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DOSAGE AND ADMINISTRATION
Do not administer CYRAMZA as an intravenous push or bolus.
Recommended Dose And Schedule
- The recommended dose of CYRAMZA either as a single agent or in combination with weekly paclitaxel is 8 mg/kg every 2 weeks administered as an intravenous infusion over 60 minutes. Continue CYRAMZA until disease progression or unacceptable toxicity.
- When given in combination, administer CYRAMZA prior to administration of paclitaxel.
- Prior to each CYRAMZA infusion, premedicate all patients with an intravenous histamine H1 antagonist (e.g., diphenhydramine hydrochloride).
- For patients who have experienced a Grade 1 or 2 infusion reaction, also premedicate with dexamethasone (or equivalent) and acetaminophen prior to each CYRAMZA infusion [see Dose Modifications].
Infusion-Related Reactions (IRR)
- Reduce the infusion rate of CYRAMZA by 50% for Grade 1 or 2 IRRs.
- Permanently discontinue CYRAMZA for Grade 3 or 4 IRRs [see Premedication and WARNINGS AND PRECAUTIONS].
- Interrupt CYRAMZA for severe hypertension until controlled with medical management.
- Permanently discontinue CYRAMZA for severe hypertension that cannot be controlled with antihypertensive therapy [see WARNINGS AND PRECAUTIONS].
- Interrupt CYRAMZA for urine protein levels ≥ 2 g/24 hours. Reinitiate treatment at a reduced dose of 6 mg/kg every 2 weeks once the urine protein level returns to < 2 g/24 hours. If the protein level ≥ 2 g/24 hours reoccurs, interrupt CYRAMZA and reduce the dose to 5 mg/kg every 2 weeks once the urine protein level returns to < 2 g/24 hours.
- Permanently discontinue CYRAMZA for urine protein level > 3 g/24 hours or in the setting of nephrotic syndrome [see ADVERSE REACTIONS].
Wound Healing Complications
- Interrupt CYRAMZA prior to scheduled surgery until the wound is fully healed [see WARNINGS AND PRECAUTIONS].
Arterial Thromboembolic Events, Gastrointestinal Perforation, or Grade 3 or 4 Bleeding
- Permanently discontinue CYRAMZA [see WARNINGS AND PRECAUTIONS].
For toxicities related to paclitaxel, refer to the current prescribing information.
Preparation For Administration
Inspect vial contents for particulate matter and discoloration prior to dilution [see DESCRIPTION]. Discard the vial, if particulate matter or discolorations are identified. Store vials in a refrigerator at 2°C to 8°C (36°F to 46°F) until time of use. Keep the vial in the outer carton in order to protect from light.
- Calculate the dose and the required volume of CYRAMZA needed to prepare the infusion solution. Vials contain either 100 mg/10 mL or 500 mg/50 mL at a concentration of 10 mg/mL solution of CYRAMZA.
- Withdraw the required volume of CYRAMZA and further dilute with only 0.9% Sodium Chloride Injection in an intravenous infusion container to a final volume of 250 mL. Do not use dextrose containing solutions.
- Gently invert the container to ensure adequate mixing.
- DO NOT FREEZE OR SHAKE the infusion solution. DO NOT dilute with other solutions or co-infuse with other electrolytes or medications.
- Store diluted infusion for no more than 24 hours at 2°C to 8°C (36°F to 46°F) or 4 hours at room temperature (below 25°C [77°F]).
- Discard vial with any unused portion of CYRAMZA.
- Visually inspect the diluted solution for particulate matter and discoloration prior to administration. If particulate matter or discolorations are identified, discard the solution.
- Administer diluted CYRAMZA infusion via infusion pump over 60 minutes through a separate infusion line. Use of a protein sparing 0.22 micron filter is recommended. Flush the line with sterile sodium chloride (0.9%) solution for injection at the end of the infusion.
Dosage Forms And Strengths
- 100 mg/10 mL (10 mg per mL) solution, single-dose vial
- 500 mg/50 mL (10 mg per mL) solution, single-dose vial
CYRAMZA is supplied in single-dose vials as a sterile, preservative-free solution.
NDC 0002-7669-01 100 mg/10
mL (10 mg/mL), individually packaged in a carton
NDC 0002-7678-01 500 mg/50 mL (10 mg/mL), individually packaged in a carton
Storage And Handling
Store vials in a refrigerator at 2°C to 8°C (36°F to 46°F) until time of use. Keep the vial in the outer carton in order to protect from light. DO NOT FREEZE OR SHAKE the vial.
For product diluted in 0.9% sodium chloride, the chemical and physical stability have been demonstrated for up to 24 hours at 2°C to 8°C (36°F to 46°F) or for 4 hours at room temperature (below 25°C [77°F]). DO NOT FREEZE OR SHAKE the diluted product.
Eli Lilly and Company, Indianapolis, IN 46285, USA. Revised: November 2014
Last reviewed on RxList: 11/12/2014
This monograph has been modified to include the generic and brand name in many instances.
Additional Cyramza Information
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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