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Ramucirumab Dosage

Medically reviewed by Drugs.com. Last updated on Nov 7, 2018.

Applies to the following strengths: 10 mg/mL

Usual Adult Dose for Gastric Cancer

As a single agent or in combination with weekly paclitaxel: 8 mg/kg IV over 60 minutes every 2 weeks until disease progression or unacceptable toxicity

Comments:
-When given in combination, this drug should be administered prior to paclitaxel.
-Premedicate patients 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.

Use: As a single agent, or in combination with paclitaxel, for the treatment of advanced or metastatic, gastric or gastroesophageal 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 until disease progression or unacceptable toxicity

Comments:
-Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving this drug.
-Premedicate patients 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.

Use: In combination with docetaxel, 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 until disease progression or unacceptable toxicity

Comments:
-Administer this drug prior to administration of FOLFIRI.
-Premedicate patients 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.

Use: In combination with FOLFIRI (irinotecan, folinic acid, and 5-fluorouracil), 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 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 and Nephrotic Syndrome:
1) Interrupt use for urine protein levels greater than or equal to 2 g/24 hours; resume at a reduced dose once the urine protein levels returns to less than 2 g/24 hours:
-Initial dose 8 mg/kg: Reduce dose to 6 mg/kg
-Initial dose 10 mg/kg: Reduce dose to 8 mg/kg
2) If the urine protein level returns to greater than or equal to 2 g/24 hours after the first dose reduction, interrupt use again. Resume treatment at a reduced dose once the urine protein levels returns to less than 2 g/24 hours:
-Initial dose 8 mg/kg: Reduce dose to 5 mg/kg
-Initial dose 10 mg/kg: Reduce dose to 6 mg/kg
3) 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 WARNINGS:
-This drug increases the risk of hemorrhage and GI perforation. Permanently discontinue use in patients who experience these events.
-Antibodies inhibiting the VEGF pathway can cause impaired wound healing. Withhold this drug prior to surgery and discontinue use if a patient develops wound healing complications.

CONTRAINDICATIONS:
-None

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

Administration advice:
-Therapy should be initiated and supervised by physicians experienced in oncology.
-Do not administer this drug as an IV push or bolus.
-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.
-Therapy should be temporarily discontinued if severe hypertension develops.
-Continue use until disease progression or unacceptable toxicity.

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).

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.

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.

Further information

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

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