Cequa is an immunosuppressant. Cequa can increase tear production that has been reduced by inflammation in the eye(s). Cequa is used to treat chronic dry eye that may be caused by inflammation.

Cequa eye drops are packaged in sterile, preservative-free, single-use vials.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Cequa if you are allergic to cyclosporine.

Tell your doctor if you are pregnant or breastfeeding.

Cequa is not approved for use by anyone younger than 16 years old.

How should I use Cequa?

Use Cequa eye drops exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Use the medicine about every 12 hours. Remove contact lenses first.

Wash your hands before using eye medication.

To apply the eye drops: Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye and squeeze a drop into this pocket. Close your eyes for 1 or 2 minutes.

Use only the number of drops your doctor has prescribed.

Wait at least 15 minutes before inserting contact lenses or using artificial tears.

Do not touch the tip of the eye dropper or place it directly on your eye. A contaminated dropper can infect your eye, which could lead to serious vision problems.

Cequa eye drops should be clear and colorless.

Each single-use bottle is for one use only (in both eyes). Throw the bottle away after one use, even if there is still medicine left inside.

Store at room temperature. Store Cequa single-use vials in their original foil pouch.

Dosing information

Usual Adult Dose for Keratoconjunctivitis Sicca:

1 drop 2 times a day in each eye approximately 12 hours apart

Comments:
– This drug can be used concomitantly with artificial tears, allowing a 15 minute interval between products.

Use: To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

An overdose of Cequa is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

What should I avoid while using Cequa eye drops?

It may be best not to wear contact lenses if you have dry eyes. Talk with your doctor about your own risk.

Cequa side effects

Get emergency medical help if you have signs of an allergic reaction to Cequa: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Cequa and call your doctor at once if you have:

• severe eye pain, burning, or stinging after putting in the drops;
• swollen eyelids; or
• signs of eye infection – swelling, redness, severe discomfort, crusting or drainage.

Common Cequa side effects may include:

• mild eye pain, redness, or other irritation;
• watery eyes;
• blurred vision; or
• feeling like something is in your eye.

Bevacizumab injection is a targeted cancer drug used to treat types of colon and rectal cancer, non-small cell lung cancer (NSCLC), glioblastoma, renal cell cancer (RCC), cervical cancer, ovarian cancer, fallopian tube cancer, or peritoneal cancer. Avastin is also used to treat types of hepatocellular carcinoma (HCC).

Bevacizumab belongs to a class of medications called antiangiogenic agents. Bevacizumab works by stopping the formation of blood vessels that bring oxygen and nutrients to tumors. This may slow the growth and spread of tumors.

Avastin was the first brand of bevacizumab to be approved by the FDA on February 26, 2004, and is called the reference product.  Biosimilars of Avastin are Alymsys, Jobevne, Mvasi, Vegzelma, and Zirabev.
Bevacizumab is used together with other chemotherapy medications.

Bevacizumab side effects

Common bevacizumab side effects may include increased blood pressure, headache, back pain, dry or watery eyes, dry or flaky skin, stuffy nose, runny nose, sneezing, or altered sense of taste.

Serious bevacizumab side effects 

Get emergency medical help if you have signs of an allergic reaction to bevacizumab, including hives, difficulty breathing, and swelling of your face, lips, tongue, or throat.

Some side effects may occur during the injection. Tell your medical caregiver right away if you feel dizzy, nauseated, light-headed, itchy, sweaty, or have a headache, chest tightness, back pain, trouble breathing, or swelling in your face.

Bevacizumab can cause a serious but rare neurologic disorder that affects the brain. Symptoms may occur within hours of your first dose or may not appear for up to a year after your treatment started. Call your doctor at once if you have extreme weakness or tiredness, headache, confusion, vision problems, fainting, or seizures (blackout or convulsions).

Bevacizumab can cause you to bleed more easily. Call your doctor or seek emergency medical attention if you have:

• easy bruising, unusual bleeding, or any bleeding that will not stop;
• signs of bleeding in your digestive tract – severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; or
• signs of bleeding in the brain – sudden numbness or weakness, slurred speech, severe headache, problems with vision or balance.

Some people taking bevacizumab have developed a perforation (a hole or tear) or a fistula (an abnormal passageway) in the stomach, intestines, throat, lungs, gallbladder, kidney, bladder, or vagina. Call your doctor if you have severe stomach pain or if you feel like you are choking when you eat or drink.

Also call your doctor if you have:

• slow wound healing;
• skin infection or open sores;
• missed menstrual periods;
• kidney problems – swelling, urinating less, feeling tired or short of breath;
• signs of a blood clot – chest pain, sudden cough or shortness of breath, dizziness, coughing up blood, pain, swelling, or warmth in one leg;
• heart problems – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating, swelling, rapid weight gain, feeling short of breath; or
• low white blood cell counts – fever, mouth sores, skin sores, sore throat, cough.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Bevacizumab can make it easier for you to bleed. Seek emergency medical attention if you have any bleeding that will not stop. You may also have bleeding on the inside of your body.

Call your doctor if you have: signs of bleeding in your digestive tract–feeling very weak or dizzy, severe stomach pain, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; or signs of bleeding in the brain–sudden numbness or weakness, slurred speech, severe headache, problems with vision or balance.

Bevacizumab can also cause problems with wound healing, which could result in bleeding or infection. Do not use bevacizumab within 28 days before or after a planned surgery.

Bevacizumab can cause a rare but serious neurologic disorder affecting the brain. Symptoms include headache, confusion, vision problems, feeling very weak or tired, fainting, and seizure (blackout or convulsions). These rare symptoms may occur within hours of your first dose of bevacizumab, or they may not appear for up to a year after your treatment started. Call your doctor at once if you have any of these side effects.

Some people receiving a bevacizumab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your medical caregiver right away if you feel dizzy, nauseated, light-headed, sweaty, itchy, or have a fast heartbeat, chills, wheezing, or chest pain during the injection.

Before taking this medicine

You may not be able to use bevacizumab if you are being treating with other cancer medicines such as doxorubicin, daunorubicin, or if you have or ever had:

• ovarian cancer with symptoms such as severe stomach pain or pelvic pain;
• slow healing of a skin wound or surgical incision;
• surgery within the past 4 weeks (28 days);
• you plan to have surgery within the next 4 weeks (28 days); or
• coughing up blood or vomit that looks like coffee grounds.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• diabetes;
• heart problems such as a heart attack, stroke, blood clot or blood clotting disorder;
• high blood pressure;
• bleeding problems or a perforation (a hole or tear) in your esophagus, stomach, or intestines; or
• kidney disease.

Pregnancy

Bevacizumab may harm an unborn baby. Do not use if you are pregnant. You may need a pregnancy test to make sure you are not pregnant. Use effective birth control while using bevacizumab and for at least 6 months after your last dose. Tell your doctor at once if you become pregnant.

This medicine may cause a woman’s ovaries to stop working correctly. Symptoms of ovarian failure include 3 or more missed menstrual periods in a row. It may be harder for you to get pregnant while you are using this medicine and after this treatment. Talk to your doctor about your individual risk.

Breastfeeding

Do not breastfeed while using bevacizumab and for at least 6 months after your last dose.

How is bevacizumab given?

Bevacizumab is given as an infusion into a vein. A healthcare provider will give you this injection.

Tell your caregivers right away if you feel dizzy, nauseated, light-headed, sweaty, or have a headache, shortness of breath, or chest pain during the injection.

Bevacizumab is usually given once every 2 or 3 weeks.

Doses are based on weight. Your dose may change if you gain or lose weight.

You may need frequent medical tests and your cancer treatments may be delayed based on the results.

For detailed bevacizumab dosing information, click the link below.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your bevacizumab injection.

What happens if I overdose?

In a medical setting, an overdose would be treated quickly.

What should I avoid while receiving bevacizumab?

Avoid activities that may increase your risk of bleeding or injury. Use extra care while shaving or brushing your teeth.

What other drugs will affect bevacizumab?

Tell your doctor about all other cancer treatments you are receiving.

Other drugs may interact with bevacizumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

Ingredients and manufacturer

Active ingredient: bevacizumab

Avastin (bevacizumab)
Inactive ingredients: a,a-trehalose dihydrate, polysorbate 20, sodium phosphate dibasic (anhydrous), sodium phosphate monobasic (monohydrate), and Water for Injection, USP.
Manufacturer: Genentech, Inc, 1 DNA Way South San Francisco, CA 94080, USA.

Alymsys (bevacizumab-maly)
inactive ingredients: dibasic sodium phosphate, monobasic sodium phosphate, polysorbate 20, trehalose, and Water for Injection, USP.
Manufacturer: Amneal Pharmaceuticals LLC Bridgewater, NJ 08807 Product of Spain 

Mvasi (bevacizumab-awwb)
Inactive ingredients: α,α-trehalose dihydrate, polysorbate 20, sodium phosphate dibasic, anhydrous, sodium phosphate monobasic, monohydrate, and Water for Injection, USP.
Manufacturer: Amgen, Inc. One Amgen Center Drive Thousand Oaks, CA 91320-1799 

Vegzelma (bevacizumab-adcd)
Inactive ingredients: dibasic sodium phosphate, monobasic sodium phosphate, polysorbate 20, trehalose, and Water for Injection, USP.
Manufacturer: CELLTRION, Inc. 20, Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea. 

Zirabev (bevacizumab-bvzr)
Inactive ingredients: edetate disodium dihydrate, polysorbate 80, succinic acid, sucrose, and Water for Injection, USP. Sodium hydroxide is added to adjust the pH.
Manufacturer: Pfizer Inc. NY, NY 10017.

Bevacizumab Biosimilars

Biosimilar and interchangeable products are biological products that are highly similar to and have no clinically meaningful differences from the reference product.

Reference products

These are biological products that have already been approved by the FDA, against which biosimilar products are compared. There is 1 for bevacizumab.Avastin (bevacizumab) – Genentech, Inc.