Icatibant Sandoz (Icatibant)

Icatibant is indicated for the treatment of hereditary angioedema, a condition mediated by excessive bradykinin activity.

• Acute attacks of hereditary angioedema type I: provides rapid reduction of subcutaneous and submucosal swelling by competitively inhibiting the bradykinin B2 receptor.
• Acute attacks of hereditary angioedema type II: achieves symptom relief and limits airway obstruction by blocking bradykinin‑mediated vascular permeability.

• Icatibant is a synthetic decapeptide that acts as a selective, competitive antagonist of the bradykinin B2 receptor. By binding to this G‑protein‑coupled receptor, it prevents bradykinin from inducing vasodilation and increasing vascular permeability, thereby interrupting the cascade that leads to the swelling characteristic of hereditary angioedema. The blockade is rapid and reversible, allowing restoration of normal vascular tone during an acute attack.

Icatibant may be associated with a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Injection site pain: mild to moderate discomfort at the subcutaneous injection site.
• Redness or swelling at injection site: localized erythema or edema.
• Nausea: transient feeling of queasiness.
• Headache: mild headache occurring shortly after administration.
• Fever: low‑grade temperature increase.
• Dizziness: transient light‑headedness.

Serious or Rare Side Effects

• Hypersensitivity reactions: including rash, urticaria, or anaphylaxis requiring immediate medical attention.
• Severe hypotension: rare drop in blood pressure following injection.
• Thrombocytopenia: very rare decrease in platelet count.
• Liver enzyme elevation: rare increase in transaminases.
• Angioedema of the airway: potentially life‑threatening swelling requiring emergency care.

When using Icatibant, certain precautions should be observed to ensure safe administration.

• Renal impairment: monitor for accumulation as clearance may be reduced.
• Hepatic dysfunction: use with caution; limited data on safety.
• Pregnancy: safety not established; avoid unless benefit outweighs risk.
• Breastfeeding: unknown excretion; consider alternatives.
• Concomitant ACE inhibitors: may increase bradykinin levels, raising risk of angioedema.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Icatibant can interact with other medicines that influence bradykinin pathways or affect its pharmacokinetics.

Major Interactions (Avoid)

• ACE inhibitors: may increase bradykinin levels, raising risk of angioedema.
• Angiotensin receptor blockers (ARBs): similar risk of enhanced bradykinin effects.
• DPP‑4 inhibitors: potential additive effect on bradykinin metabolism.

Moderate Interactions (Monitor Closely)

• NSAIDs: may exacerbate swelling if angioedema occurs.
• C1‑esterase inhibitor concentrates: concurrent use may not provide additional benefit; monitor clinical response.