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Mechanism of action


Bevarest comprises an active compound like Bevacizumab which binds to VEGF and avoid the communication of VEGF to its receptors like Flt-1 & KDR) present on the surface of the cells This interaction prevents endothelial cell multiplication and new blood vessel production occurs Hence in counts cessation of metastatic cancer cells development happens

Distribution


The volume of distribution is 2.9 (22%) L

Elimination


The Bevacizumab half life period is 20days (11 to 50days)

Brand : Bevarest
Ingredients : Bevacizumab
Strength : 400mg/16ml & 100mg/4ml
Manufactured : Emcure Pharmaceuticals
Package : 400mg of Bevacizumab containing vial

Key point

Avoid administration of Bevarest before at least 28 days following surgery and the wound is completely cured

Metastatic colorectal carcinoma

Concomitant use with 5-fluorouracil based chemotherapy is the usual dosage of Bevarest : While concomitant use with bolus IFL the dose is 5mg/kg of Bevarest for every 2 weeks IV. While in combination with FOLFOX4 the dose is 10mg/kg of Bevarest for every 2 weeks IV 5mg/kg IV Bevarest for every 2 weeks or 7.5 mg/kg Bevarest as IV every 3 weeks by concurrently used with fluoropyrimidine Irinotecan or fluoropyrimidine oxaliplatin based therapy

Non-small cell lung cancer

While combining with carboplatin and paclitaxel : The Bevarest usual dosage is 15mg/kg IV for every 3 weeks by

Glioblastoma

For every 2 weeks : 10mg/kg of Bevarest administered IV

Metastatic cervical cancer

Combining with paclitaxel and cisplatin or with paclitaxel and topotecan : The drug Bevarest usual dosage is 15mg/kg of Bevarest given intravenously for every 3 weeks

Metastatic renal cell cancer

Concurrent use with interferon alfa : The Bevarest usual dosage is 10mg/kg IV for every 2 weeks

Epithelial ovarian, fallopian tube or peritoneal cancer

Platinum opposing: Concurrent use with paclitaxel, pegylated liposomal doxorubicin or topotecan :The Bevarest regular dosage is 10mg/kg of Bevarest for every 2 weeks Or Combining with topotecan : The Bevarest regular dosage 15mg/kg of Bevarest given through IV for every 3 weeks Platinum responsive concomitant with carboplatin and paclitaxel for 6 to 8 cycles : The drug Bevarest recommended dosage of is 15mg/kg given IV for 3 weeks Combining with gemcitabine & carboplatin for 6 to 10 cycles : The Bevarest recommended dosage is 15mg/kg of Bevarest given IV for 3 weeks

Preparation & administration

Bevarest is intravenous solution At initial infusion: given IV infusion over 90 minutes Following infusions: give second infusion over 60 minutes, if tolerated Administer all following infusion over 30minutes Bevarest IV infusion is prepared in aseptic condition Bevarest 400mg containing 16ml solution whereas 100mg containing 4ml Bevarest dilute into 100ml of 0.9% NS Do not dilute with dextrose solution Dispose the remaining portion of medicine which is left in a vial

Side effects

Gastrointestinal perforation and fistulae Surgery and wound healing complication Hemorrhage Arterial thromboembolic events Venous thromboembolic events Hypertension Posterior reversible encephalopathy syndrome Renal injury & Proteinuria Infusion reactions Ovarian failure Congestive heart failure Neutropenia, mucosal inflammation, infection, neuropathy, Epistaxis, erythrodysaesthesia



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Precautions

There are some complications occurred during treatment with Bevarest , care should be taken Arterial thromboembolic events: cessation of treatment with Bevarest in patients who are suffered with severe ATE. Venous thromboembolic events: Toxicity Incidence should be detected; If severe condition therapy should be stopped. Hemorrhage: While on Bevarest treatment some Serious hemorrhages will occur like GI hemorrhage, hemoptysis, Hematemesis, CNS hemorrhage, nose bleeding & vaginal bleeding. Hence Discontinue the treatment.

Hypertension: Bp is increased in patients who are receiving Bevarest therapy, must be frequently check up with blood pressure and provided with alternative medication for correct the pressure. In hypertension crisis or encephalopathy should be discontinue the treatment.

Posterior reversible encephalopathy syndrome Embryo fetal toxicity occurs : During pregnancy condition Bevarest is contraindicated which produce fetal harm. Ovarian failure: The patients who are receiving Bevarest may have a chance of getting ovarian failure. Congestive heart failure: the drug combination with anthracycline based chemotherapy, treatment with Bevarest must not be used. Bevarest treatment should be stopped while CHF occurs.






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