Nurses Compass
Drug Guide
Bevacizumab
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Vascular endothelial growth factor (VEGF) inhibitor
FDA Approved Indications
- Metastatic colorectal cancer
- Non-squamous non-small cell lung cancer
- Glioblastoma multiforme
- Persistent/recurrent glioma in adults
- Metastatic cervical cancer
- Ovarian, fallopian tube, or primary peritoneal carcinoma
Mechanism of Action
Bevacizumab is a monoclonal antibody that binds to VEGF, preventing it from activating its receptors on endothelial cells, thereby inhibiting angiogenesis that tumors need for growth and metastasis.
Dosage and Administration
Adult: Typically administered intravenously at 5-15 mg/kg every 2-3 weeks, depending on the indication.
Pediatric: Not generally used in pediatric populations; data limited.
Geriatric: No specific dose adjustment, but elderly patients should be monitored closely for hypertension and bleeding.
Renal Impairment: Use with caution; no specific dose adjustment recommended.
Hepatic Impairment: No specific data, use caution.
Pharmacokinetics
Absorption: Administered intravenously, bypassing absorption barriers.
Distribution: Widely distributed in body tissues; volume of distribution approximately 5-7 liters.
Metabolism: Broken down by proteolytic enzymes into small peptides and amino acids.
Excretion: Metabolized; not eliminated renally or hepatically in intact form.
Half Life: Approximately 20 days.
Contraindications
- Known hypersensitivity to Bevacizumab or any component of the formulation.
Precautions
- Risk of bleeding, gastrointestinal perforation, wound healing complications, hypertension, proteinuria, thromboembolic events. Use with caution in patients with wound healing issues or recent surgery.
Adverse Reactions - Common
- Hypertension (Common)
- Proteinuria (Common)
- Fatigue (Common)
- Anemia (Common)
Adverse Reactions - Serious
- Gastrointestinal perforation (Rare)
- Severe bleeding (Rare)
- Hemorrhage (Rare)
- Impaired wound healing (Rare)
- Hypertensive crisis (Rare)
Drug-Drug Interactions
- Increased risk of bleeding with anticoagulants or antiplatelet agents.
- Limited data on interactions; monitor closely.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure regularly, watch for signs of bleeding, wound healing status, proteinuria, and signs of thrombosis.
Diagnoses:
- Risk for bleeding,
- Risk for impaired skin integrity
Implementation: Administer IV infusion as prescribed. Monitor for adverse effects. Educate patient on signs of complications.
Evaluation: Assess treatment response and adverse reactions periodically; adjust therapy accordingly.
Patient/Family Teaching
- Report any bleeding, unusual symptoms, wound healing issues, or new hypertension.
- Avoid invasive procedures without consulting healthcare provider.
- Maintain regular blood pressure monitoring and follow-up appointments.
Special Considerations
Black Box Warnings:
- Gastrointestinal perforation, wound healing complications, hemorrhage, severe bleeding, surgery or trauma risk
Genetic Factors: Limited data; no specific genetic testing recommended.
Lab Test Interference: May cause proteinuria and hypertension, monitored via urine protein and blood pressure tests.
Overdose Management
Signs/Symptoms: Potential for increased risk of bleeding, hypertension, or other adverse effects.
Treatment: Supportive care; management of symptoms; no specific antidote. Discontinue infusion and provide symptomatic treatment as needed.
Storage and Handling
Storage: Store vials at 2-8°C, protect from light. Use immediately after reconstitution.
Stability: Stable for 24 hours at room temperature after reconstitution; follow package insert for specific stability data.