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Cyramza Dosage

Generic name: ramucirumab 10mg in 1mL
Dosage form: intravenous infusion

Medically reviewed by Drugs.com. Last updated on May 10, 2019.

Premedication

  • Prior to each CYRAMZA infusion, premedicate all patients with an intravenous histamine-1 receptor antagonist (e.g., diphenhydramine hydrochloride) [see Warnings and Precautions (5.6)].
  • For patients who have experienced a Grade 1 or 2 IRR, premedicate with a histamine-1 receptor antagonist, dexamethasone (or equivalent), and acetaminophen prior to each CYRAMZA infusion [see Dosage and Administration (2.6)].

Recommended Dosage for Gastric Cancer

  • The recommended dosage of CYRAMZA, either as a single agent or in combination with weekly paclitaxel, is 8 mg/kg every 2 weeks administered by intravenous infusion over 60 minutes. Continue CYRAMZA until disease progression or unacceptable toxicity.
  • When given in combination with paclitaxel, administer CYRAMZA prior to administration of paclitaxel.
  • Refer to the prescribing information for paclitaxel for dosage information.

Recommended Dosage for Non-Small Cell Lung Cancer

  • The recommended dosage of CYRAMZA is 10 mg/kg administered by intravenous infusion over 60 minutes on day 1 of a 21-day cycle prior to docetaxel infusion. Continue CYRAMZA until disease progression or unacceptable toxicity.
  • Refer to the prescribing information for docetaxel for dosage information.

Recommended Dosage for Colorectal Cancer

  • The recommended dosage of CYRAMZA is 8 mg/kg every 2 weeks administered by intravenous infusion over 60 minutes prior to FOLFIRI administration. Continue CYRAMZA until disease progression or unacceptable toxicity.
  • Refer to the prescribing information for fluorouracil, leucovorin, and irinotecan for dosage information.

Recommended Dosage for Hepatocellular Carcinoma

  • ‚ÄčThe recommended dosage of CYRAMZA is 8 mg/kg every 2 weeks administered by intravenous infusion over 60 minutes. Continue CYRAMZA until disease progression or unacceptable toxicity.

Dosage Modifications for Adverse Reactions

Reduce dose, withhold dose, or discontinue CYRAMZA to manage adverse reactions as described in Table 1.

Table 1: Dosage Modifications for CYRAMZA
Adverse Reaction Severitya Dosage Modification

a National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE) version 4.0 used to identify adverse reactions

Hemorrhage
[see Warnings and Precautions (5.1)]
Grade 3 or 4 Permanently discontinue CYRAMZA
Gastrointestinal Perforation
[see Warnings and Precautions (5.2)]
All Grades Permanently discontinue CYRAMZA
Wound Healing Complications
[see Warnings and Precautions (5.3)]
All Grades
  • Withhold CYRAMZA for 28 days prior to elective surgery. Resume CYRAMZA no sooner than 28 days after surgery and the wound is fully healed.
  • Discontinue CYRAMZA for wound healing complications that require medical intervention.
Arterial Thromboembolic Events
[see Warnings and Precautions (5.4)]
All Grades Permanently discontinue CYRAMZA
Hypertension
[see Warnings and Precautions (5.5)]
Severe hypertension Withhold CYRAMZA until controlled with medical management
Severe hypertension that cannot be controlled with antihypertensive therapy Permanently discontinue CYRAMZA
Infusion-Related Reaction (IRR)
[see Dosage and Administration (2.1), Warnings and Precautions (5.6)]
Grade 1 or 2 IRRs Reduce the infusion rate of CYRAMZA by 50%
Grade 3 or 4 IRRs Permanently discontinue CYRAMZA
Proteinuria
[see Warnings and Precautions (5.9)]
First occurrence of increased urine protein levels greater than or equal to 2 g per 24 hours
  • Withhold CYRAMZA until urine protein level is less than 2 g per 24 hours
  • Resume CYRAMZA at a reduced dose:
    • Reduce 8 mg dose to 6 mg
    • Reduce 10 mg dose to 8 mg
Reoccurrence of urine protein level greater than 2 g per 24 hours following initial dose reduction
  • Withhold CYRAMZA until urine protein level is less than 2 g per 24 hours
  • Resume CYRAMZA at a reduced dose:
    • Reduce 6 mg dose to 5 mg
    • Reduce 8 mg dose to 6 mg
Urine protein level greater than 3 g per 24 hours or in the setting of nephrotic syndrome Permanently discontinue CYRAMZA

Preparation and Administration

Preparation

  • Visually inspect vials for particulate matter and discoloration. Discard if particulate matter or discolorations are identified.
  • Calculate the dose and the required volume of CYRAMZA needed for the calculated dose.
  • Withdraw the required volume of CYRAMZA and further dilute with only 0.9% Sodium Chloride Injection in an intravenous infusion container to a final volume of 250 mL. Do not use dextrose containing solutions.
  • Do not shake. Gently invert the container to ensure adequate mixing.
  • Do not dilute with other solutions or co-infuse with other electrolytes or medications.
  • Do not freeze. Store diluted solution for no more than 24 hours at 2°C to 8°C (36°F to 46°F) or 4 hours at room temperature (below 25°C [77°F]).
  • Discard any unused portion of CYRAMZA.

Administration

  • Visually inspect the diluted solution for particulate matter and discoloration prior to administration. Discard if particulate matter or discolorations are identified.
  • Do not administer CYRAMZA as an intravenous push or bolus.
  • Administer diluted CYRAMZA solution via infusion pump over 60 minutes through a separate infusion line. Use of a protein sparing 0.22 micron filter is recommended.
  • Flush the line with sterile 0.9% Sodium Chloride Injection at the end of the infusion.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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