allergyatlasCANADIAN TREATMENT GUIDEFor Canadian clinicians

Hereditary angioedema.

4 prevention treatments

Subcutaneous

U.S. reference · 2017

Haegarda

Human C1 esterase inhibitor

2000 IU and 3000 IU vials

60 IU/kg twice weekly

Every 3–4 days

Adolescents & adults
Dosing & precautionsDetails

Routine prevention of HAE attacks in adolescents and adults. Not an acute treatment.

Dosing

Inject 60 IU/kg subcutaneously twice weekly, every 3–4 days.

The Canadian indication does not specify a numeric minimum age. Pediatric study entry ages are not an approved age cutoff; review the full label with an HAE specialist.

Administration

  • Reconstitute before use. Self-administration requires appropriate training.
  • Maintain access to on-demand medicine for breakthrough attacks.

Precautions

  • Serious hypersensitivity can occur. Human-plasma products carry a residual infectious-agent risk.
  • Consider hepatitis A/B vaccination with repeated plasma-derived therapy. Thrombosis with high-dose, off-label IV C1-inhibitor should not be equated with demonstrated risk at the recommended SC dose.
Canadian monograph ↗Health Canada ↗

Haegarda label: 13 April 2022

multivu.com ↗ · U.S. Haegarda 2000 IU and 3000 IU cartons and vials

Subcutaneous

U.S. reference

Takhzyro

Lanadelumab

300 mg/2 mL · 150 mg/1 mL paediatric

Every 2–4 weeks

Age- and weight-specific schedules

2+ years · ≥10 kg
Dosing & precautionsDetails

Routine prevention of HAE attacks from age 2. Pediatric patients must weigh at least 10 kg. Not an acute treatment.

Dosing

Age 12+: 300 mg SC every 2 weeks. Every 4 weeks may be considered after more than 6 months of stable, attack-free control.

Age 2–<12, 10–<20 kg: 150 mg every 4 weeks; may increase to every 3 weeks for inadequate control.

Age 2–<12, ≥20 kg: 150 mg every 2 weeks; may reduce to every 4 weeks with stable attack-free control.

A stably attack-free patient weighing 20–<40 kg may continue the pediatric regimen on reaching age 12. Review the full dosing table.

Administration

  • Under age 12: administration by a trained caregiver or healthcare professional. Do not use the prefilled pen.
  • Use the correct prescribed presentation; do not infer a pediatric dose can be delivered from the adult pen.

Precautions

  • Hypersensitivity, including severe reactions, and injection-site reactions may occur.
  • Pregnancy/lactation evidence is limited. Lanadelumab may interfere with aPTT assays.

The 150 mg/1 mL prefilled syringe is approved but not listed as marketed in the DPD. The marketed vial permits withdrawal of the prescribed dose; consult the full preparation instructions and confirm supply. Do not use the prefilled pen under age 12.

Canadian monograph ↗Health Canada ↗

Takhzyro label: 2 March 2026

store.takeda.com ↗ · U.S. Takhzyro 300 mg/2 mL prefilled syringe

Oral

U.S. reference

Orladeyo

Berotralstat

150 mg capsule

Once daily

150 mg with food

12+ years · pediatric ≥40 kg
Dosing & precautionsDetails

Routine prevention of HAE attacks in adults and pediatric patients aged 12 and older. The labeled pediatric dosing group weighs at least 40 kg.

Dosing

Take one 150 mg capsule orally once daily with food.

Not rescue treatment. Do not take additional doses for an attack; maximum one dose per day.

Administration

  • Swallow the capsule whole. Review the full interaction list before prescribing.
  • Canadian dosing must not be replaced with U.S. pediatric or lower-dose schedules.

Precautions

  • Excess exposure can prolong QT. Avoid moderate/severe hepatic impairment and severe renal impairment; consult the label if treatment is necessary.
  • Important P-gp, BCRP and CYP interactions; avoid P-gp inducers. GI effects are common. Avoid abrupt discontinuation of androgens when transitioning.
  • Prefer avoiding use in pregnancy; review risks and benefits.
Canadian monograph ↗Health Canada ↗

Orladeyo label: 7 May 2025

rss.globenewswire.com ↗ · U.S. Orladeyo 150 mg packs and capsule

Subcutaneous

U.S. reference

Andembry

Garadacimab

200 mg prefilled pen

Once monthly

200 mg after a loading dose

12+ years
Dosing & precautionsDetails

Routine prevention of HAE attacks in adults and pediatric patients aged 12 and older. Not an acute treatment.

Dosing

Day 1: 400 mg SC, given as two 200 mg injections. Then 200 mg SC once monthly.

Administration

  • Train the patient or caregiver in injection technique.
  • The prefilled pen is marketed; the prefilled syringe is approved but not listed as marketed.

Precautions

  • Hypersensitivity may occur. Garadacimab may interfere with aPTT assays.
  • Evidence is limited in patients with coagulation disorders, thromboembolic history or concomitant anticoagulants.
  • Some normal-C1-inhibitor HAE subtypes may not respond. Prefer avoiding pregnancy; lactation risk cannot be excluded.
Canadian monograph ↗Health Canada ↗

Andembry label: 6 August 2025

andembry.com ↗ · U.S. manufacturer reference of the Andembry autoinjector

Keep on-demand treatment for at least two attacks available, including during prevention.

Clinical notes

Before a procedure

IV plasma-derived C1-inhibitor is guideline-supported prophylaxis. Berinert use for this purpose is off label in Canada; select dose and timing with an HAE specialist.

Keep on-demand treatment for at least two attacks available during and after the procedure, with a plan for delayed symptoms over 48 hours.

Pregnancy & breastfeeding

The International/Canadian guideline favours plasma-derived C1-inhibitor. Individualize treatment with an HAE specialist.

Scope

Evidence is strongest for HAE types 1/2. Normal-C1-inhibitor HAE needs specialist confirmation and an individualized plan.

Approval, marketed status, supply and coverage are different. Age filters do not assess weight or formulation eligibility.

Clinical guideline ↗

About Allergy Atlas

Payam Salimi

AUTHOR

Payam Salimi

PGY-4 · Clinical Immunology & Allergy
University of Manitoba

I created Allergy Atlas during my allergy residency as a practical educational resource. I’m continually updating the content, adding resources, and improving the site as I learn and receive feedback. I hope you find it useful.

If you notice an error, have a suggestion, or would like to get in touch, please contact salimip@myumanitoba.ca.

Reviewers & Advisors

Allergy Atlas continues to evolve with advice, feedback, and contributions from colleagues. Thank you to those helping improve this resource.

  • Dr. Lundy McKibbin (University of Manitoba)

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