Icatibant
FIRAZYR
What it isSelective bradykinin B2 receptor antagonist; acute attacks of hereditary angioedema.
Why this oneIt blocks the mediator directly, so it works in the bradykinin-mediated angioedema that antihistamines, steroids and epinephrine do not touch.
What limits it⚑ That distinction is the teaching point: ACE-inhibitor and hereditary angioedema are bradykinin-mediated, and the usual anaphylaxis drugs fail. Self-injected subcutaneously; injection-site reactions are near-universal.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute attacks of hereditary angioedema (HAE) | Adults (≥18 yr) | 30 mg SC (abdominal area) at attack onset | 30 mg SC; may repeat if response inadequate or symptoms recur (≥6 h apart) | 3 doses (90 mg) SC per 24 h |
Renal No adjustment needed
Hepatic No adjustment needed
Repeat doses at intervals of at least 6 h; no more than 3 doses in any 24-h period
Instructions
- SC injection into abdominal area over at least 30 seconds; use only the provided 25-gauge needle
- Inspect visually: solution should be clear and colorless; do not use if particulates or discolored
- Patients may self-administer upon recognizing an HAE attack after training by a healthcare professional
- After treating a laryngeal attack, seek immediate medical attention (airway obstruction risk)
Cautions
- Laryngeal attacks: treat, then seek immediate medical attention in an appropriate healthcare facility (airway obstruction risk)
Adverse reactions
- Injection site reactions (97%: bruising, erythema, pain, swelling, pruritus, etc.)
- Pyrexia
- Transaminase increase
- Dizziness
- Rash
- Urticaria (postmarketing)
Pregnancy Human data have not identified drug-associated risk of birth defects or miscarriage; animal studies showed premature birth/abortion (rabbits) and delayed parturition/fetal death (rats) at low multiples of MRHD
Lactation No human data; present in rat milk, but systemic absorption in infant via breast milk not expected — weigh benefits against risk
NO BOXED WARNINGS
Principal riskInjection-site reactions; it does not treat histaminergic angioedema
Classes and tags
Clinical profile
Mechanism of action: Icatibant ballicule
