Ramucirumab Medication Information

Get detailed information on Ramucirumab, including pronunciation, uses, dosage guidelines, indications, and instructions on how and when to take it and when to avoid it.

The updated prescription information on Ramucirumab provides an overview of possible side effects, precautions, warnings, and storage tips.

You'll also find brand names used in india and internationally, along with pricing details. For further clarification, consult your healthcare provider.

Generic Name : Ramucirumab

Pronunciation : ra-mue-SIR-ue-mab

Therapeutic Classification : Chemotherapy

Trade Names/Brand Names of Ramucirumab

India :

Cyramza

Why is Ramucirumab Prescribed? (Indications)

Ramucirumab is used to treat stomach cancer or cancer at the junction of the stomach and esophagus, in patients with advanced or cancer that has migrated to other body parts.

It can either be used in combination with paclitaxel in patients whose cancer progresses after treating with platinum and fluoropyrimidine chemotherapy or alone in patients who cannot tolerate paclitaxel.

Ramucirumab is used to treat metastatic colorectal cancer (mCRC) in combination with 5-fluorouracil, folinic acid, and irinotecan, mainly in adult patients whose cancer has moved to other body parts. It is also used in patients who showed treatment failure with oxaliplatin, bevacizumab, and a fluoropyrimidine chemotherapy medication.

Patients with a locally advanced or metastatic non-small cell lung cancer can be treated with ramucirumab and docetaxel combination, particularly those who showed disease progression after treatment with platinum-based drugs.

Ramucirumab is a human monoclonal antibody that works by binding to specific receptors and thereby slowing down the cancer growth by preventing the multiplication and migration of cancer cells.

When should Ramucirumab not be taken? (Contraindications)

Ramucirumab should not be used in patients-

• Allergic to ramucirumab
• Pregnancy and breastfeeding
• Undergoing treatment for infertility (women)
• Children below 18 years of age
• History of severe bleeding disorders or patients taking blood thinners

What is the dosage of Ramucirumab?

Stomach cancer:

• The recommended adult dose of ramucirumab, when given as a single agent is 8 mg/kg body weight given every two weeks.

• The recommended adult dose of ramucirumab when given in combination with paclitaxel is 8 mg/kg body weight every two weeks usually on days 1 and 15 of a 28-day cycle before paclitaxel infusion.

• Paclitaxel infusion is given on days 1, 8, and 15 of a 28-day cycle at a dose of 80 mg/m².

Colorectal cancer:

• The recommended adult dose of ramucirumab is 8 mg/kg body weight for every two weeks before the administration of 5-fluorouracil, folinic acid, and irinotecan medications.

Non-small cell lung cancer:

• The recommended adult dose of ramucirumab is 10 mg/kg body weight given on day 1 of the 21-day cycle before docetaxel infusion.

• Docetaxel infusion is given as a 75 mg/m² dose on the first day of the treatment cycle.

• The treatment with ramucirumab can be continued until the patient shows no disease progression or if the treatment with ramucirumab does not result in intolerable toxicity.

• The dose of ramucirumab can be modified based on the side effects experienced by the patient during the treatment. Treatment can either be permanently discontinued or temporarily stopped until the side effects are managed appropriately.

• No dose adjustment is required when ramucirumab is given to patients with kidney damage or mild to moderate liver damage. However, patients with severe liver damage need a dose adjustment.

How should Ramucirumab be taken?

• Ramucirumab is available in an injection form that should be given directly into the vein (Intravenously) very slowly for at least 1 hour. Do not give in large volumes or as a direct intravenous (IV) push.

• Ramucirumab must be given only by a trained cancer specialist or an oncologist.

• The dose and the required volume for infusion should be calculated, and the contents of the ramucirumab vial should be diluted with 0.9% sodium chloride solution in an intravenous container to make up the final volume of 250 ml.

• Gently invert the intravenous container for proper mixing of the diluted mixture and administer through a separate IV line. Flush the IV line with 0.9% sodium chloride solution at the end of the infusion.

• Avoid mixing ramucirumab contents with the dextrose solution.

• Patients can be premedicated with fever-reducing pills (Paracetamol), drugs to treat allergies (Diphenhydramine), and steroids (Dexamethasone) to reduce the side effects of ramucirumab infusion. These medications help to manage infusion-related reactions while giving subsequent infusions.

What are the warnings and precautions for Ramucirumab?

• Women of reproductive potential should take effective contraceptive measures during ramucirumab treatment and should continue the contraceptives for three months after the last dose of ramucirumab.

• Ramucirumab increases the risk of bleeding events such as stomach bleeding mainly in patients who take medications for pain and swelling. If the bleeding episodes are frequent and high, permanently discontinue the use of ramucirumab and treat the patient accordingly.

• Patients should be monitored for their blood pressure level every two weeks or even more frequently if the patients have a history of high blood pressure as ramucirumab can cause severe high blood pressure.

• Monitor patients for symptoms and signs of infusion-related reactions such as tremors, breathing difficulty, and chills during the infusion and permanently discontinue the infusion if the side effects are severe.

• Ramucirumab can weaken or slow the process of wound healing; therefore do not use ramucirumab before any surgical procedure and re-use only when the wound is completely healed.

• Ramucirumab can cause liver damage, neurological disorder such as Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and thyroid dysfunction. Monitor patients for symptoms and signs of these illnesses and consider for medical management if the side effects are severe.

• Damage to the kidneys can be expected during ramucirumab treatment. Patients should check their protein levels in urine (proteinuria) by urine dipstick or urinary protein creatinine ratio if worsening of kidney damage occurs.

• Blot clots can occur in the blood vessels during ramucirumab treatment that may lead to a heart attack or reduced blood supply to the areas of the brain. Discontinue the use of ramucirumab in such cases and treat the patient in an ICU setting of a hospital.

What are the side effects of Ramucirumab?

Gastrointestinal: Diarrhea, stomach bleeding, pain and swelling of mouth sores, loss of appetite
Blood: High blood pressure, low levels of albumin, sodium, platelets, and neutrophils in blood, fluid accumulation in the hands or feet
Respiratory: Nosebleeds
Skin: Redness, swelling or skin blisters, thick skin on hands or soles of the feet, skin peeling, sensitivity to touch
Others: Headache, excessive tiredness, an excess quantity of protein in the urine, increased tear secretion

What are the other precautions for Ramucirumab?

• Check the contents of ramucirumab vials or the dilution mixture for the presence of any particles or discoloration before giving it to the patient. If any such changes are seen, discard the solution.

• Breastfeeding should be stopped during ramucirumab therapy. Women who wish to have children in future must store their eggs in an egg bank as ramucirumab can affect the fertility status of women.

What are the Drug Interactions of Ramucirumab?

Inform the doctor if the patient is taking or planning to take any prescription, Over-The-Counter (OTC) drugs or herbal supplements to minimize the side effects caused by the drugs accordingly.

What are the storage conditions for Ramucirumab?

• Store the ramucirumab vials in a refrigerator between 2°C and 8°C and protect from excess light and moisture.

• The diluted solutions should be stored in a refrigerator between 2°C and 8°C for 24 hours and at room temperature for about 4 hours.

• Discard the unused portion if the medication is not used within the scheduled time.

• Do not shake or keep the vials or diluted contents in a freezer.