Zirabev is used in adults alone or in combination with other cancer treatments to treat a certain type of brain tumor and certain types of cancers of the kidney, liver, lung, colon, rectum, cervix, ovary, or fallopian tube.

Zirabev is also used to treat cancer of the membrane lining the internal organs in your abdomen. It is usually given as part of a combination of cancer medicines.

Zirabev may also be used for purposes not listed in this medication guide.

Zirabev can make it easier for you to bleed. Seek emergency medical attention if you have any bleeding that will not stop. Bleeding may also happen inside your body.

Zirabev 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.

Zirabev 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.

You may not be able to use Zirabev 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.

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.

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 Zirabev and for at least 6 months after your last dose. Tell your doctor at once if you become pregnant.

Zirabev 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 Zirabev and after this treatment. Talk to your doctor about your individual risk.

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

Call your doctor for instructions if you miss an appointment for your Zirabev.

In a medical setting an overdose would be treated quickly.

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

Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, 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.

Zirabev 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).

Zirabev 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 Zirabev 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.

Common side effects of Zirabev 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.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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

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