• 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.
• 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.
• 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
• 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.
Dosage & When it is to be taken
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.
When it is not to 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
