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Ramucirumab Dosage

Medically reviewed by Drugs.com. Last updated on Dec 11, 2019.

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.
-Refer to the prescribing information for paclitaxel for dosage information.
-Premedicate patients with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should 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 (GEJ) 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 be premedicated with dexamethasone (or equivalent) and acetaminophen.

Use: In combination with docetaxel, for the treatment 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.
-Refer to the prescribing information for fluorouracil, leucovorin, and irinotecan for dosage information.
-Premedicate patients with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should be premedicated with dexamethasone (or equivalent) and acetaminophen.

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

Usual Adult Dose for Hepatocellular Carcinoma

8 mg/kg IV over 60 minutes every 2 weeks until disease progression or unacceptable toxicity

Comments:
-Premedicate patients with an IV histamine H1 antagonist (e.g., diphenhydramine).
-Patients who have developed a Grade 1 or 2 infusion reaction should be premedicated with dexamethasone (or equivalent) and acetaminophen.

Use: As a single agent for the treatment of patients with hepatocellular carcinoma (HCC) who have an alpha fetoprotein (AFP) of 400 ng/mL or greater and have been treated with sorafenib

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

-Mild (total bilirubin within ULN and aspartate aminotransferase [AST] greater than ULN or total bilirubin greater than 1 to 1.5 times ULN and any AST) or moderate (total bilirubin greater than 1.5 to 3 x ULN and any AST) hepatic impairment: No adjustment recommended.
-Severe renal impairment: Data not available
-Clinical deterioration was reported in patients with Child-Pugh B or C cirrhosis who received this drug as a single agent.

Dose Adjustments

MANUFACTURER RECOMMENDED DOSE MODIFICATIONS:
HEMORRHAGE:
-Grade 3 or 4: Permanently discontinue therapy.
GI PERFORATION:
-All Grades: Permanently discontinue therapy.
WOUND HEALING COMPLICATIONS:
-All Grades: Withhold therapy for 28 days prior to elective surgery; resume therapy no sooner than 28 days after surgery and the wound is fully healed; discontinue therapy for wound healing complications that require medical intervention.
ARTERIAL THROMBOEMBOLIC EVENTS:
-All Grades: Permanently discontinue therapy.
HYPERTENSION:
-Severe hypertension: Withhold therapy until controlled.
-Severe hypertension not controlled with antihypertensives: Permanently discontinue therapy.
INFUSION RELATED REACTIONS (IRRs):
-Grade 1 or 2 IRRs: Reduce the infusion rate by 50%.
-Grade 3 or 4 IRRs: Permanently discontinue therapy.
PROTEINURIA:
-First occurrence of increased urine protein levels greater than or equal to 2 g per 24 hours: Withhold therapy until urine protein level is less than 2 g per 24 hours; resume therapy 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 therapy until urine protein level is less than 2 g per 24 hours; resume therapy at a reduced dose: Reduce 6 mg dose to 5 mg; reduce 8 mg dose to 6 mg.

Precautions

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.