Zirabev (Intravenous)

Generic name: bevacizumab-bvzr (intravenous route) [ be-va-SIZ-yoo-mab-- bvzr ]
Drug class: VEGF/VEGFR inhibitors

Medically reviewed by Drugs.com. Last updated on Nov 29, 2022.

Commonly used brand name(s)

In the U.S.

• Zirabev

Available Dosage Forms:

• Solution

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Bevacizumab

Uses for Zirabev

Bevacizumab-bvzr injection is used together with other cancer medicines to treat patients with metastatic (cancer that has spread) carcinoma of the colon or rectum.

Bevacizumab-bvzr injection is also used to treat nonsquamous, non-small cell lung cancer (NSCLC) that has spread, come back, or cannot be removed by surgery. It is also used to treat a type of brain tumor called glioblastoma that keeps coming back (recurrent).

Bevacizumab-bvzr injection is also used together with other medicines (eg, interferon alfa) to treat patients with metastatic kidney cancer. It is also used in combination with other medicines (eg, paclitaxel and cisplatin, or paclitaxel and topotecan) to treat patients with cervical cancer that is continuing, keeps coming back, or has spread to other parts of the body.

Bevacizumab-bvzr injection is also used in combination with other medicines (eg, paclitaxel, pegylated liposomal doxorubicin, topotecan, carboplatin and paclitaxel, or carboplatin and gemcitabine followed by Zirabev™ alone) to treat patients with platinum-resistant, platinum-sensitive, recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer with or without having previous surgery or who have received 2 previous treatments.

Bevacizumab is an antineoplastic that helps the body fight cancer. It prevents the growth of certain types of blood vessels to cancer cells. This helps to decrease the growth of cancer cells by starving the cells of nutrients that are needed to grow.

This medicine is to be given only by or under the immediate supervision of your doctor.

Before using Zirabev

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of bevacizumab-bvzr injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of bevacizumab-bvzr injection in the elderly. However, elderly patients are more likely to have age-related heart or blood vessel problems, which may require caution in patients receiving bevacizumab-bvzr injection.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with food/tobacco/alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina (severe chest pain) or
• Bleeding problems or
• Blood clots or
• Diabetes or
• Esophagus problems or
• Heart attack, history of or
• Heart failure or
• Hypertension (high blood pressure) or
• Kidney problems or
• Liver problems or
• Protein in the urine or
• Stomach or bowel problems (eg, blockage, fistula, perforation) or
• Stroke, history of or
• Wound healing problems—Use with caution. May make these conditions worse.

• Hemoptysis (coughing up blood), recent history of—Should not be used in patients with this condition.

Proper use of Zirabev

Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.

A nurse or other trained health professional will give you this medicine in a medical facility. It is given through a needle placed into one of your veins. It must be given slowly, so the needle will have to stay in place for at least 30 to 90 minutes.

Bevacizumab-bvzr is often given together with other cancer medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them. Ask your doctor to help you plan a way to remember to take your medicines at the right times.

Precautions while using Zirabev

It is very important that your doctor check your progress closely and at regular visits to make sure that this medicine is working properly. Blood and urine tests are needed to check for unwanted effects. Be sure to keep all appointments. You may be taught how to check your blood pressure at home.

Receiving this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to prevent pregnancy while you are receiving this medicine and for at least 6 months after the last dose. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

Using this medicine may increase risk of ovarian failure. Talk with your doctor if you plan to have children. Some women receiving this medicine have become infertile (unable to have children).

This medicine can cause stomach or bowel perforation (tear or hole), including blockage. Check with your doctor right away if you have severe stomach pain, constipation, fever, nausea, or vomiting.

This medicine may also increase your risk of having a serious condition called tracheoesophageal fistula (an abnormal opening in one or more places between the esophagus and the trachea). Tell your doctor right away if you start having trouble swallowing, coughing, or choking while eating, trouble breathing, or chest pain or discomfort while you are receiving this medicine.

This medicine may affect the way your body heals. Make sure any doctor who treats you knows that you are receiving this medicine. You may need to stop receiving this medicine at least 28 days before and after having surgery.

Bevacizumab-bvzr can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor right away if you start to cough up blood or if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

This medicine may increase your chance of having blood clots or a brain condition called posterior reversible encephalopathy syndrome (PRES). Tell your doctor right away if you develop chest pain, sudden and severe headaches, fainting spells, seizures, unusual drowsiness, confusion, or problems with vision, speech, or walking while you are using this medicine.

Your blood pressure might get too high while you are receiving this medicine. This may cause headaches, dizziness, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.

Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

Bevacizumab-bvzr may cause infusion-related reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you start to have a fever, chills or shaking, dizziness, trouble breathing, itching or rash, lightheadedness or fainting after receiving this medicine.

Do not receive bevacizumab-bvzr together with cancer medicines containing anthracycline, especially if you have heart failure.

Zirabev side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Black, tarry stools
• bleeding gums
• body aches or pain
• burning, tingling, numbness, or pain in the hands, arms, feet, or legs
• chest pain or discomfort
• chills
• cloudy urine
• cough
• cracks in the skin
• decreased urine output
• difficult or labored breathing
• dilated neck veins
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• ear congestion
• extreme tiredness or weakness
• fever
• irregular breathing
• irregular heartbeat
• lack or loss of strength
• lightheadedness
• loss of appetite
• loss of heat from the body
• loss of voice
• mood changes
• nervousness
• pain, redness, or swelling in the arm or leg
• painful or difficult urination
• pinpoint red spots on the skin
• pounding in the ears
• rapid breathing
• redness
• runny or stuffy nose
• seizures
• sensation of pins and needles
• slow or fast heartbeat
• sore throat
• sores on the skin
• sores, ulcers, or white spots on the lips or in the mouth
• stabbing pain
• sunken eyes
• sweating
• swelling of the face, fingers, feet, or lower legs
• swelling or inflammation of the mouth
• swollen glands
• thirst
• tightness in the chest
• trouble breathing
• unusual bleeding or bruising
• unusual tiredness or weakness
• vomiting of blood or material that looks like coffee grounds
• watery or bloody diarrhea
• weight gain
• wrinkled skin
• yellow skin

Less common

• Bone pain
• difficulty with swallowing
• fainting
• severe constipation
• severe vomiting
• stomach pain or tenderness

Rare

• Back pain
• blisters
• blurred vision
• confusion
• dizziness
• drowsiness
• headache
• increased thirst
• loss of consciousness
• muscle pain or cramps
• open sores
• pale skin

Incidence not known

• Bloody mucus or unexplained nosebleeds
• constipation
• diarrhea
• heartburn
• heavy jaw feeling
• high fever
• hoarseness
• indigestion
• loosening of a tooth
• nausea
• pain, swelling, or numbness in the mouth or jaw
• severe stomach pain
• stomach cramping or burning
• stomach pain, usually after eating a meal
• sudden weakness in the arms or legs
• sudden, severe chest pain
• unexplained bleeding or bruising
• unusual tiredness or weakness
• voice changes

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Belching
• change in taste or bad unusual or unpleasant (after) taste
• change in walking and balance
• clumsiness or unsteadiness
• dry mouth
• excess flow of tears
• hair loss or thinning of hair
• stomach discomfort or upset
• weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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

Frequently asked questions

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Zirconium Cyclosilicate

Brand name: Lokelma
Drug class: Potassium-removing Agents
Chemical name: disodium;2,2,4,4,6,6-hexahydroxyl-1,3,5,2,4,6-trioxatrisilinane;zirconium
Molecular formula: Na_~1.5H_~0.5ZrSi₃O₉•2–3H₂O
CAS number: 242800-27-7

Medically reviewed by Drugs.com on Apr 19, 2022. Written by ASHP.

Introduction

Nonabsorbed cation-exchange crystalline compound used for the removal of excess potassium.

Uses for Zirconium Cyclosilicate

Hyperkalemia

Treatment of hyperkalemia.

Has been shown to reduce elevated serum potassium concentrations and maintain normal serum potassium concentrations in patients with hyperkalemia.

Degree of reduction in serum potassium concentrations appears to be greater in patients with higher serum potassium concentrations at baseline.

Efficacy maintained during continued treatment for up to 1 year in clinical studies.

Not used as an emergency treatment for life-threatening hyperkalemia because of delayed onset of action.

Zirconium Cyclosilicate Dosage and Administration

Administration

Oral Administration

Administer orally as a suspension.

Administer ≥2 hours before or ≥2 hours after other oral drugs. (See Drugs that Exhibit pH-dependent Solubility under Interactions.)

Preparation of Oral Suspension

Empty entire contents of packet(s) containing sodium zirconium cyclosilicate into a glass containing approximately 45 mL of water, or more if desired. Stir thoroughly and administer immediately.

If any powder remains in glass after initial administration, add more water, stir, and administer immediately; repeat, as needed, until the entire dose is administered.

Dosage

Adults

Hyperkalemia

Oral

Initial treatment: 10 g 3 times daily for up to 48 hours.

Maintenance therapy: 10 g once daily. Monitor serum potassium concentration; dosage may be increased (in 5-g increments at intervals of ≥1 week, up to 15 g daily) or decreased, or therapy may be discontinued based on serum potassium concentration and desired target range. Usual maintenance dosage is 5 g every other day to 15 g once daily.

Prescribing Limits

Adults

Hyperkalemia

Oral

Maximum 15 g once daily for maintenance therapy.

Special Populations

Hepatic Impairment

No special dosage recommendations.

Renal Impairment

No special dosage recommendations.

Geriatric Patients

No special dosage recommendations.

Cautions for Zirconium Cyclosilicate

Contraindications

• Manufacturer states none known.

Warnings/Precautions

Worsening of GI Motility Disorders

Not evaluated in patients with severe constipation, bowel obstruction, or fecal impaction, including abnormal postoperative bowel motility disorders. Avoid use in such patients because the drug may not be effective and may worsen GI conditions.

Edema

Each 5-g dose of sodium zirconium cyclosilicate contains approximately 400 mg of sodium; possible risk of edema if sodium is absorbed from preparation. In clinical trials, edema was generally mild to moderate in severity and was more common in patients receiving higher dosages (i.e., 15 g once daily).

Monitor for signs of edema, especially in patients who should restrict their sodium intake or have conditions predisposing them to fluid overload (e.g., heart failure, renal disease). Advise patients to reduce dietary sodium intake, if appropriate. Increase dosage of concomitant diuretics as needed.

Specific Populations

Pregnancy

Not expected to result in fetal exposure if used during pregnancy because sodium zirconium cyclosilicate is not absorbed systemically following oral administration.

Lactation

Breast-feeding not expected to result in infant exposure because sodium zirconium cyclosilicate is not absorbed systemically following oral administration.

Pediatric Use

Safety and efficacy not established in pediatric patients.

Geriatric Use

No overall differences in efficacy observed between geriatric patients and younger adults.

Renal Impairment

Patients with renal disease may be at greater risk for edema. (See Edema under Cautions.)

Common Adverse Effects

Edema, hypokalemia.

Interactions for Zirconium Cyclosilicate

Drugs that Exhibit pH-dependent Solubility

Sodium zirconium cyclosilicate causes transient increases in gastric pH and can affect solubility (and consequent bioavailability) of certain pH-dependent drugs. Administer sodium zirconium cyclosilicate ≥2 hours before or ≥2 hours after other oral drugs unless it is determined that the other drug does not exhibit pH-dependent solubility.

Drugs that Inhibit the Renin-angiotensin-aldosterone System

Concomitant use does not appear to alter pharmacokinetics of renin-angiotensin-aldosterone system inhibitors.

Specific Drugs

Zirconium Cyclosilicate Pharmacokinetics

Absorption

Bioavailability

Not absorbed systemically after oral administration.

Onset

1–6 hours.

Duration

4–12 hours.

Food

Binds potassium in food.

Elimination

Metabolism

Not metabolized.

Elimination Route

Excreted in feces.

Stability

Storage

Oral

Powder for Suspension

15–30°C.

Actions

• Highly selective inorganic cation-exchange crystalline compound that preferentially captures potassium in exchange for hydrogen (i.e., protons) and sodium.

• High specificity for potassium attributed to the drug''s chemical composition and crystal structure. Exhibits high affinity for potassium, even in the presence of other cations (e.g., calcium, magnesium); >25 times more selective for potassium than for calcium and magnesium.

• Binds potassium throughout the entire lumen of the GI tract (including the acidic condition of the duodenum and potassium in food), resulting in reduced concentrations of free potassium in the GI lumen, increased fecal potassium excretion, and decreased serum potassium concentrations.

• Potassium-binding capacity of sodium zirconium cyclosilicate is 9.3 times that of sodium polystyrene sulfonate.

• Demonstrates dose-dependent increases in fecal potassium excretion and decreases in urinary potassium excretion and serum potassium concentrations. Reductions in serum potassium concentration observed ≤1 hour after first dose and maintained with continued therapy.

• Causes mild, dose-dependent increases in serum bicarbonate concentrations and mild increases in urinary pH and reductions in BUN; clinical importance of such effects not known.

Advice to Patients

• Importance of instructing patients regarding proper preparation and administration of sodium zirconium cyclosilicate, including importance of taking the full dose.

• Importance of informing patients who are taking other oral drugs to administer these drugs ≥2 hours before or ≥2 hours after administration of sodium zirconium cyclosilicate.

• Risk of edema. Importance of advising patients that reduced dietary sodium intake may be required.

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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Frequently asked questions

• How does the drug Lokelma work?

Medical Disclaimer