Icatibant Acetate

Name: Icatibant Acetate

Introduction

Synthetic decapeptide similar in structure to bradykinin; a selective bradykinin type 2 (B2) receptor antagonist.1 2 5

Icatibant Acetate Dosage and Administration

General

  • Patients may self-administer drug after receiving training from healthcare provider.1

Administration

Sub-Q Administration

Inject sub-Q into abdomen over at least 30 seconds until entire contents of syringe have been expelled; administer about 5–10 cm (2–4 inches) below the umbilicus and ≥5 cm (≥2 inches) from scars.1

Use 25-gauge needle supplied by manufacturer; do not use any other needle.1

Dosage

Available as icatibant acetate; dosage expressed in terms of icatibant.1

Adults

Hereditary Angioedema Sub-Q

Inject 30 mg at onset of acute attack.1 12 May repeat dose every 6 hours as needed for recurring symptoms or inadequate response, up to maximum of 3 doses (90 mg total) within a 24-hour period.1 12

Prescribing Limits

Adults

Hereditary Angioedema Sub-Q

Maximum 90 mg in 24-hour period.1 12

Special Populations

Hepatic Impairment

No dosage adjustment required.1

Renal Impairment

No dosage adjustment required.1

Geriatric Patients

No dosage adjustment required.1

Interactions for Icatibant Acetate

No formal drug interaction studies to date.1 However, icatibant is not metabolized by CYP isoenzymes.1

Specific Drugs

Drug

Interaction

ACE inhibitors (e.g., captopril)1 10

Potential for decreased hypotensive effect of ACE inhibitor1 10

Actions

  • A synthetic decapeptide similar in structure to bradykinin; a selective bradykinin type 2 (B2) receptor antagonist.1 2 5

  • HAE is a rare autosomal-dominant genetic disorder characterized by a mutation in the complement 1 (C1)-inhibitor gene;1 8 14 15 16 17 18 21 deficiency in C1-esterase inhibitor results in unrestrained activity of plasma kallikrein and elevated bradykinin levels, which leads to increased vascular permeability and angioedema.1 4 5 8 12 14 15 16 17 18 19 20

  • Competitive inhibition of the bradykinin B2 receptor reduces the vasodilatory effects of excess bradykinin.1 4 5 7 8

Advice to Patients

  • Advise patients of maximum dosage; do not administer >3 doses of 30 mg each (total of 90 mg) within a 24-hour period.1

  • Advise patients to immediately seek medical attention after treating a laryngeal HAE attack with icatibant.1

  • Risk of injection site reactions.1 Importance of patients informing clinicians if any erythema, bruising, swelling, warmth, burning sensation, pruritus, irritation, urticaria, numbness, pressure, or pain occurs at injection site.1

  • Risk of pyrexia, elevated serum aminotransferases (ALT, AST), and rash.1

  • Risk of fatigue, drowsiness, and dizziness; do not perform hazardous activities requiring mental alertness or physical coordination (e.g., operating machinery, driving a motor vehicle) if such symptoms occur.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

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