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ramucirumab

Generic Name: ramucirumab (RA mue SIR ue mab)
Brand Name: Cyramza

What is ramucirumab?

Ramucirumab is a cancer medicine that interferes with the growth and spread of cancer cells in the body.

Ramucirumab is used to treat stomach cancer, colorectal cancer, or non-small cell lung cancer that has spread to other parts of the body. Ramucirumab may be given alone or in combination with other cancer medicines.

Ramucirumab is usually given after other cancer medicines have been tried without success.

Ramucirumab may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ramucirumab?

Ramucirumab can increase your risk of serious bleeding. Stop using this medicine and call your doctor at once if you have severe stomach pain, bloody or tarry stools, coughing up blood, or any heavy or unusual bleeding.

What should I discuss with my healthcare provider before receiving ramucirumab?

You should not use ramucirumab if you are allergic to it, or if you have:

  • uncontrolled high blood pressure.

To make sure ramucirumab is safe for you, tell your doctor if you have:

  • high blood pressure;

  • an unhealed incision from recent surgery;

  • a thyroid disorder;

  • if you take any NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This medicine can harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Ramucirumab may affect fertility (your ability to have children).

Use birth control to prevent pregnancy while you are receiving ramucirumab, and for at least 3 months after your treatment ends.

It is not known whether ramucirumab passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How is ramucirumab given?

Ramucirumab is injected into a vein through an IV. A healthcare provider will give you this injection.

You may be given medication to prevent certain side effects while you are receiving ramucirumab.

Ramucirumab is sometimes given once every 2 weeks. Ramucirumab may also be given in a 21-day treatment cycle and you may only need to use the medicine during the first day of each cycle. Follow your doctor's dosing instructions very carefully.

While using ramucirumab, you may need frequent blood or urine tests. Your blood pressure will need to be checked often.

If you need surgery, tell the surgeon ahead of time that you are using ramucirumab. You may need to stop using the medicine for a short time.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your ramucirumab injection.

What happens if I overdose?

Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while receiving ramucirumab?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Ramucirumab side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Some side effects may occur during the injection. Tell your caregiver right away if you feel light-headed, chilled, sweaty, or have chest pain, chest tightness, back pain, trouble breathing, or numbness and tingling.

Ramucirumab can increase your risk of serious bleeding.

Call your doctor at once if you have:

  • any wound that will not heal;

  • headache, confusion, change in mental status, vision loss, seizure (convulsions);

  • severe or ongoing stomach pain, vomiting, or diarrhea;

  • a light-headed feeling, like you might pass out;

  • low white blood cell counts--fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough, trouble breathing;

  • dangerously high blood pressure--severe headache, blurred vision, buzzing in your ears, anxiety, shortness of breath, uneven heartbeats;

  • kidney problems--puffy eyes, swelling in your ankles or feet, weight gain, urine that looks foamy;

  • signs of stomach bleeding--severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • symptoms of a blood clot--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance; or

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common side effects may include:

  • feeling weak or tired;

  • diarrhea;

  • nosebleed;

  • low white blood cell counts; or

  • high blood pressure.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ramucirumab dosing 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.

What other drugs will affect ramucirumab?

Other drugs may interact with ramucirumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about ramucirumab.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.04.

Date modified: November 30, 2016
Last reviewed: April 28, 2015

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