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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Zaltrap
Generic Name
Ziv-aflibercept
Active Ingredient
AfliberceptCategory
Vascular Endothelial Growth Factor Inhibitor [EPC]
Variants
2
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Zaltrap, you must consult a qualified healthcare professional.
Detailed information about Zaltrap
Aflibercept is a potent Vascular Endothelial Growth Factor (VEGF) inhibitor used to treat various retinal diseases and metastatic colorectal cancer by preventing the growth of abnormal blood vessels.
The dosage of Aflibercept varies significantly depending on the condition being treated and the specific product used. Healthcare providers follow strict protocols to ensure safety and efficacy.
Aflibercept is approved for a very specific pediatric condition: Retinopathy of Prematurity (ROP).
No specific dose adjustments are required for elderly patients. However, older adults may be at a higher risk for certain systemic side effects, such as hypertension, when receiving the intravenous form.
Aflibercept is never self-administered. It must be given by a qualified healthcare professional in a clinical setting.
If you miss an appointment for an Aflibercept injection or infusion, contact your healthcare provider immediately to reschedule. Maintaining a consistent schedule is vital for preventing vision loss or controlling cancer growth. For the eye injection, missing a dose can lead to a rapid return of fluid and permanent vision damage.
An overdose of Aflibercept in the eye may lead to increased intraocular pressure (pressure inside the eye). Signs include eye pain, redness, and sudden blurring of vision. In the case of an intravenous overdose, side effects like severe high blood pressure may occur. Emergency measures include monitoring intraocular pressure (for Eylea) or blood pressure (for Zaltrap) and providing supportive care. If you suspect an overdose, seek emergency medical attention or contact a poison control center immediately.
> Important: Follow your healthcare provider's dosing instructions precisely. Do not adjust your treatment schedule without professional medical guidance.
Side effects vary greatly depending on whether Aflibercept is injected into the eye or given intravenously.
Aflibercept is a powerful medication that requires careful monitoring. Patients must be aware that while it is highly effective, it carries risks related to its mechanism of action—specifically its effect on blood vessels throughout the body. Whether you are receiving it for eye disease or cancer, your healthcare team will perform regular check-ups to ensure the drug is not causing unintended harm.
While Aflibercept (Eylea) for the eye does not carry an FDA Black Box Warning, Zaltrap (intravenous) has several major warnings that are critical to patient safety:
Because Aflibercept is a biologic protein, it does not have the same 'small molecule' drug-drug interactions as many pills (like those involving the CYP450 enzyme system). However, there are critical contraindications:
Conditions where Aflibercept must NEVER be used include:
Based on its mechanism of action, Aflibercept is likely to cause fetal harm. VEGF is essential for the development of the fetus's vascular system. Animal studies have shown that systemic exposure to Aflibercept leads to severe birth defects (teratogenicity) and fetal death.
It is not known if Aflibercept passes into human breast milk. Because many drugs and large proteins are excreted in milk, and because of the potential for serious adverse reactions in the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug. Most oncologists recommend against breastfeeding while on Zaltrap.
Aflibercept is a recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1. It acts as a soluble decoy receptor (often called a 'VEGF Trap'). Unlike other VEGF inhibitors like Ranibizumab, which only bind to VEGF-A, Aflibercept binds to all isoforms of VEGF-A, as well as VEGF-B and Placental Growth Factor (PlGF).
By binding these ligands with a much higher affinity than their natural receptors, Aflibercept prevents them from activating the VEGFR-1 and VEGFR-2 receptors on endothelial cells. This inhibition prevents the phosphorylation of these receptors and the subsequent downstream signaling cascades (such as the MAPK and PI3K pathways) that lead to endothelial cell proliferation, migration, and increased vascular permeability.
In the eye, Aflibercept reduces the thickness of the retina by decreasing the leakage from abnormal blood vessels. This effect is usually seen within 1 to 4 weeks after injection. Systemically, Aflibercept reduces the blood supply to tumors, leading to tumor shrinkage or stabilization. The duration of effect in the eye is typically 4 to 12 weeks, which is why repeated injections are necessary.
Common questions about Zaltrap
Aflibercept is a medication used to treat several serious conditions involving abnormal blood vessel growth. In ophthalmology, under the brand name Eylea, it is injected into the eye to treat 'wet' age-related macular degeneration, diabetic macular edema, and retinal vein occlusion, all of which can cause blindness. In oncology, under the brand name Zaltrap, it is used as an intravenous infusion to treat advanced colorectal cancer that has spread to other parts of the body. It works by blocking VEGF, a protein that signals the body to grow new blood vessels. By inhibiting this protein, the drug can stop the leakage in the eye or starve a tumor of its blood supply. Your doctor will determine which form is appropriate based on your diagnosis.
The side effects of Aflibercept depend on how it is administered. For eye injections (Eylea), the most common effects include a small red spot on the eye (conjunctival hemorrhage), eye pain, and seeing 'floaters' or spots in your vision. For the intravenous form (Zaltrap) used for cancer, common side effects include high blood pressure, fatigue, diarrhea, and a decrease in white blood cells which can increase infection risk. Some patients also experience mouth sores and protein in their urine. Most of these side effects are manageable with the help of your healthcare team. Always report new or worsening symptoms to your doctor immediately.
There is no known direct chemical interaction between Aflibercept and alcohol. However, for patients receiving the intravenous form (Zaltrap) for cancer, alcohol should be consumed with caution. Alcohol can contribute to dehydration, which can worsen the diarrhea and fatigue often caused by the medication and accompanying chemotherapy. Additionally, alcohol can affect blood pressure, which Aflibercept is already known to increase. It is generally recommended to discuss your alcohol consumption with your oncologist or ophthalmologist to ensure it does not interfere with your overall treatment plan and recovery.
Aflibercept is generally not recommended during pregnancy because it can interfere with the development of the fetus's blood vessels. Animal studies have shown that the drug can cause severe birth defects and even fetal death. For women receiving the cancer treatment (Zaltrap), it is crucial to use effective birth control during treatment and for at least three months after the final dose. For the eye injection (Eylea), the amount of drug that reaches the rest of the body is very low, but the risk is still not fully known. You should only use Aflibercept during pregnancy if your doctor decides the benefit to you outweighs the potential risk to your unborn baby.
The time it takes for Aflibercept to work varies by the condition being treated. For eye conditions like macular degeneration, some patients notice an improvement in their vision or a reduction in 'blurriness' within one to four weeks after the first injection. However, the full effect often requires multiple monthly injections to stabilize the retina. For colorectal cancer, the drug works by slowing tumor growth over time, and its effectiveness is typically measured by imaging scans (like CT scans) every few months. It is important to keep all scheduled appointments, even if you do not notice an immediate change in your symptoms.
Stopping Aflibercept suddenly can have serious consequences, particularly for eye conditions. If you stop Eylea injections for macular degeneration or diabetic edema, the abnormal blood vessels can quickly begin leaking again, leading to a rapid and potentially permanent loss of vision. For cancer treatment, stopping Zaltrap may allow the tumor to begin growing or spreading more quickly. You should only stop treatment under the direct supervision of your healthcare provider. If you are experiencing severe side effects, your doctor may decide to pause or discontinue the medication safely while monitoring your condition closely.
If you miss an appointment for an Aflibercept injection or infusion, you should contact your doctor's office immediately to reschedule. Because this medication is administered by a professional, 'missing a dose' usually means missing a clinical appointment. For eye conditions, delay in treatment can allow fluid to build up in the retina, which can damage your sight. For cancer treatment, staying on the two-week schedule is important for keeping the medication at an effective level in your body. Your healthcare provider will advise you on the best timing for your next dose based on how long it has been since your last treatment.
Weight gain is not a typical side effect of Aflibercept. In fact, for patients taking the intravenous form (Zaltrap) for cancer, weight loss is much more common. This can be due to side effects like diarrhea, decreased appetite, or the underlying cancer itself. If you notice sudden weight gain while taking Aflibercept, it could be a sign of fluid retention or a kidney problem (proteinuria), which should be reported to your doctor immediately. For the eye injection (Eylea), the medication does not enter the systemic circulation in high enough amounts to affect your body weight. Always discuss significant changes in weight with your medical team.
Aflibercept can interact with other medications, primarily through 'overlapping' side effects rather than chemical interference. For example, taking Aflibercept with blood thinners (like Warfarin) can significantly increase your risk of serious bleeding. It can also interfere with the effectiveness of blood pressure medications, requiring a dose adjustment. Because it is a protein-based biologic, it doesn't interact with the liver enzymes that process most common pills. However, you must inform your doctor of all medications, including herbal supplements and over-the-counter drugs, to ensure they do not increase the risk of kidney stress or bleeding.
As of 2024, Aflibercept is a brand-name biologic medication and is not available in a traditional 'generic' form. However, several 'biosimilars' are in development or have recently received FDA approval (such as Opuviz and Yesafili). A biosimilar is a biologic product that is highly similar to the original brand-name drug with no clinically meaningful differences in safety or effectiveness. These biosimilars may become more widely available in 2025 and 2026 as patent protections for the original Eylea product expire. Your doctor or insurance provider will inform you if a biosimilar version becomes an option for your treatment.
Other drugs with the same active ingredient (Aflibercept)
> Warning: Stop taking Aflibercept (or contact your doctor immediately) if you experience any of the following symptoms. These may indicate a life-threatening reaction or a severe complication.
With prolonged use of ophthalmic Aflibercept, some patients may develop persistent changes in intraocular pressure or a higher risk of developing cataracts. For oncologic use, long-term exposure can lead to chronic kidney issues (proteinuria) or persistent high blood pressure. There is also a theoretical risk of geographic atrophy (thinning of the retina) with long-term VEGF inhibition in the eye, though this is a subject of ongoing clinical debate.
Zaltrap carries significant risks that are highlighted in its prescribing information, though they are not always formatted as a formal 'Black Box' in every jurisdiction, they are considered 'Warnings and Precautions' of the highest level:
Report any unusual symptoms to your healthcare provider immediately. Early intervention is key to managing these risks.
As a protein-based biologic, Aflibercept can cause hypersensitivity reactions. Signs of an allergic reaction include rash, itching, swelling of the face or throat, and difficulty breathing. If these occur during or after an infusion, seek emergency care.
There is a potential risk of arterial thromboembolic events (ATEs), including non-fatal stroke, non-fatal myocardial infarction (heart attack), or vascular death. This risk is slightly higher in patients with a history of heart disease or stroke.
For patients receiving Zaltrap, Aflibercept can cause significant protein loss in the urine (proteinuria). In severe cases, this can lead to nephrotic syndrome, a serious kidney condition. Regular urine tests are mandatory during treatment.
VEGF inhibitors are notorious for raising blood pressure. This is because VEGF helps blood vessels relax; blocking it causes them to constrict. Blood pressure must be well-controlled before starting treatment and monitored weekly during therapy.
To ensure safety, the following monitoring is typically required:
After an intravitreal injection (Eylea), your vision may be temporarily blurred due to the injection itself or the dilating drops used during the exam. Do not drive or operate machinery until your vision has fully recovered. For Zaltrap, fatigue or dizziness may occur; assess your reaction to the medication before driving.
There are no direct chemical interactions between Aflibercept and alcohol. However, alcohol can worsen certain side effects like dehydration (from diarrhea) or high blood pressure. It is best to limit alcohol consumption during treatment, especially when combined with chemotherapy.
Do not stop Aflibercept treatment without consulting your doctor. In the eye, stopping treatment can lead to a rapid and irreversible loss of vision. In cancer treatment, discontinuation is usually only recommended if the disease progresses or if side effects (like a GI perforation or severe bleeding) become life-threatening.
> Important: Discuss all your medical conditions, including any history of stroke, heart disease, or bleeding disorders, with your healthcare provider before starting Aflibercept.
Most interactions with Aflibercept are pharmacodynamic. This means the drugs don't necessarily change the concentration of Aflibercept in your blood, but they have 'overlapping' effects (like both increasing bleeding risk or both affecting the kidneys).
Your healthcare provider will manage these interactions by:
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter pain relievers.
These conditions require a careful risk-benefit analysis by your specialist:
Patients who have had an allergic reaction to other VEGF inhibitors (like Bevacizumab/Avastin or Ranibizumab/Lucentis) may be at a higher risk of reacting to Aflibercept, although they are different proteins. Always inform your doctor of any previous reactions to 'biologic' or 'monoclonal antibody' treatments.
> Important: Your healthcare provider will evaluate your complete medical history, including any recent surgeries or infections, before prescribing Aflibercept.
Aflibercept is approved for Retinopathy of Prematurity (ROP) in neonates. In this specific population, it helps prevent blindness caused by overgrowth of blood vessels in the developing eye. However, the long-term effects on the development of other organs in infants are still being studied. It is not approved for any other pediatric conditions.
A large percentage of patients receiving Eylea are over 65 (due to the nature of AMD). Clinical trials have shown that Aflibercept is effective and generally safe in this age group. However, elderly patients receiving the intravenous form (Zaltrap) may be more prone to diarrhea, dehydration, and hypertension. Doctors should monitor kidney function and blood pressure more frequently in patients over 75.
> Important: Special populations, particularly pregnant women and the elderly, require individualized medical assessment and frequent monitoring.
| Parameter | Value (Systemic/Zaltrap) |
|---|---|
| Bioavailability | 100% (IV); Minimal (Intravitreal) |
| Protein Binding | High affinity to VEGF ligands |
| Half-life | ~6 days (Free Aflibercept) |
| Tmax | End of infusion (IV) |
| Metabolism | Proteolysis (catabolism) |
| Excretion | Not renally excreted as intact protein |
Aflibercept is a Vascular Endothelial Growth Factor (VEGF) Inhibitor. It is categorized as an 'Antineoplastic Agent' in oncology and an 'Ophthalmic Agent / Antineovascular Agent' in ophthalmology. Related medications include Bevacizumab (Avastin), Ranibizumab (Lucentis), and Brolucizumab (Beovu).