(eye KAT i bant)
Hereditary angioedema: Treatment of acute attacks of hereditary angioedema (HAE)
There are no contraindications listed in the U.S. manufacturer 's labeling.
Canadian labeling: Hypersensitivity to icatibant acetate or any component of the formulation.
Hereditary angioedema (HAE): SubQ: 30 mg; may repeat every 6 hours if response is inadequate or symptoms recur (maximum daily dose: 90 mg).
ACE inhibitor-induced angioedema (off-label use): SubQ: 30 mg; if symptoms of angioedema continue to worsen after 6 hours, a second injection may be administered. The authors administered intravenous prednisolone (not available in the US) with the second dose of icatibant (Bas, 2015).
Refer to adult dosing. Systemic exposure may be increased; however, no dosage adjustments are recommended.
No dosage adjustments are recommended (has not been studied); however, icatibant is cleared by nonrenal mechanisms and is not expected to accumulate in patients with renal impairment.
No dosage adjustments necessary.
For SubQ injection only. Inject into the abdomen over ≥30 seconds, using the 25 gauge needle provided. Inject 2 to 4 inches below belly button and away from any scars; do not inject into an area that is bruised, swollen, or painful.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 3]).
Store between 2 ‚ °C to 25 ‚ °C (36 ‚ °F to 77 ‚ °F); do not freeze. Store in original container until time of administration.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Subcutaneous [preservative free]:
Firazyr: 30 mg/3 mL (3 mL)
ACE Inhibitors: Icatibant may diminish the antihypertensive effect of ACE Inhibitors. Monitor therapy
Symptom relief; laryngeal symptoms or airway obstruction (immediate medical attention required in addition to icatibant therapy)
>10%: Local: Injection site reaction (97%)
1% to 10%:
Central nervous system: Dizziness (3%)
Hepatic: Increased serum transaminase (4%)
Miscellaneous: Fever (4%)
<1% (Limited to important or life-threatening): Antibody development (anti-icatibant, no association with efficacy observed), chest pain, headache, myocardial infarction, nausea, skin rash
Elderly subjects had a 2-fold higher AUC compared with younger subjects. Only minor differences (12% to 14%) in Cmax were observed. No dosage adjustment is needed.
Women have a 2-fold higher AUC and Cmax compared with men because of differences in body weight. Dosage adjustment is not needed.
Concerns related to adverse effects:
- Airway obstruction: Airway obstruction may occur during acute laryngeal attacks of HAE. Patients with laryngeal attacks should be instructed to seek medical attention immediately in addition to treatment with icatibant.
- CNS effects: Dizziness has been observed following use; advise patients to use caution when driving or operating machinery.
Special handling:
- Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 3]).
C
Adverse events were observed in animal reproduction studies with doses close to or less than the recommended human dose. Has not been adequately studied in pregnant women.
Icatibant is a selective competitive antagonist for the bradykinin B2 receptor. Patients with HAE have an absence or dysfunction of C1-esterase-inhibitor which leads to the production of bradykinin. The presence of bradykinin may cause symptoms of localized swelling, inflammation, and pain. Icatibant inhibits bradykinin from binding at the B2 receptor, thereby treating the symptoms associated with acute attack.
Vdss: 20.3 to 37.7 L
Metabolized by proteolytic enzymes to metabolites (inactive)
Urine (<10% unchanged)
Median time to 50% decrease of symptoms: ~2 hours
0.75 hours
Inhibits symptoms caused by bradykinin for ~6 hours
1 to 1.8 hours
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber severe injection site irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.