Ramucirumab (Intravenous)

Ramucirumab is an injection used to treat various types of cancer. It may be used alone or alongside other medications.

Overview

Ramucirumab is used either alone or in combination with paclitaxel to treat gastroesophageal junction cancer or advanced stomach cancer patients have received other medications to treat cancer. It's also used alongside docetaxel to treat metastatic non-small cell lung cancer (cancer that has already spread) in those who have received other medications that treat cancer. This drug is also used in combination with 5-fluorouracil, folinic acid, and irinotecan in the treatment of metastatic colorectal cancer (cancer that has already spread) in patients who have received other medications that treat cancer. This drug is only given under direct supervision from a trained health professional. It is available in the dosage form: solution.

Conditions Treated

  • Colon and rectal cancer that has spread to another area
  • Stomach Cancer
  • Non-small cell lung cancer

Type of Medicine

  • Solution

Side Effects

Along with its intended effects, the use of ramucirumab can produce some unwanted side effects. Not all of these side effects may be present at one time, but if they are present, they may require medical attention.

Inform your doctor if you suffer from any of the following side effects whilst taking this drug.

More common side effects:

  • Blurred vision
  • Chest pain
  • Crawling, burning, numbness, itching, prickling, tingling feelings or "pins and needles" feelings.
  • Chills
  • Back spasms or pain
  • Convulsions
  • Confusion
  • Decreased urine output
  • Fainting
  • Faintness, dizziness, or lightheadedness when getting up suddenly from a sitting or lying position
  • Irregular, pounding, or fast pulse or heartbeat
  • Feeling unusually cold
  • Feeling of warmth
  • Muscle cramps or pain
  • Headache
  • Increased thirst
  • Vomiting or nausea
  • Pounding in the ears
  • Nervousness
  • Redness of the neck, face, arms, and occasionally, upper chest
  • Sweating
  • Shakiness in the arms, legs, hands, or feet
  • Shivering
  • Swelling of the ankles, face, or hands
  • Unusual weakness or tiredness
  • Shaking or trembling of the hands or feet

Less common side effects:

  • Bleeding gums
  • Stomach or abdominal pain, cramping, or burning
  • Coughing up blood
  • Bloody nose
  • Cough
  • Difficulty with swallowing or breathing
  • Fever
  • Dizziness
  • Inability to speak
  • Low blood pressure or pulse
  • Increased vaginal bleeding or menstrual flow
  • Lower back or side pain
  • Pain in the groin, chest or legs, especially calves of the legs
  • Nosebleeds
  • Pain or discomfort in the jaw, arms, back, or neck
  • Pale skin
  • Painful or difficult urination
  • Paralysis
  • Red or dark brown urine
  • Prolonged bleeding from cuts
  • Red or black, tarry stools
  • Severe headaches of sudden onset
  • Severe constipation
  • Severe numbness, especially on one side of the face or body
  • Slurred speech
  • Sudden loss of coordination
  • Sore throat
  • Sudden onset of shortness of breath for no apparent reason
  • Sudden vision changes
  • Sudden onset of slurred speech
  • Unusual bruising or bleeding
  • Sweating
  • Temporary blindness
  • Vomiting of material that looks like coffee grounds, severe and continuing
  • Sores, ulcers, or white spots in the mouth
  • Unconsciousness

Some side effects that occur with ramucirumab may not require medical attention. The side effects usually begin to disappear as your body begins to adjust to the medication. If they are giving you bother, you should contact your local pharmacist or a doctor for information and advice on ways to reduce these side effects.

More common side effects:

Remember you can report all side effects to the FDA on 1-800-FDA-1088.

Dosage

Typical Adult Dose for Gastric Cancer

8 mg/kg IV every two weeks

  • This drug should be administered either on its own or in combination with weekly paclitaxel. When combined, this drug should be administered prior to administration of paclitaxel.
  • Continue to use this drug until unacceptable toxicity levels or disease progression.
  • Do not administer this drug as a bolus or IV push.
  • Prior to each drug infusion, all patients should be given an IV histamine H1 antagonist.
  • Patients who have developed a grade one or two infusion reaction should also be given dexamethasone and acetaminophen prior to each infusion of the drug.

Typical Adult Dose for Non-Small Cell Lung Cancer

10 mg/kg IV over sixty minutes on day one and twenty-one-day cycle prior to the docetaxel infusion.

  • This drug should be given prior to administration of docetaxel.
  • Patients with ALK or EGFR genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations before taking this drug.
  • Continue to use for unacceptable toxicity and for disease progression.
  • Do not administer this drug as a bolus or an IV push.
  • Prior to each drug infusion, all patients should be given with an IV histamine H1 antagonist.
  • Patients who have developed a grade one or two infusion reaction should also be given with dexamethasone and acetaminophen before each infusion of this drug.

Typical Adult Dose for Colorectal Cancer

8 mg/kg IV over sixty minutes every two weeks

  • This drug should be given prior to administration of folfiri.
  • Continue to use for unacceptable toxicity and for disease progression.
  • Do not administer this drug as a bolus or an IV push.
  • Prior to each drug infusion, all patients should be given with an IV histamine H1 antagonist.
  • Patients who have developed a grade one or two infusion reaction should also be given with dexamethasone and acetaminophen before each infusion of this drug.

Interactions

Drug interactions can cause severe side effects or reduce the effectiveness of either drug. To limit the possibility of drug interactions, you should give your doctor a list of all the current medications you are currently taking and have taken in the past. This list should include prescription, non-prescription drugs, vitamins, and herbal remedies. You should also let them know if you currently suffer from any medical problems, or have a history of medical conditions. This includes any medical conditions that run in your family history.

There are over 191 drugs that are known to interact with ramucirumab. Let your doctor know if you are currently taking any of the following drugs. This list is not complete.

  • Acalabrutinib
  • Magnesium hydroxide
  • Acetaminophen
  • Phenyltoloxamine
  • Abciximab
  • Alteplase
  • Ado-trastuzumab emtansine
  • Aluminum hydroxide
  • Anagrelide
  • Anistreplase
  • Anisindione
  • Antithrombin
  • Argatroban
  • Apixaban
  • Ardeparin
  • Aspirin
  • Phenylpropanolamine
  • Benzoic acid
  • Baclofen
  • Betrixaban
  • Phenyl salicylate
  • Benzoic acid
  • Bismuth subsalicylate
  • Bromfenac ophthalmic
  • Bivalirudin
  • Bromfenac
  • Cabozantinib
  • Salicylate
  • Caffeine
  • Cangrelor
  • Choline salicylate
  • Capsaicin
  • Cilostazol
  • Clomipramine
  • Citalopram
  • Clopidogrel
  • Danaparoid
  • Dabigatran
  • Dalteparin
  • Dasatinib
  • Deferasirox
  • Deoxycholic acid
  • Defibrotide
  • Desirudin
  • Dexfenfluramine
  • Desvenlafaxine
  • Dextran
  • Diclofenac ophthalmic
  • Diclofenac
  • Diclofenac topical
  • Diflunisal
  • Dicumarol
  • Diphenhydramine
  • Duloxetine
  • Dipyridamole
  • Drotrecogin alfa
  • Edoxaban
  • Eptifibatide
  • Enoxaparin
  • Epoprostenol
  • Escitalopram
  • Famotidine
  • Etodolac
  • Fenfluramine
  • Flurbiprofen
  • Fenoprofen
  • Fluoxetine
  • Flurbiprofen ophthalmic
  • Fondaparinux
  • Fluvoxamine
  • Hemin
  • Horse chestnut
  • Heparin
  • Hydrocodone
  • Ibrutinib
  • Ibritumomab
  • Ibuprofen
  • Iloprost
  • Idelalisib
  • Indomethacin
  • Ketoprofen
  • Iodine i 131 tositumomab
  • Ketamine
  • Ketorolac
  • Lepirudin
  • Ketorolac ophthalmic
  • Levomilnacipran
  • Meclofenamate
  • Magnesium salicylate
  • Mefenamic acid
  • Nabumetone
  • Meloxicam
  • Milnacipran
  • Naproxen
  • Omacetaxine
  • Panobinostat
  • Oxaprozin
  • Pentosan polysulfate sodium
  • Paroxetine
  • Phenylbutazone
  • Plicamycin
  • Piroxicam
  • Ponatinib
  • Regorafenib
  • Prasugrel
  • Reteplase
  • Rivaroxaban
  • Ruxolitinib
  • Sertraline
  • Sodium salicylate
  • Sibutramine
  • Sodium thiosalicylate
  • Sulfinpyrazone
  • Streptokinase
  • Suprofen ophthalmic
  • Sulindac
  • Tenecteplase
  • Ticlopidine
  • Ticagrelor
  • Tinzaparin
  • Tirofiban
  • Tipranavir
  • Tolmetin
  • Treprostinil
  • Tositumomab
  • Urokinase
  • Vilazodone
  • Venlafaxine
  • Vorapaxar
  • Warfarin
  • Vortioxetine

Other medical problems

If you suffer from any other medical conditions, this may affect the use of this medication. You should inform y our doctor or a healthcare professional if you suffer from any other conditions including:

  • Blood clotting problems (eg, stroke or heart attack)
  • Hypertension (high blood pressure)
  • Cirrhosis
  • Thyroid problems - Caution should be exercised as this medication can make this condition worse.
  • Kidney disease

Warnings

Use in pediatric population

Studies have not been conducted on the relationship of age to the effects of ramucirumab injection on the pediatric population. Therefore efficacy and safety have not been established.

Use in geriatric population

Appropriate studies on the relationship of age to the effects of ramucirumab injection have not been conducted in the older population. Therefore no geriatric-specific problems have been noted to date.

Use in pregnancy and breastfeeding

This medicine should be used when clearly needed as it may harm an unborn child. Discuss the risks and benefits associated with taking this drug with your doctor and obtain reliable forms of birth control for use during and for three months after you stop treatment. If you fall pregnant or think you may be pregnant, inform your doctor immediately.

This drug can be absorbed via the lungs and skin and therefore may harm an unborn baby.

With regards to breastfeeding, it's unknown if this medication passes into breast milk. Due to the possible risk to the infant, breastfeeding while using this drug is not recommended. Speak with your doctor or a healthcare professional before you start breastfeeding.

This drug can make you more prone to infections and may worsen any current infections. Therefore, make sure you wash your hands well to prevent spreading infections. Avoid contact with others who have infections that could spread to others and you such as chicken pox and flu. Speak with your doctor if you have been exposed to an infection.

This medication can also increase your risk of bleeding and cause delays in wounds healing. Stay away from rough sports or other areas where you could be cut, bruised or injured. Floss and brush your teeth gently. Be careful when using sharp objects, including fingernail clippers and razors. Inform your doctor immediately if you notice any unusual bruising or bleeding, black, tarry stools, blood in the stools or urine, or pinpoint red spots on your skin.

You may need to monitor your blood pressure at home while taking ramucirumab. If you notice any changes to your normal blood pressure, inform your doctor immediately.

This medication can increase your risk of gastrointestinal perforation. Let your doctor know immediately if you have severe stomach cramps or pain, bloody, black, or tarry stools, or vomiting of material that looks similar to coffee grounds.

This medication may increase your chance of having a brain condition known as reversible posterior leukoencephalopathy syndrome. Inform your doctor immediately if you suddenly develop severe headaches, seizures, fainting spells, unusual drowsiness, confusion, or problems with speech, vision or walking.

Storage

This drug should be stored intact vials at 36°F to 46°F (2°C to 8°C). Do not freeze this drug. Keep drug in its original carton to protect from direct light. Don't shake product.

Summary

When used correctly, ramucirumab is successful in the treatment of stomach or gastroesophageal junction cancer. To gain the most benefit from this medication, you should receive it regularly. To help you remember, mark a calendar to keep note of when to receive the next dose. Due to the high list of drugs that can interact with this medication, it's important to let your doctor know of all current medications you are taking. This drug should not be used during pregnancy or breastfeeding. If you are planning on becoming pregnant, you should let your doctor know, as in some cases, patients who have taken this medication have reported fertility problems. This drug will be given via injection in your arm by a trained professional in a clinical setting.

 

Resources
Last Reviewed:
January 28, 2018
Last Updated:
April 26, 2018