Icatibant Sandoz (Icatibant)

Icatibant is used to treat hereditary angioedema by blocking the bradykinin pathway.

• Hereditary angioedema type I and II: provides rapid relief of swelling during acute attacks in adults.
• Hereditary angioedema with normal C1‑INH (type III): reduces symptom severity and duration.
• Acquired angioedema related to bradykinin excess: helps control episodic swelling.

• Icatibant selectively binds to the bradykinin B2 receptor on vascular endothelial cells, preventing bradykinin from activating the receptor. By blocking this interaction, it inhibits bradykinin‑induced vasodilation and increased vascular permeability, which are responsible for the rapid swelling seen in hereditary angioedema. The antagonism is competitive and reversible, allowing normal physiological signaling to resume after the drug is cleared.

Icatibant may cause a range of adverse reactions, most of which are related to its injection route or pharmacologic activity.

Common Side Effects

• Injection site pain: mild to moderate discomfort at the injection site.
• Redness or swelling at injection site: localized erythema or edema.
• Nausea: occasional feeling of queasiness.
• Headache: transient head discomfort.
• Dizziness: light‑headed sensation.

Serious or Rare Side Effects

• Hypersensitivity reactions: rash, urticaria, or anaphylaxis.
• Severe hypotension: marked drop in blood pressure.
• Worsening angioedema: paradoxical increase in swelling.
• Thrombocytopenia: low platelet count.
• Injection‑site infection: signs of local infection requiring medical attention.

Before using Icatibant, healthcare professionals should consider several safety measures to minimize risks.

• Assess severity of HAE attack: confirm that the episode requires pharmacologic intervention.
• Verify patient history of hypersensitivity: avoid use in individuals with known allergy to icatibant or its excipients.
• Use with caution in pregnancy or breastfeeding: safety has not been established; weigh potential benefits against risks.
• Ensure proper subcutaneous administration technique: train patient or caregiver on correct injection method.
• Monitor for signs of severe reactions: observe for anaphylaxis or worsening angioedema after injection.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Icatibant can interact with other medicines, affecting its safety or efficacy.

Major Interactions (Avoid)

• ACE inhibitors: may increase bradykinin levels and exacerbate angioedema.
• Other bradykinin B2 receptor antagonists: additive pharmacologic effect may increase risk of adverse events.
• Concomitant use of potent vasodilators: can lead to excessive hypotension.

Moderate Interactions (Monitor Closely)

• Estrogen‑containing oral contraceptives: may influence frequency of HAE attacks.
• C1‑INH concentrate therapy: concurrent use requires clinical monitoring of response.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may increase risk of injection‑site irritation.
• Diuretics: monitor blood pressure due to potential additive hypotensive effect.