What is ramucirumab?
Ramucirumab is a prescription medicine that is used to treat cancer.
Ramucirumab is a human VEGFR2 antagonist. It is a recombinant human IgG1 monoclonal antibody. Ramucirumab has an approximate molecular weight of 147 kDa. Ramucirumab is produced in genetically engineered mammalian NS0 cells.
CYRAMZA (ramucirumab) injection for intravenous use is a sterile, preservative-free, clear to slightly opalescent and colorless to slightly yellow solution. CYRAMZA is supplied at a concentration of 10 mg/mL in either 100 mg (10 mL) or 500 mg (50 mL) single-dose vials. CYRAMZA is formulated in glycine (9.98 mg/mL), histidine (0.65 mg/mL), histidine monohydrochloride (1.22 mg/mL), polysorbate 80 (0.1 mg/mL), sodium chloride (4.383 mg/mL), and Water for Injection, USP, pH 6.0.
Mechanism of Action
Ramucirumab is a VEGFR2 antagonist that specifically binds VEGFR2 and blocks binding of VEGFR ligands, VEGF-A, VEGF-C, and VEGF-D. As a result, ramucirumab inhibits ligand-stimulated activation of VEGFR2, thereby inhibiting ligand-induced proliferation, and migration of human endothelial cells. Ramucirumab inhibited angiogenesis in an in vivo animal model.
Before taking ramucirumab, tell your doctor:
- If you are allergic to ramucirumab; any part of this medicine; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
- If you have high blood pressure.
- If you are breast-feeding. Do not breast-feed while you take ramucirumab or for 2 months after your last dose.
This is not a list of all drugs or health problems that interact with ramucirumab.
Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take ramucirumab with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take ramucirumab?
- Tell all of your health care providers that you take ramucirumab. This includes your doctors, nurses, pharmacists, and dentists.
- This medicine may affect how wounds heal. If you have surgery, you may need to stop ramucirumab before surgery. Start taking it again after surgery as you are told by your doctor.
- Diarrhea, throwing up, upset stomach, and feeling less hungry are common with ramucirumab. If these happen, talk with your doctor about ways to lower these side effects. Call your doctor right away if any of these effects bother you, do not get better, or get very bad.
- Blood clots have happened with ramucirumab. Sometimes, blood clots like heart attack and stroke have been deadly. Talk with the doctor.
- High blood pressure has happened with ramucirumab. Have your blood pressure checked as you have been told by your doctor.
- Some patients have very bad side effects during the infusion. Tell your doctor if you have any bad effects during the infusion.
- Other drugs may be given to help with infusion side effects.
- Have blood work checked as you have been told by the doctor. Talk with the doctor.
- Have your urine checked as you have been told by your doctor.
- This medicine may cause liver problems to get worse in people who already have liver problems. Talk with your doctor if you have liver problems .
- A very bad and sometimes deadly brain problem called posterior reversible encephalopathy syndrome (PRES) has happened with ramucirumab. Call your doctor right away if you have signs like feeling confused, lowered alertness, change in eyesight, loss of eyesight, seizures, or very bad headache.
- Very bad and sometimes deadly holes in the GI (gastrointestinal) tract have happened with ramucirumab. Talk with the doctor.
- This medicine may cause fertility problems. This may affect being able to have children. Talk with the doctor.
- This medicine may cause harm to an unborn baby. A pregnancy test will be done before you start ramucirumab to show that you are NOT pregnant.
- Women must use birth control while taking ramucirumab and for some time after the last dose. Ask your doctor how long to use birth control. If you get pregnant, call your doctor right away.
How is ramucirumab best taken?
Use ramucirumab as ordered by your doctor. Read all information given to you. Follow all instructions closely.
- It is given as an infusion into a vein over a period of time.
What do I do if I miss a dose?
- Call your doctor to find out what to do.
What are the side effects of ramucirumab that I need to call my doctor about immediately?
WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
- Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
- Signs of bleeding like throwing up or coughing up blood; vomit that looks like coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a cause or that get bigger; or bleeding you cannot stop.
- Signs of high or low blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
- Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
- Signs of low thyroid levels like constipation; not able to handle cold; memory problems; mood changes; or a burning, numbness, or tingling feeling that is not normal.
- Signs of electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, seizures, not hungry, or very bad upset stomach or throwing up.
- Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight.
- Back pain or spasms.
- A burning, numbness, or tingling feeling that is not normal.
- Chest pain or pressure or a fast heartbeat.
- Fever or chills.
- Shortness of breath.
- Skin wound that will not heal.
- Feeling very tired or weak.
- Redness or irritation of the palms of hands or soles of feet.
What are some other side effects of ramucirumab?
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
- More tears.
- Feeling tired or weak.
- Mouth irritation or mouth sores.
- Trouble sleeping.
- Back pain.
- Stomach pain.
These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.
If overdose is suspected:
If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
How do I store and/or throw out ramucirumab?
- If you need to store ramucirumab at home, talk with your doctor, nurse, or pharmacist about how to store it.
SRC: NLM .