By Medically reviewed by hellodoktor

Generic Name: Ziv-aflibercept Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: C


What is Ziv-aflibercept used for?

Ziv-aflibercept is used with other medications to treat cancer of the colon and rectum.

How should I take Ziv-aflibercept?

This medication is given by injection into a vein by a health care professional. It is given as directed by your doctor, usually every 2 weeks. The medication is injected slowly into a vein over 1 hour.

The dosage is based on your medical condition, weight, and response to treatment.

You should receive this medication regularly to get the most benefit from it. To help you remember, mark your calendar to keep track of when to receive the next dose.

How do I store Ziv-aflibercept?

Store diluted ZALTRAP at 2°–8°C (36°–46°F) for up to 24 hours, or at controlled room temperature 20°–25°C (68°–77°F) for up to 8 hours. Discard any unused portion left in the infusion bag.

There may be different brands of Ziv-aflibercept 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 Ziv-aflibercept 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 Ziv-aflibercept?

Before receiving ziv-aflibercept, tell your doctor or pharmacist if you are allergic to it; or to aflibercept; 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: high blood pressure, kidney disease, recent surgery, recent injuries/wounds, recent/current infection, blood/bone marrow disorders (such as low platelet/neutrophil/red blood cell levels), bleeding problems (such as bleeding of the stomach/intestines).

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).

Ziv-aflibercept 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 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.

Older adults may be more sensitive to the side effects of this drug, especially diarrhea, dehydration, weight loss, and weakness.

This medication is not recommended for use during pregnancy. It may harm an unborn baby. Therefore, it is important to prevent pregnancy (in female patients and female partners of male patients) while using this medication and for 3 months after stopping treatment. Consult your doctor for more details and to discuss using reliable forms of birth control (such as condoms, birth control pills) while using this medication. If you or your partner become pregnant or if you think you or your partner may be pregnant, tell your doctor right away.

It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. 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 Ziv-aflibercept during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Ziv-aflibercept. Ziv-aflibercept 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 Ziv-aflibercept?

Diarrhea, headache, mouth pain/sores, runny nose, voice changes, weight loss, weakness, tiredness, or darkening of the skin may occur. If any of 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: signs of kidney problems (such as change in the amount of urine), swelling hands/ankles/feet, severe/persistent diarrhea, signs of dehydration (such as muscle cramps, extreme thirst, dizziness), pain/redness/swelling/tingling/burning of the hands/feet.

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

This medication may lower your ability to fight infections. This may make you more likely to get a serious infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as fever, chills, persistent sore throat, cough).

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.

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.


What drugs may interact with Ziv-aflibercept?

Ziv-aflibercept is very similar to aflibercept. Do not use ziv-aflibercept while using the form of aflibercept that is also given by injection into a vein.

Ziv-aflibercept 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 Ziv-aflibercept?

Ziv-aflibercept 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 Ziv-aflibercept?

Ziv-aflibercept 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.


The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Ziv-aflibercept.

What is the dose of Ziv-aflibercept for an adult?

Usual Adult Dose for Metastatic Colorectal Cancer

IV: 4 mg/kg every 2 weeks (in combination with fluorouracil, leucovorin, and irinotecan [FOLFIRI]), continue until disease progression or unacceptable toxicity

Usual Geriatric Dose for Metastatic Colorectal Cancer

Refer to adult dosing.

Renal Dose Adjustment

There are no dosage adjustments provided in the manufacturer’s labeling; however, need for adjustment is not likely because exposure in patients with mild, moderate, and severe impairment was similar to that of patients with normal renal function.

Hepatic Dose Adjustment

Mild (total bilirubin >1 to 1.5 times ULN) to moderate (total bilirubin >1.5 to 3 times ULN) impairment: There are no dosage adjustments provided in the manufacturer’s labeling; however, need for adjustment is not likely because exposure was similar to that of patients with normal hepatic function.

Severe impairment (total bilirubin >3 times ULN): There are no dosage adjustments provided in the manufacturer’s labeling (no data available).

Adjustment for Toxicity

Arterial thrombotic events: Discontinue treatment.

Fistula formation: Discontinue treatment.

Gastrointestinal perforation: Discontinue treatment.

Hemorrhage, severe: Discontinue treatment.


Recurrent or severe hypertension: Temporarily withhold treatment until controlled and then resume with a permanent dose reduction to 2 mg/kg every 2 weeks.

Hypertensive crisis or hypertensive encephalopathy: Discontinue treatment.

Neutropenia: Temporarily withhold treatment until ANC is ≥1500/mm3.

Renal effects:

Proteinuria (≥2 g/24 hours): Temporarily withhold treatment until proteinuria <2 g/24 hours and then resume at previous dose.

Recurrent proteinuria: Temporarily withhold treatment until proteinuria <2 g/24 hours and then resume with a permanent dose reduction to 2 mg/kg every 2 weeks.

Nephrotic syndrome or thrombotic microangiopathy: Discontinue treatment

Reversible posterior leukoencephalopathy syndrome (RPLS): Discontinue treatment.

Surgery/wound healing impairment:

Elective surgery: Temporarily withhold treatment for at least 4 weeks prior to elective surgery; do not resume until at least 4 weeks after major surgery AND until wound is fully healed; for minor surgery (eg, biopsy, central venous port placement, tooth extraction), may be resumed after wound is fully healed.

Wound healing impaired: Discontinue treatment.

Note: For toxicities related to FOLFIRI, refer to individual Fluorouracil or Irinotecan monographs.


Certain adverse events, such as diarrhea, dizziness, weakness, weight loss, and dehydration, occurred at a higher incidence in elderly compared to younger adults; monitor closely during treatment.

Other comments


IV: Infuse over 1 hour. Do not administer as an IV push or bolus. Administer prior to any FOLFIRI component. Do not administer other medications through the same intravenous line.

Infuse via a 0.2 micron polyethersulfone filter; do not use filters made of polyvinylidene fluoride (PVDF) or nylon. Administer with one of the following types of infusion sets: Polyvinyl chloride (PVC) containing DEHP, DEHP-free PVC containing trioctyl-trimellitate (TOTM), polypropylene, polyethylene lined PVC, or polyurethane.

What is the dose of Ziv-aflibercept 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 Ziv-aflibercept available?

Ziv-aflibercept is available in the following dosage forms and strengths:

  • 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 Ziv-aflibercept, 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: July 26, 2018 | Last Modified: September 12, 2019

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