Drug Guide
Icatibant Acetate
Classification
Therapeutic: Antagonist of bradykinin B2 receptor, used in hereditary angioedema attacks
Pharmacological: Peptide receptor antagonist
FDA Approved Indications
- Treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years and older
Mechanism of Action
Icatibant is a selective and competitive antagonist of the bradykinin B2 receptor, which blocks the vasodilatory and permeability-increasing effects of bradykinin, thereby reducing the severity and duration of angioedema attacks in HAE.
Dosage and Administration
Adult: 30 mg subcutaneously as a single dose; may be repeated at 6-hour intervals if symptoms persist, with a maximum of 3 doses within 24 hours.
Pediatric: Not approved for pediatric use; safety and efficacy not established.
Geriatric: No specific adjustments required, but caution advised due to limited data.
Renal Impairment: No specific dosage adjustments; caution recommended.
Hepatic Impairment: No specific dosage adjustments known.
Pharmacokinetics
Absorption: Rapidly absorbed after subcutaneous administration.
Distribution: Widely distributed; plasma protein binding approximately 65%.
Metabolism: Metabolized primarily by peptidases and proteolytic enzymes.
Excretion: Excreted mainly as peptides and amino acids via urine.
Half Life: Approximately 2 hours.
Contraindications
- Known hypersensitivity to icatibant or any component of the formulation.
Precautions
- Use with caution in patients with cardiac disease; monitor for signs of hypersensitivity reactions; use in pregnancy only if clearly needed.
Adverse Reactions - Common
- Injection site reactions (pain, erythema, swelling) (Common)
- Headache (Common)
- Nausea (Common)
Adverse Reactions - Serious
- Anaphylaxis (Rare)
- Serious hypersensitivity reactions (Rare)
Drug-Drug Interactions
- No well-documented significant interactions, but concurrent use with drugs affecting bradykinin pathways is not recommended.
Drug-Food Interactions
- No specific food interactions identified.
Drug-Herb Interactions
- Limited data; use caution with herbal supplements.
Nursing Implications
Assessment: Monitor for symptom relief and adverse reactions; assess for hypersensitivity.
Diagnoses:
- Ineffective breathing pattern related to allergic response
- Risk for hypersensitivity reactions
Implementation: Administer as prescribed; prepare for potential emergencies such as anaphylaxis.
Evaluation: Evaluate attack symptom improvement and monitor for adverse effects.
Patient/Family Teaching
- Inject medication as instructed; do not exceed the recommended dose.
- Seek immediate medical attention if signs of allergic reaction or anaphylaxis occur.
- Notify healthcare provider of any adverse reactions or if attacks are not adequately controlled.
Special Considerations
Black Box Warnings:
- None currently assigned.
Genetic Factors: Genetic variations have not been shown to affect response.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Potential increased risk of hypersensitivity reactions.
Treatment: Supportive care; monitor respiratory and cardiovascular status; no specific antidote.
Storage and Handling
Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F).
Stability: Stable for up to 24 hours at room temperature (up to 25°C/77°F) if necessary before use.