Trastuzumab

By Medically reviewed by hellodoktor

Generic Name: Trastuzumab Brand Name(s): Trastuzumab, Trastuzumab and Trastuzumab. Avability: Rx Pregnancy Category: N

Uses

What is Trastuzumab used for?

Trastuzumab is used alone or with other medications to treat certain types of breast cancer. It is also used along with other medications to treat certain types of stomach cancer. The types of cancers trastuzumab is used to treat are tumors that produce more than the normal amount of a certain substance called HER2 protein.

This medication is called a monoclonal antibody. It works by attaching to the HER2 cancer cells and blocking them from dividing and growing. It may also destroy the cancer cells or signal the body (immune system) to destroy the cancer cells.

How should I take Trastuzumab?

Trastuzumab is not the same as trastuzumab emtansine or ado-trastuzumab emtansine. Do not substitute trastuzumab emtansine or ado-trastuzumab emtansine for trastuzumab.

This medication is given by slow injection into a vein by a health care professional, usually once every week or once every 3 weeks. The first injection is given over at least 90 minutes.

The dosage is based on your medical condition, response to treatment, body weight, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

To get the most benefit from this medication, do not miss any doses. To help you remember, mark the days on the calendar when you need to receive the medication.

Your doctor may prescribe other medications (e.g., acetaminophen, diphenhydramine) for you to take before the start of your treatment to help prevent serious side effects.

How do I store Trastuzumab?

Trastuzumab is best stored in the refrigerator. To prevent drug damage, do not freeze. There may be different brands of Trastuzumab that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Trastuzumab down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Trastuzumab?

Before using trastuzumab, tell your doctor or pharmacist if you are allergic to it; or to other mouse protein medications; or if you have any other allergies. This product may contain inactive ingredients (such as benzyl alcohol), 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: previous cancer treatments (including radiation therapy to the chest), current infection, virus infection with returning symptoms (e.g.,

What should I know before using Trastuzumab?

Before using trastuzumab, tell your doctor or pharmacist if you are allergic to it; or to other mouse protein medications; or if you have any other allergies. This product may contain inactive ingredients (such as benzyl alcohol), 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: previous cancer treatments (including radiation therapy to the chest), current infection, virus infection with returning symptoms (e.g., herpes, shingles), heart disease, high blood pressure, lung problems, previous severe reaction to monoclonal antibody treatment.

Trastuzumab can make you more likely to get infections or may worsen any current infections. Therefore, wash your hands well to prevent the spread of infection. 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 your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

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

Caution is advised when using this drug in the elderly because they may be at greater risk for heart problems (e.g., heart failure).

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using trastuzumab. Trastuzumab may harm an unborn baby. Ask about reliable forms of birth control while using this medication and for 7 months after stopping treatment. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding while using this medication and for 7 months after stopping treatment.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Trastuzumab during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Trastuzumab. Trastuzumab is pregnancy risk category N 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

, shingles), heart disease, high blood pressure, lung problems, previous severe reaction to monoclonal antibody treatment.

Trastuzumab can make you more likely to get infections or may worsen any current infections. Therefore, wash your hands well to prevent the spread of infection. 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 your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

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

Caution is advised when using this drug in the elderly because they may be at greater risk for heart problems (e.g., heart failure).

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using trastuzumab. Trastuzumab may harm an unborn baby. Ask about reliable forms of birth control while using this medication and for 7 months after stopping treatment. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding while using this medication and for 7 months after stopping treatment.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Trastuzumab during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Trastuzumab. Trastuzumab is pregnancy risk category N 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 Trastuzumab?

Diarrhea, redness/irritation at injection (IV) site, muscle/joint/back pain, stomach/abdominal pain, trouble sleeping, nausea, vomiting, mouth sores, and loss of appetite may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If these effects persist or worsen, tell your doctor or pharmacist promptly.

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: symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), bone pain, increased coughing, severe headache, tingling/numbness (e.g., in the hands, feet, leg), mental/mood changes, fast/pounding heartbeat, easy bruising/bleeding.

Get medical help right away if you have any very serious side effects, including: weakness on one side of the body, slurred speech, vision changes, confusion.

This medication can lower the body’s ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as fever, chills, or persistent sore throat.

This medication can sometimes cause a serious infusion (IV) reaction. Immediately tell your doctor of the following side effects that occur while this drug is being given or within 24 hours after your treatment is finished, such as chills, fever, flushing, nausea, headache, dizziness, fainting, rash, and weakness.

Trastuzumab can commonly cause a rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe reaction. Therefore, tell your doctor right away if you develop any rash.

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 Trastuzumab?

If you will be using an anthracycline (such as doxorubicin) after stopping trastuzumab treatment, if possible, wait at least 7 months.

Trastuzumab 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 Trastuzumab?

Trastuzumab 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 Trastuzumab?

Trastuzumab 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 Trastuzumab.

What is the dose of Trastuzumab for an adult?

Usual Adult Dose for Breast Cancer

Metastatic HER2-Overexpressing Breast Cancer:

Initial dose: 4 mg/kg IV over 90 minutes, alone or with paclitaxel

Maintenance dose: 2 mg/kg IV over 30 minutes once weekly

Duration of therapy: Until disease progression

Comments:

-Do not administer as an IV push or bolus.

Use: In combination with paclitaxel for first line treatment of HER2 overexpressing metastatic breast cancer, OR as a single agent for treatment of HER2 overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease

Usual Adult Dose for Breast Cancer – Adjuvant

Adjuvant Treatment of HER2-Overexpressing Breast Cancer:

Administer according to one of the following doses and schedules for a total of 52 weeks of therapy:

4 mg/kg IV over 90 minutes, then at 2 mg/kg IV over 30 minutes weekly for 12 weeks (with paclitaxel or docetaxel) or 18 weeks (with docetaxel/carboplatin); one week following the last weekly dose, administer 6 mg/kg IV over 30 to 90 minutes every 3 weeks for 52 weeks

OR

As a single agent within 3 weeks following completion of multi-modality, anthracycline based chemotherapy regimens: 8 mg/kg IV over 90 minutes, then 6 mg/kg IV over 30 to 90 minutes every 3 weeks for 52 weeks; extending adjuvant therapy beyond one year is not recommended

Comments:

-Do not administer as an IV push or bolus.

Use: Adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature) breast cancer: as part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel, OR with docetaxel and carboplatin, OR as a single agent following multi-modality anthracycline based therapy

Usual Adult Dose for Esophageal Carcinoma

Metastatic Gastric Cancer:

Initial dose: 8 mg/kg IV over 90 minutes

Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks

Duration of therapy: Until disease progression

Comments:

-Do not administer as an IV push or bolus.

Use: In combination with cisplatin and capecitabine or 5-fluorouracil, for the treatment of patients with HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma who have not received prior treatment for metastatic disease

Usual Adult Dose for Gastric Cancer

Metastatic Gastric Cancer:

Initial dose: 8 mg/kg IV over 90 minutes

Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks

Duration of therapy: Until disease progression

Comments:

-Do not administer as an IV push or bolus.

Use: In combination with cisplatin and capecitabine or 5-fluorouracil, for the treatment of patients with HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma who have not received prior treatment for metastatic disease

Dose Adjustments

Missed Doses:

-If a dose is missed by one week or less, then the usual maintenance dose (weekly schedule: 2 mg/kg; three-weekly schedule: 6 mg/kg) should be administered as soon as possible. Do not wait until the next planned cycle. Subsequent maintenance doses should be administered 7 days or 21 days later according to the weekly or three-weekly schedules, respectively.

-If a dose is missed by more than one week, a reloading dose should be administered over approximately 90 minutes (weekly schedule: 4 mg/kg; three-weekly schedule: 8 mg/kg) as soon as possible. Subsequent maintenance doses (weekly schedule: 2 mg/kg; three-weekly schedule 6 mg/kg) should be administered 7 days or 21 days later according to the weekly or three-weekly schedules, respectively.

Infusion Reactions:

-Decrease the rate of infusion for mild or moderate infusion reactions.

-Interrupt the infusion in patients with dyspnea or significant hypotension.

-Discontinue therapy for severe or life-threatening infusion reactions.

Cardiomyopathy:

-Assess left ventricular ejection fraction (LVEF) prior to initiation of therapy and at regular intervals during therapy. Withhold dosing for at least 4 weeks for either of the following:

-Greater than or equal to 16% absolute decrease in LVEF from pretreatment values.

-LVEF below institutional limits of normal and 10% or more absolute decrease in LVEF from pretreatment values.

-Therapy may be resumed if, within 4 to 8 weeks, the LVEF returns to normal limits and the absolute decrease from baseline is 15% or less.

-Permanently discontinue therapy for a persistent (greater than 8 weeks) LVEF decline or for suspension of dosing on more than 3 occasions for cardiomyopathy.

What is the dose of Trastuzumab 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 Trastuzumab available?

Trastuzumab is available in the following dosage forms and strengths:

  • Intravenous powder for injection.

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 Trastuzumab, 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.

Sources

Review Date: August 9, 2018 | Last Modified: September 12, 2019

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