Home Drug Guide Ramucirumab

Drug Guide

Generic Name

Ramucirumab

Brand Names Cyramza

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Monoclonal antibody (VEGFR-2) inhibitor

FDA Approved Indications

Gastric or gastroesophageal junction adenocarcinoma
Non-small cell lung cancer (NSCLC)
Colorectal cancer
Hepatocellular carcinoma

Mechanism of Action

Ramucirumab is a recombinant human IgG1 monoclonal antibody that binds to VEGFR-2, blocking its activation by VEGF ligands and thereby inhibiting angiogenesis, which reduces tumor growth and metastasis.

Dosage and Administration

Adult: Typically 8 mg/kg IV every 2 weeks or 10 mg/kg IV weekly, depending on indication.

Pediatric: Not approved for pediatric use; safety and efficacy not established.

Geriatric: Use with caution; monitor for adverse effects as elderly may have increased risk.

Renal Impairment: No specific adjustment indicated, but monitor closely.

Hepatic Impairment: No specific adjustment indicated, caution advised.

Pharmacokinetics

Absorption: Administered IV; absorption not applicable.

Distribution: Widely distributed, mainly in vascular and interstitial spaces.

Metabolism: Metabolized via catabolism to amino acids.

Excretion: Primarily via proteolytic degradation.

Half Life: Approximately 8-12 days.

Contraindications

Hypersensitivity to ramucirumab or any component.

Precautions

Use with caution in patients with bleeding risk or recent surgery.
Monitor for hypertension, proteinuria, bleeding, wound healing complications.

Adverse Reactions - Common

Hypertension (Common)
Diarrhea (Common)
Fatigue (Common)
Proteinuria (Common)

Adverse Reactions - Serious

Hemorrhage (Serious, monitor closely)
Gastrointestinal perforation (Rare but serious)
Hypertension complications (Serious)
Impaired wound healing (Serious)

Drug-Drug Interactions

Potential increased bleeding risk with anticoagulants or antiplatelet agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, signs of bleeding, wound healing, proteinuria.

Diagnoses:

Risk for bleeding
Impaired tissue perfusion
Risk for hypertension

Implementation: Administer IV as scheduled; monitor for adverse effects; manage hypertension if it occurs.

Evaluation: Assess for adverse reactions; evaluate tumor response and patient symptoms.

Patient/Family Teaching

Report any signs of bleeding, severe fatigue, or unusual symptoms.
Avoid NSAIDs or blood thinners unless prescribed by doctor.
Attend all scheduled appointments for monitoring.

Special Considerations

Black Box Warnings:

Wound healing complications, hemorrhage, GI perforation, pregnancy may cause fetal harm.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Potential severe bleeding, hypertension, or allergic reactions.

Treatment: Supportive care; discontinue drug; symptomatic treatment as needed.

Storage and Handling

Storage: Store refrigerated at 2-8°C, protected from light.

Stability: Stable until expiration date on the label when stored properly.