Avastin (bevacizumab)

By Medically reviewed by hellodoktor

Generic Name: Avastin (bevacizumab) Brand Name(s): Generics only. No brands available.

Uses

What is Avastin (bevacizumab) used for?

Avastin (bevacizumab) is commonly used to treat a certain type of brain tumor, and certain types of cancers of the kidney, lung, colon, rectum, cervix, ovary, or fallopian tube.

Avastin is also used to treat cancer of the membrane lining the internal organs in your abdomen. It is usually given as part of a combination of cancer medicines.

How should I take Avastin (bevacizumab)?

This medication is given by infusion into a vein by a health care professional. The first dose is usually given over 90 minutes. If you tolerate the first dose well, then later infusions may be given over a shorter time (60 or 30 minutes).

The dosage is based on your medical condition, response to previous therapy, and your weight. Tell your doctor if your weight changes.

Use this medication regularly in order to get the most benefit from it. Try not to miss any doses.

How do I store Avastin (bevacizumab)?

Avastin vials [100 mg (NDC 50242-060-01) and 400 mg (NDC 50242-061-01)] are stable at 2–8°C (36–46°F). Avastin vials should be protected from light. Do not freeze or shake.

Diluted Avastin solutions may be stored at 2–8°C (36–46°F) for up to 8 hours. Store in the original carton until time of use. No incompatibilities between Avastin and polyvinylchloride or polyolefin bags have been observed.

Precautions & warnings

What should I know before using Avastin (bevacizumab)?

Before using bevacizumab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestinal ulcers, bleeding problems (such as recent bloody vomiting or coughing up blood), recent major surgery, recent injuries/wounds, high blood pressure, kidney disease, diabetes.

Before having surgery or any medical procedure, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Bevacizumab can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.

Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Caution is advised when using this drug in the elderly because they may be at greater risk for side effects (e.g., blood clots, kidney effects such as protein in the urine).

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. Women of child-bearing age should use reliable forms of birth control while using this medication and for 6 months after stopping treatment. If you become pregnant or think you may be pregnant, tell your doctor right away.

Based on information from related drugs, this medication may pass into breast milk. Therefore, breast-feeding while using this medication is not recommended. Also, do not breast-feed for extended period after stopping this drug. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Avastin (bevacizumab) during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this Avastin (bevacizumab). This Avastin (bevacizumab) is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Avastin (bevacizumab)?

Dry mouth, cough, voice changes, loss of appetite, diarrhea, vomiting, constipation, mouth sores, nausea, or headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist right away.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: swelling of ankles/feet, sudden weight gain, fast heartbeat, signs of infection (e.g., fever, persistent sore throat), muscle cramps, muscle loss, yellowing eyes/skin, dark urine, difficulty urinating, signs of kidney problems (such as change in the amount of urine, frothy urine).

Symptoms of a severe infusion reaction that may occur during bevacizumab treatment include difficulty breathing, flushing, severe dizziness, nausea/vomiting, shaking, or chest pain. Tell your healthcare professional if you have any of these symptoms during your treatment. Your doctor will monitor you closely and will temporarily stop your treatment if a reaction occurs.

Bevacizumab may rarely cause blood clots (such as pulmonary embolism, stroke, heart attack, deep vein thrombosis). You may be at increased risk for blood clots if you have a history of blood clots, heart/blood vessel disease, or if you are immobile (such as on very long plane flights or being bedridden). If you use estrogen-containing products, these may also increase your risk. Before using this medication, if you have any of these conditions report them to your doctor or pharmacist. Get medical help right away if any of these side effects occur: shortness of breath/rapid breathing, chest/jaw/left arm pain, unusual sweating, confusion, sudden dizziness/fainting, pain/swelling/warmth in groin/calf, sudden/severe headaches, slurred speech, weakness on one side of the body, sudden vision changes.

This medication can cause bleeding. Some episodes may be minor including nosebleeds, minor gum bleeding, and vaginal bleeding. If these persist or worsen, notify your doctor or pharmacist promptly. Other episodes may be more serious including stomach bleeding or bleeding in the lungs (see also Warning section).

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high. Your doctor may control your blood pressure with medication.

Rarely, bevacizumab may cause a condition called PRES (posterior reversible encephalopathy syndrome). Get medical help right away if you develop persistent headache, seizures, sudden vision changes, mental/mood changes (e.g., confusion).

This medication may affect the ovaries, possibly reducing fertility and causing hormone changes. Talk to your doctor for more details.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Avastin (bevacizumab)?

A product that may interact with this drug is: sunitinib.

Avastin (bevacizumab) may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Avastin (bevacizumab)?

Avastin (bevacizumab) may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Avastin (bevacizumab)?

Avastin (bevacizumab) may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Avastin (bevacizumab).

What is the dose of Avastin (bevacizumab) for an adult?

INJECTION SOLUTION

Administration

Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.

Do not initiate Avastin until at least 28 days following major surgery. Administer Avastin after the surgical incision has fully healed.

First infusion: Administer infusion over 90 minutes.

Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Recommended Doses and Schedules

Patients should continue treatment until disease progression or unacceptable toxicity.

Metastatic Colorectal Cancer (mCRC)

The recommended doses are 5 mg/kg or 10 mg/kg every 2 weeks when used in combination with intravenous 5-FU-based chemotherapy.

Administer 5 mg/kg when used in combination with bolus-IFL.

Administer 10 mg/kg when used in combination with FOLFOX4.

Administer 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks when used in combination with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line Avastin-containing regimen.

Non-Squamous Non-Small Cell Lung Cancer (NSCLC)

The recommended dose is 15 mg/kg every 3 weeks in combination with carboplatin and paclitaxel.

Glioblastoma

The recommended dose is 10 mg/kg every 2 weeks.

Metastatic Renal Cell Carcinoma (mRCC)

The recommended dose is 10 mg/kg every 2 weeks in combination with interferon alfa.

Cervical Cancer

The recommended dose of Avastin is 15 mg/kg every 3 weeks as an intravenous infusion administered in combination with one of the following chemotherapy regimens: paclitaxel and cisplatin, or paclitaxel and topotecan.

Platinum-Resistant Recurrent Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer

The recommended dose is 10mg/kg every 2 weeks in combination with one of the following intravenous chemotherapy regimens: paclitaxel, pegylated liposomal doxorubicin, or topotecan (weekly); or 15 mg/kg every 3 weeks in combination with topotecan (every 3 weeks).

Platinum-Sensitive Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

The recommended dose is 15 mg/kg every 3 weeks when administered in combination with carboplatin and paclitaxel for 6 cycles and up to 8 cycles, followed by continued use of Avastin 15 mg/kg every 3 weeks as a single agent until disease progression. Alternatively, 15 mg/kg every 3 weeks when administrated in combination with carboplatin and gemcitabine for 6 cycles and up to 10 cycles, followed by continued use of Avastin 15 mg/kg every 3 weeks as a single agent until disease progression.

Preparation for Administration

Use appropriate aseptic technique. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Withdraw necessary amount of Avastin and dilute in a total volume of 100 mL of 0.9% Sodium Chloride Injection, USP. Discard any unused portion left in a vial, as the product contains no preservatives.

DO NOT ADMINISTER OR MIX WITH DEXTROSE SOLUTION.

INTRAVENOUS SOLUTION

Usual Adult Dose for Colorectal Cancer

5 mg/kg IV every 2 weeks when used in combination with irinotecan, fluorouracil, and leucovorin in the IFL regimen.

10 mg/kg IV every 2 weeks when used in combination with oxaliplatin, folinic acid, and fluorouracil in the FOLFOX4 regimen.

Administer 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks when used in combination with a fluoropyrimidine-irinotecan or fluoropyrimidine-oxaliplatin based chemotherapy regimen in patients who have progressed on a first-line bevacizumab containing regimen.

Duration of therapy: Continue treatment until disease progression or unacceptable toxicity occurs.

Comments:

  • Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
  • Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
  • First infusion: Administer infusion over 90 minutes.
  • Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:

  • First- or second-line treatment of patients with metastatic carcinoma of the colon or rectum in combination with IV 5-fluorouracil-based chemotherapy
  • Second-line treatment of patients with metastatic colorectal cancer who have progressed on a first-line bevacizumab-containing regimen, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy
  • Limitation of Use: This drug is not indicated for adjuvant treatment of colon cancer

Usual Adult Dose for Non-Small Cell Lung Cancer

For use in combination with carboplatin and paclitaxel for the treatment of non-squamous, non-small cell lung cancer:

Initial dose: 15 mg/kg as an IV infusion every 3 weeks

Comments:

  • Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
  • Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
  • First infusion: Administer infusion over 90 minutes.
  • Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:

  • First-line treatment of unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer in combination with carboplatin and paclitaxel

Usual Adult Dose for Glioblastoma Multiforme

Recommended dose: 10 mg/kg every 2 weeks

Comments:

  • Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
  • Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
  • First infusion: Administer infusion over 90 minutes.
  • Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:

  • For the treatment of glioblastoma with progressive disease in adult patients following prior therapy as a single agent. The effectiveness of bevacizumab in glioblastoma is based on an improvement in objective response rate. There are no data demonstrating an improvement in disease-related symptoms or increased survival with bevacizumab.

Usual Adult Dose for Cervical Cancer

15 mg/kg IV every 3 weeks

Comments:

  • Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
  • Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
  • First infusion: Administer infusion over 90 minutes.
  • Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:

  • For the treatment of persistent, recurrent, or metastatic carcinoma of the cervix in combination with paclitaxel and cisplatin or paclitaxel and topotecan.

Usual Adult Dose for Renal Cell Carcinoma

10 mg/kg IV every 3 weeks

Comments:

  • Do not administer as an intravenous push or bolus. Administer only as an intravenous (IV) infusion.
  • Do not initiate this drug until at least 28 days following major surgery. Administer after the surgical incision has fully healed.
  • First infusion: Administer infusion over 90 minutes.
  • Subsequent infusions: Administer second infusion over 60 minutes if first infusion is tolerated; administer all subsequent infusions over 30 minutes if infusion over 60 minutes is tolerated.

Uses:

  • For the treatment of metastatic renal cell carcinoma in combination with interferon alfa.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

There are no recommended dose reductions for the use of bevacizumab. If needed, bevacizumab should be either discontinued or temporarily suspended.

What is the dose of Avastin (bevacizumab) for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Avastin (bevacizumab) available?

Avastin (bevacizumab) is available in the following dosage forms and strengths:

  • Injection solution
  • Intravenous solution

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Avastin (bevacizumab), take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: January 8, 2018 | Last Modified: September 12, 2019

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