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Ramucirumab Dosage

Applies to the following strength(s): 10 mg/mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Gastric Cancer

8 mg/kg IV every 2 weeks

Comments:
-This drug is administered either as a single agent or in combination with weekly paclitaxel. When given in combination, this drug should be administered prior to administration of paclitaxel.
-Continue use until disease progression or unacceptable toxicity.
-Do not administer this drug as an IV push or bolus.
-Prior to each drug infusion, all patients should be premedicated with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should also be premedicated with dexamethasone (or equivalent) and acetaminophen prior to each drug infusion.

Use: Treatment of advanced or metastatic, gastric or gastro-esophageal junction adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy.

Usual Adult Dose for Non-Small Cell Lung Cancer

10 mg/kg IV over 60 minutes on day 1 of a 21 day cycle prior to docetaxel infusion

Comments:
-This drug should be administered prior to administration of docetaxel.
-Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving this drug.
-Continue use until disease progression or unacceptable toxicity.
-Do not administer this drug as an IV push or bolus.
-Prior to each drug infusion, all patients should be premedicated with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should also be premedicated with dexamethasone (or equivalent) and acetaminophen prior to each drug infusion.

Use: This drug, in combination with docetaxel, is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with disease progression on or after platinum-based chemotherapy

Usual Adult Dose for Colorectal Cancer

8 mg/kg IV over 60 minutes every 2 weeks

Comments:
--This drug should be administered prior to administration of FOLFIRI.

-Continue use until disease progression or unacceptable toxicity.
-Do not administer this drug as an IV push or bolus.
-Prior to each drug infusion, all patients should be premedicated with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should also be premedicated with dexamethasone (or equivalent) and acetaminophen prior to each drug infusion.

Use: This drug, in combination with FOLFIRI (irinotecan, folinic acid, and 5-fluorouracil), is indicated for the treatment of patients with metastatic colorectal cancer (mCRC) with disease progression on or after prior therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine.

Renal Dose Adjustments

No dose adjustment recommended

Liver Dose Adjustments

Mild to moderate hepatic impairment (Child-Pugh A and B): No adjustment recommended
Severe hepatic impairment (Child-Pugh C): Data not available

Dose Adjustments

Infusion Related Reactions (IRR):
-Reduce the infusion rate by 50% for Grade 1 or 2 IRRs.
-Permanently discontinue for Grade 3 or 4 IRRs.

Hypertension:
-Interrupt use for severe hypertension until controlled.
-Permanently discontinue use for severe hypertension that cannot be controlled.

Proteinuria:
-Interrupt use for urine protein levels greater than or equal to 2 g/24 hours. Resume treatment at a reduced dose of 6 mg/kg every 2 weeks once the urine protein level returns to less than 2 g/24 hours. If a protein level greater than or equal to 2 g/24 hours reoccurs, interrupt use and reduce the dose to 5 mg/kg every 2 weeks once the urine protein level returns to less than 2 g/24 hours.
-Permanently discontinue use for urine protein levels greater than 3 g/24 hours or for nephrotic syndrome.

Wound Healing Complications:
-Interrupt use prior to scheduled surgery until the wound is fully healed.

Arterial Thromboembolic Events, Gastrointestinal Perforation, or Grade 3 or 4 Bleeding:
-Permanently discontinue use.

Precautions

US BOXED WARNING:
-Ramucirumab increased the risk of hemorrhage, including severe and sometimes fatal hemorrhagic events.
-Permanently discontinue use in patients who experience severe bleeding.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Reconstitution/preparation techniques:
-Sodium chloride 0.9% is the only diluent that should be used for reconstitution. Dextrose solutions should not be used.
-Refer to the manufacturer product information.

Administration advice:
-Gently invert the container for adequate mixing.
-Do not dilute with other solutions or co-infuse with other electrolytes or drugs.
-Administer drug via infusion pump over 60 minutes through a separate infusion line.
-Flush the line with sterile sodium chloride (0.9%) solution for injection at the end of the infusion.

Storage requirements:
-Store in a refrigerator at 2C to 8C (36F to 46F)
-Do not freeze the vial.
-The reconstituted solution is stable for 24 hours under refrigeration 2C to 8C (36F to 46F) and for 4 hours at room temperature (below 25C or 77F).

General:
-Protect from light
-Do not shake the vial.
-Discard the vial if matter or discolorations are present.

Patient advice:
-This drug can cause severe bleeding. Contact your healthcare provider if you are bleeding or have symptoms of bleeding (including lightheadedness).
-Your blood pressure should be monitored every 2 weeks or more frequently.
-You should notify your healthcare provider if you experience severe diarrhea, vomiting, or severe abdominal pain.
-This drug can delay wound healing. Discuss any surgical procedures with your healthcare provider.
-Avoid getting pregnant during treatment with this drug and for at least 3 months following your last dose.
-Do not nurse a baby while being treated with this drug.

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