Ramucirumab

Ramucirumab is a prescription medication used to treat advanced gastric cancer or gastro-esophageal junction adenocarcinoma. It is used to treat lung cancer. Ramucirumab is also approved to treat metastatic colorectal cancer when used in combination with a certain chemotherapy regimen. 

Ramucirumab belongs to a group of drugs called vascular endothelial growth factor receptor 2 (VEGFR2) antagonists. These work by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.

This medication comes in an injectable form to be given directly into a vein (IV) as an infusion every 2 or 3 weeks by a healthcare professional.

Common side effects of ramucirumab include an increase in blood pressure and diarrhea.

Ramucirumab is a prescription medication used to treat advanced gastric cancer or gastro-esophageal junction adenocarcinoma, as a single-agent after prior fluoropyrimidine or platinum containing chemotherapy. Ramucirumab is also approved to treat metastatic colorectal cancer when used in combination with a certain chemotherapy regimen. 

Ramucirumab is also approved for use in combination with docetaxel to treat patients with metastatic non-small cell lung cancer (NSCLC).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Ramucirumab may be found in some form under the following brand names:

• Cyramza

Common side effects of ramucirumab include the following:

• an increase in blood pressure
• diarrhea

This is not a complete list of ramucirumab side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

No drug interactions have been studied by the manufacturer. However, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Serious side effects have been reported with ramucirumab including the following:

• Severe bleeding. Ramucirumab may increase the risk for severe bleeding. Tell your healthcare provider right away if you experience severe bleeding.
• Arterial Thromboembolic Events. Ramucirumab increases the risk for developing blood clots which can lead to heart attack, cardiac arrest, and stroke.

• Hypertension. Tell your healthcare provider right away if blood pressure is elevated or if you have some or all of the following symptoms of hypertension.
  • severe headache
  • lightheadedness
  • neurologic symptoms
• Infusion Related Reactions. Tell your healthcare provider right away if you have some or all of the following symptoms of infusion related reactions.
  • Rigors/tremors
  • Back pain/spasms
  • chest pain and/or tightness
  • chills
  • flushing
  • difficult or labored breathing
  • wheezing
  • hypoxia
  • sensation of prickling or burning of a person's skin
• Gastrointestinal perforation. Ramucirumab increases the risk for gastrointestinal perforation which is a hole that develops through the whole wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder.
• Impaired wound healing. Ramucirumab may affect how well wounds heal. Tell your doctor if you are going to have surgery.
• Clinical deterioration in patients with cirrhosis. Ramucirumab may worsen liver conditions.
• Reversible posterior leukoencephalopathy syndrome (RPLS). Tell your healthcare provider right away if you have some or all of the following symptoms of RPLS.
  • headache
  • confusion or decreased level of consciousness
  • visual changes
  • seizures

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of ramucirumab, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking ramucirumab, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to ramucirumab or to any of its ingredients
• have or have had hypertension

• have liver problems
• have had an arterial thromboembolic event
• have or have had gastrointestinal perforation
• if you are going to have surgery
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify  the possible risks to an unborn baby when a medication is taken during pregnancy.

Ramucirumab falls into category C. No studies have been done in animals, and no well-controlled studies have been done in pregnant women. Ramucirumab should be given to a pregnant woman only if clearly needed.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if ramucirumab crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. It is generally not recommended to breastfeed during ramucirumab treatment.

Take ramucirumab exactly as prescribed.

Ramucirumab comes in an injectable form to be given directly into a vein (IV) as an infusion every 2 or 3, depending on what is being treated. It is injected by a healthcare professional.

If you miss a dose, be sure to make a follow up appointment.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• other medical conditions you have
• how you respond to this medication
• your weight

The recommended dose of ramucirumab for the treatment of advanced gastric cancer or gastro-esophageal junction adenocarcinoma is 8 mg/kg every 2 weeks.

The recommended dose and schedule for ramucirumab in combination with docetaxel for non-small cell lung cancer (NSCLC) is ramucirumab 10 mg/kg intravenously and docetaxel 75 mg/m2 intravenously administered every 3 weeks.

If ramucirumab is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Patients will be given medications such as diphenhydramine before administration of ramucirumab.
• For patients who have experienced a Grade 1 or 2 infusion reaction, may be premedicated with dexamethasone (or equivalent) and acetaminophen prior to administration of ramucirumab.

Ramucirumab increased the risk of hemorrhage, including severe and sometimes fatal hemorrhagic events. Permanently discontinue ramucirumab in patients who experience severe bleeding.