Medically reviewed by Drugs.com. Last updated on Jul 11, 2019.
(eye KAT i bant)
- HOE 140
- Icatibant Acetate
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Subcutaneous [preservative free]:
Firazyr: 30 mg/3 mL (3 mL)
Generic: 30 mg/3 mL (3 mL)
Brand Names: U.S.
- Selective Bradykinin B2 Receptor Antagonist
Icatibant is a selective competitive antagonist for the bradykinin B2 receptor. Patients with HAE have an absence or dysfunction of C1-esterase-inhibitor which leads to the production of bradykinin. The presence of bradykinin may cause symptoms of localized swelling, inflammation, and pain. Icatibant inhibits bradykinin from binding at the B2 receptor, thereby treating the symptoms associated with acute attack.
Children ≥2 years: 0.39 ± 0.11 L/kg (Farkas 2017)
Adolescents: 0.44 ± 0.18 L/kg (Farkas 2017)
Adults: 29 ± 8.7 L
Metabolized by proteolytic enzymes to metabolites (inactive)
Urine (<10% unchanged)
Onset of Action
Median time to 50% decrease of symptoms: ~2 hours
Time to Peak
Children ≥2 years: 0.42 ± 0.13 hours (Farkas 2017)
Adolescents: 0.55 ± 0.19 hours (Farkas 2017)
Adults: ~0.75 hours
Duration of Action
Inhibits symptoms caused by bradykinin for ~6 hours
Children ≥2 years: 0.8 ± 0.04 hours (Farkas 2017)
Adolescents: 1.34 ± 0.96 hours (Farkas 2017)
Adults: 1.4 ± 0.4 hours
Special Populations: Elderly
Elderly subjects had a 2-fold higher AUC compared with younger subjects. Only minor differences (12% to 14%) in Cmax were observed.
Special Populations: Gender
Women have a 2-fold higher AUC and Cmax compared with men because of differences in body weight.
Use: Labeled Indications
Hereditary angioedema: Treatment of acute attacks of hereditary angioedema (HAE)
Off Label Uses
Angiotensin-converting enzyme inhibitor–induced angioedema, severe or life-threatening
Data regarding the efficacy of icatibant for the treatment of angiotensin-converting enzyme (ACE) inhibitor-induced angioedema involving the upper aerodigestive tract (ie, face, lips, cheeks, tongue, soft palate or uvula, pharynx, larynx) are conflicting. In 2 randomized, double-blind, placebo-controlled studies, no difference in time for meeting discharge criteria or resolution of symptoms was found between icatibant and placebo [Sinert 2017], [Straka 2017]. However, data from a multicenter, randomized, double-blind, double-dummy trial suggests that the use of icatibant for the treatment of ACE inhibitor–induced angioedema may be beneficial to improve time to resolution of edema and symptom relief. In the setting of life-threatening airway compromise, rescue procedures (including intubation or tracheotomy with mechanical ventilation) may still be required [Baş 2015].
There are no contraindications listed in the manufacturer’s labeling.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to icatibant acetate or any component of the formulation.
Hereditary angioedema: SubQ: 30 mg; may repeat every 6 hours if response is inadequate or symptoms recur (maximum dose: 90 mg/day).
Angiotensin-converting enzyme inhibitor–induced angioedema, severe or life-threatening (off-label use): SubQ: 30 mg; a second 30 mg injection may be administered if symptoms of angioedema continue to worsen after 6 hours (Baş 2015; Hirschy 2018). Note: Most likely to be effective if administered within the first few hours of angioedema attack (ie, ≤6 hours) when swelling is increasing and has not yet peaked and/or stabilized (Baş 2015; Guyer 2019). IV prednisolone (not available in the US) was administered with the second dose of icatibant (Baş 2015).
Refer to adult dosing.
Hereditary angioedema (HAE): Limited data available: Children ≥2 years and Adolescents: SubQ: 0.4 mg/kg once; maximum dose: 30 mg/dose. Dosing based on an open-label study of 32 patients (mean age: 12.3 ± 3.5 years) with HAE (Farkas 2017).
SubQ: For SubQ injection only. Patients may self-administer upon recognition of an HAE attack. Inject into the abdomen over ≥30 seconds, using the 25 gauge needle provided. Inject 2 to 4 inches below belly button and away from any scars; do not inject into an area that is bruised, swollen, or painful.
Store between 2°C to 25°C (36°F to 77°F); do not freeze. Store in original container until time of administration.
Angiotensin-Converting Enzyme Inhibitors: Icatibant may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy
>10%: Local: Injection site reaction (97%)
1% to 10%:
Central nervous system: Dizziness (3%)
Hepatic: Increased serum transaminase (4%)
Miscellaneous: Fever (4%)
<1%: Antibody development (anti-icatibant, no association with efficacy observed), chest pain, headache, myocardial infarction, nausea, skin rash
Concerns related to adverse effects:
• Airway obstruction: Airway obstruction may occur during acute laryngeal attacks of HAE. Patients with laryngeal attacks should be instructed to seek medical attention immediately in addition to treatment with icatibant.
• CNS effects: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).
Symptom relief; laryngeal symptoms or airway obstruction (immediate medical attention required in addition to icatibant therapy)
Pregnancy Risk Factor
Adverse events were observed in some animal reproduction studies.
Information related to the use of icatibant in pregnancy is limited (Boufleur 2014; Farkas 2016; Kaminsky 2017; Tran 2013; Zanichelli 2015). When treatment for hereditary angioedema (HAE) in pregnancy is needed, other agents are recommended (WAO/EEACI [Maurer 2018]).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience dizziness, nausea, or headache. Have patient report immediately to prescriber severe injection site irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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More about icatibant
- Side Effects
- During Pregnancy
- Dosage Information
- Drug Interactions
- Pricing & Coupons
- En Español
- 5 Reviews
- Drug class: miscellaneous cardiovascular agents
Other brands: Firazyr