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Precautions and Warnings With Ziv-Aflibercept

Because some potentially serious complications may occur in people using ziv-aflibercept, a number of safety precautions and warnings are in place to help ensure safe treatment. Some of these include warnings for people who have certain medical conditions, such as high blood pressure or kidney disease. Other risks apply to people who have a history of a blood clot, heart attack, or stroke.

What Should I Tell My Healthcare Provider?

Talk with your healthcare provider prior to receiving ziv-aflibercept (Zaltrap®) if you have:
In addition, let your healthcare provider know if you are:
  • Breastfeeding
  • Pregnant or thinking of becoming pregnant.
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Ziv-Aflibercept Precautions and Warnings

Some warnings and precautions to be aware of prior to using this medication include the following:
  • People treated with ziv-aflibercept are at risk for serious bleeding problems, which may be life-threatening in some cases. Let your healthcare provider know right away if you experience any unusual bleeding or bruising, including blood in your urine or stool, or if you cough up blood. Also, seek immediate medical attention if you have signs of bleeding in the brain, such as:
    • A sudden headache
    • Changes in vision
    • Numbness or weakness of the face or one side of the body
    • Difficulty speaking or walking.
  • Although rare, ziv-aflibercept may cause a hole to develop in the gastrointestinal (GI) tract, known medically as a GI perforation. A GI perforation is a medical emergency. Seek medical attention right away if you have severe abdominal (stomach) pain, as this is often the earliest sign of this complication.
  • Ziv-aflibercept can interfere with wound healing. If you are having surgery, your healthcare provider may recommend you temporarily stop treatment for four weeks before the surgery and not to resume treatment again until your surgical wounds have completely healed. Let your healthcare provider know if you have any wounds or sores that are not healing during treatment.
  • This medication may increase blood pressure. Your healthcare provider will monitor your blood pressure during treatment. If you develop high blood pressure (known medically as hypertension), you may need to be treated with medication. If your blood pressure becomes dangerously elevated, your healthcare provider may recommend you stop ziv-aflibercept treatment.
  • Ziv-aflibercept may increase the risk for blood clots and strokes. Talk to your healthcare provider about this risk, especially if you have had a blood clot or stroke in the past. Seek immediate medical attention if you develop chest pain or have signs of a stroke (see Stroke Symptoms).
  • This medicine may increase the risk for fistulas, which are abnormal connections between two organs or vessels that do not normally connect. For example, an anal fistula is an abnormal channel that develops between the anal glands and the skin. If you develop a fistula during ziv-aflibercept treatment, you will need to stop using it.
  • Ziv-aflibercept has been reported to cause kidney problems, including damage to the small blood vessels in the kidneys that filter water and waste products from your blood. Let your healthcare provider know if you have any signs of kidney problems, including foamy urine, which could be caused by too much protein in the urine, or swelling in the ankles, legs, or feet (fluid retention).
Your healthcare provider will monitor the amount of protein in your urine during treatment, as kidney damage can cause your body to excrete an abnormal amount of protein.
  • Like other anticancer medicines, ziv-aflibercept can decrease the amount of white blood cells and platelets in your blood, which could increase the risk for infections and bleeding problems. Let your healthcare provider know if you have any unusual bleeding or bruising, or signs of an infection, such as:
  • Diarrhea is a common side effect of ziv-aflibercept. Older adults are more likely to experience diarrhea during treatment with this drug. Let your healthcare provider know if you have severe or persistent diarrhea, or if you become dehydrated. Signs of dehydration include:
    • A dry mouth
    • Feeling thirsty
    • A decrease in the amount you usually urinate.
  • Ziv-aflibercept may rarely cause a serious brain condition known as reversible posterior leukoencephalopathy. Contact your healthcare provider right away if you have signs of this condition, such as:
  • It is unknown if ziv-aflibercept passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the drug (see Zaltrap and Breastfeeding).
  • Ziv-aflibercept is a pregnancy Category C medication, which means it may not be safe for use during pregnancy, although the full risks are currently unknown (see Zaltrap and Pregnancy).
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Ziv-Aflibercept Medication Information

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