/sfx/donanemab-side-effects.html

[3] https://kisunla.lilly.com/side-effects

[4] https://www.drugs.com/donanemab.html

[5] https://medlineplus.gov/druginfo/meds/a624048.html

[6] https://www.veteranshealthlibrary.va.gov/medicationsva/203,a624048

[7] https://www.webmd.com/drugs/2/drug-388270/kisunla/details

[8] https://www.alz.org/alzheimers-dementia/treatments/donanemab