Injectable synthetic peptide to treat acute attacks of hereditary angioedema. The patient can self-inject after training.
Regulatory status
Approved (FDA / EMA)
Family
Bradykinin B2 receptor antagonist
Scientific evidence
High
Number of findings
1
Where it acts
Immunity and defense
Also known as
icatibant, Firazyr, HOE 140
Regulatory status
FDA (US): Approved (2011, Firazyr) for acute attacks of hereditary angioedema in adults.
EMA (EU): Approved (2008, Firazyr) for acute attacks of hereditary angioedema in adults, adolescents, and children aged 2 years and older.
Dose
Adults: 30 mg subcutaneously in the abdomen; it can be repeated every 6 hours, up to 3 doses in 24 hours (FDA label 2011 / EMA 2008). In children, the dose is based on weight (EMA).
Safety
Almost all patients have local reactions (pain, redness, swelling) that resolve within hours. Also dizziness, nausea, and headache. In a throat attack, go to the emergency room even if you have injected.
Interactions
It could theoretically reduce the antihypertensive effect of ACE inhibitors (which, in addition, are not recommended in angioedema).
Differences between women and men
Pregnancy: experience with icatibant in pregnant women is scarce (isolated cases with no problems reported). For that reason, in pregnancy the treatment of choice remains plasma-derived C1 inhibitor, and icatibant is considered case by case. View the study →
Effect by goal · level of evidence
Acute attacks of hereditary angioedema (FAST-1 and FAST-2)
improvesHighRCT (AA)in people
2 h vs 12 h relief
Two double-blind trials with 130 patients and a single 30 mg injection. Compared with tranexamic acid, relief came much sooner (median 2 vs 12 hours). Compared with placebo it was faster (2.5 vs 4.6 hours), although not significant, partly because many placebo patients used rescue medication.
It blocks the B2 receptor where bradykinin acts. This prevents bradykinin from dilating blood vessels and letting fluid leak out, which is what causes the swelling during an attack.
What the evidence says
In people
Acute attacks of hereditary angioedema (FAST-1 and FAST-2). Two double-blind trials with 130 patients and a single 30 mg injection. Compared with tranexamic acid, relief came much sooner (median 2 versus 12 hours). Compared with placebo it was faster (2.5 versus 4.6 hours), although not significantly so, partly because many patients on placebo used rescue medication. PubMed 20818888