Pricing
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All price changes →Indications & Uses
Cyramza is indicated for:
Pharmacology
Ramucirumab is a VEGFR2 antagonist. It binds specifically to VEGFR2 and stops the VEGFR ligands VEGF-A, VEGF-C and VEGF-D from attaching to it. Because of this, ramucirumab blocks the activation of VEGFR2 that these ligands would normally cause, and so it also blocks the ligand-induced proliferation and migration of human endothelial cells. In an in vivo animal model, ramucirumab inhibited angiogenesis.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Ramucirumab is given by intravenous infusion only. Don't give it as an intravenous push or bolus. Premedicate before each infusion.
For gastric cancer, the dose is Ramucirumab 8 mg/kg every 2 weeks, either as a single agent or together with weekly paclitaxel.
For non-small cell lung cancer, give Ramucirumab 10 mg/kg every 2 weeks along with daily erlotinib. Another schedule is Ramucirumab 10 mg/kg on Day 1 of a 21-day cycle, given before docetaxel.
For colorectal cancer, the dose is 8 mg/kg every 2 weeks, given before FOLFIRI.
For hepatocellular carcinoma, give 8 mg/kg every 2 weeks.
Side Effects
In patients with gastric cancer who were given Ramucirumab on its own, the most common side effects were hypertension and diarrhea. These appeared at a rate of ≥10% and at least 2% higher than with placebo. When Ramucirumab was given with paclitaxel, the most common side effects were fatigue/asthenia, neutropenia, diarrhea and epistaxis. Each occurred at a rate of ≥30% and at least 2% higher than with placebo plus paclitaxel. With erlotinib, the most common side effects were infections, hypertension, stomatitis, proteinuria, alopecia and epistaxis, again at a rate of ≥30% and at least 2% higher than with placebo plus erlotinib. The most common laboratory abnormalities, at ≥30% and a difference of at least 2% in incidence between the two arms, were increased alanine aminotransferase, increased aspartate aminotransferase, anemia, thrombocytopenia and neutropenia. With docetaxel, the most common side effects were neutropenia, fatigue/asthenia and stomatitis/mucosal inflammation. These occurred at ≥30% and at least 2% higher than with placebo plus docetaxel. With FOLFIRI, the most common side effects were diarrhea, neutropenia, decreased appetite, epistaxis and stomatitis, at ≥30% and at least 2% higher than with placebo plus FOLFIRI. In HCC patients who received Ramucirumab alone, the most common side effects were fatigue, peripheral edema, hypertension, abdominal pain, decreased appetite, proteinuria, nausea and ascites. These were seen at ≥15% and at least 2% higher than with placebo. The most common laboratory abnormalities, at ≥30% and a difference of at least 2% in incidence between the two arms, were thrombocytopenia, hypoalbuminemia and hyponatremia.
Cautions & Contraindications
Warnings & Precautions
Hemorrhage: Ramucirumab increases the risk of hemorrhage and gastrointestinal hemorrhage, and some of these events have been severe or fatal. Stop it permanently in patients who have severe bleeding. Gastrointestinal Perforations: The medicine also raises the risk of gastrointestinal perforation, which can be fatal, so stop it permanently if a perforation happens. Impaired Wound Healing: Hold Ramucirumab for 28 days before elective surgery. Don't give it for at least 2 weeks after a major surgical procedure, and not until the wound has healed adequately. Whether it is safe to restart after wound healing complications have resolved has not been established. Arterial Thromboembolic Events (ATEs): Serious and sometimes fatal ATEs can occur, and treatment must be stopped permanently in any patient who has one. Hypertension: Monitor blood pressure and treat hypertension. Withhold the medicine for severe hypertension. Stop it permanently if hypertension can't be controlled with antihypertensive therapy, and also for hypertensive crisis or hypertensive encephalopathy. Infusion-Related Reactions (IRR): Watch for signs and symptoms during the infusion. Reduce the infusion rate for Grade 1 or 2 IRR, and stop permanently for Grade 3 or 4 IRR. Worsening of Pre-existing Hepatic Impairment: New onset or worsening encephalopathy, ascites or hepatorenal syndrome can occur in patients with Child-Pugh B or C cirrhosis. Posterior Reversible Encephalopathy Syndrome: Stop Ramucirumab permanently. Proteinuria Including Nephrotic Syndrome: Monitor for proteinuria. Withhold the medicine when urine protein is greater than or equal to 2 g per 24 hours. Stop it permanently when urine protein is greater than 3 g per 24 hours, or if nephrotic syndrome develops. Thyroid Dysfunction: Monitor thyroid function during treatment. Embryo-Fetal Toxicity: Ramucirumab can cause fetal harm. Tell females of reproductive potential about the potential risk to a fetus, and advise them to use effective contraception.
Pregnancy & Breastfeeding
Going by how it works, Ramucirumab can harm the fetus when it is given to a pregnant woman. There are no data on its use in pregnant women. Animal models link angiogenesis, VEGF and VEGFR2 to key parts of female reproduction, embryo-fetal development and postnatal development. No animal studies have been done to look at the effect of the medicine on reproduction and fetal development. A pregnant woman should be told about the potential risk to the fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognised pregnancies is 2 to 4% and 15 to 20%, respectively.
There is no information on whether ramucirumab is present in human milk, or on its effects on the breastfed child or on milk production. Human IgG is present in human milk, but published data suggest that antibodies in breast milk do not enter the circulation of newborns and infants in substantial amounts. Because breastfed children could have serious adverse reactions, women should be advised not to breastfeed during treatment with Ramucirumab and for 2 months after the last dose.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Storage
Keep Ramucirumab vials in a refrigerator at 2°C to 8°C, and leave them in the original carton so the light stays off them until you are ready to use them. Don't freeze the vial and don't shake it.
Drug Interactions
Common questions about Cyramza 10 mg/ml
What is Cyramza 10 mg/ml IV Infusion?
Cyramza 10 mg/ml IV Infusion is a medicine that contains Ramucirumab. It is made by Healthcare Pharmaceuticals Ltd. It belongs to the Cytotoxic Chemotherapy group of medicines.
What is Cyramza used for?
Cyramza is used for: Cancer.
What are the side effects of Cyramza?
In patients with gastric cancer who were given Ramucirumab on its own, the most common side effects were hypertension and diarrhea. These appeared at a rate of ≥10% and at least 2% higher than with placebo.
Can I take Cyramza during pregnancy or while breastfeeding?
Going by how it works, Ramucirumab can harm the fetus when it is given to a pregnant woman. There are no data on its use in pregnant women. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store Cyramza?
Keep Ramucirumab vials in a refrigerator at 2°C to 8°C, and leave them in the original carton so the light stays off them until you are ready to use them. Don't freeze the vial and don't shake it.
Do I need a prescription for Cyramza?
Cyramza is a prescription (Rx) medicine. Take it as your doctor advises.