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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.