Ziv-aflibercept (Generic Name)

Other Names: Zaltrap®

About This Drug

Ziv-aflibercept is a drug used to treat colorectal cancer. This drug is given intravenously (IV).

Possible Side Effects (More Common)

  • Slow wound healing (see Special Instructions)
  • Nose bleeds (see Special Instructions)
  • High blood pressure. Your doctor will check your blood pressure as needed.
  • Redness and/or swelling of the hands or feet, especially in combination with other cancer therapies.
  • Bone marrow depression, especially in combination with other anti-cancer therapies. This is a decrease in the number of white blood cells, red blood cells, and platelets.
  • Effects on your kidneys. Your doctor will test your kidney function as needed.
  • Fatigue
  • Headache
  • Diarrhea
  • Abdominal pain
  • Infection
  • Soreness of the mouth and throat
  • Weight loss
  • Decrease in appetite
  • Shortness of breath
  • Difficulty speaking

Possible Side Effects (Less Common)

  • Changes to the pigmentation (color) of your skin
  • Dehydration
  • Runny nose
  • Chest pain or symptoms of a heart attack. (rare). Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes. Or the discomfort may go away and come back. It can feel like uncomfortable pressure, squeezing, fullness, or pain. Sometimes discomfort is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Stroke (rare).  Symptoms of a stroke, such as sudden numbness or weakness of your face, arm, or leg, especially on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; or sudden, severe headache with no known cause. If you have any of these symptoms for 2 minutes or more, call 911.
  • Blood in your stools (report immediately)

Allergic Reactions

  • Severe allergic reactions to this drug are rare, but may occur in some patients. While you are receiving this drug by IV, tell your nurse immediately if you have any of the following symptoms of an allergic reaction:
    • Difficulty catching your breath
    • Feeling like your tongue or throat are swelling
    • Feeling your heart beat rapidly (palpitations)
    • Dizziness or lightheadedness
    • Flushing/itching/rash/hives

Special Instructions

  • Ziv-aflibercept may cause slow wound healing. It should not be given within 28 days of surgery or any procedure requiring conscious sedation. If you must have emergency surgery or have an accident that results in a wound, tell the treating doctor that you are on ziv-aflibercept. Call your cancer doctor as soon as possible for further instructions.
  • If you have a nose bleed, sit with your head tipped slightly forward. Apply pressure by lightly pinching the bridge of your nose between your thumb and forefinger. Call your doctor if you feel dizzy or faint or if the bleeding doesn’t stop after 10 to 15 minutes.

Reproduction Concerns

  • Pregnancy warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used during your cancer treatment and for up to 3 months following treatment.
  • Genetic counseling is available to you to discuss the effects of this drug therapy on future pregnancies. In addition, a genetic counselor can review the potential risks of problems in the fetus due to this medication, if an exposure during pregnancy has occurred.
  • Breast feeding warning: It is not known if this drug passes into breast milk. For this reason, women are advised to discuss with their doctor the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and seriously harm a breast-feeding infant.

Treating Side Effects

  • Drink 6 - 8 cups of fluids every day unless your doctor has told you to restrict your fluid intake. A cup is 8 ounces of fluid. If you vomit or have diarrhea, you should drink more fluids so that you do not become dehydrated.
  • Mouth care is very important. Your mouth care should consist of regular, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of ½ teaspoon of salt in 8 ounces of water or ½ teaspoon of sodium bicarbonate (baking soda) in 8 ounces of water. This should be done at least after every meal and at bedtime.
  • Ask your doctor or nurse about medicine to help prevent or lessen nausea, vomiting, diarrhea, constipation, indigestion, abdominal pain, bloating, or headache.
  • If you have mouth sores, avoid mouthwash that contains alcohol. Avoid alcohol and smoking because they can irritate your mouth and throat.

Food and Drug Interactions

There are no known interactions of ziv-aflibercept with food. This drug may interact with other medications. Tell your doctor and pharmacist about all the medication and dietary supplements (vitamins, minerals, herbs, and others) that you are currently taking. The safety and effectiveness of dietary supplements and alternative diets are often unknown. Using these might unexpectedly affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's advice.

When to Call the Doctor

Call your doctor or nurse immediately if you have any of the following:

  • Fever of 100.5 F (38 C) or above
  • Chills
  • Unusual bleeding and/or uncontrolled bleeding
  • Severe abdominal pain
  • Dizziness
  • Wheezing or difficulty breathing
  • Uncontrolled nausea that prevents you from eating or drinking
  • Chest pain or symptoms of a heart attack. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes. Or the discomfort may go away and come back. It can feel like uncomfortable pressure, squeezing, fullness, or pain. Sometimes discomfort is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes or more, call 911.
  • Symptoms of a stroke, such as sudden numbness or weakness of your face, arm, or leg, especially on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; or sudden, severe headache with no known cause. If you have any of these symptoms for 2 minutes or more, call 911.
  • Vomiting more than three times a day
  • Diarrhea 4 times a day or diarrhea with weakness or lightheadedness
  • Severe headache, confusion, seizures and/or visual loss
  • Changes in vision
  • Swelling in your legs or arms
  • You become pregnant while on this medication

Call your doctor or nurse as soon as possible if any of the following symptoms occur:

  • Pain or redness on your hands or feet
  • Nausea or vomiting that does not go away with prescribed medicine
  • Persistent loss of appetite or rapid weight loss (more than 5 pounds in 1 week)
  • Extreme weakness that interferes with normal activities

Revised January 2013

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com