Zaltrap (ziv-aflibercept) - Uses, Side Effects, and More

What are the most common side effects of Zaltrap?

The most common side effects of Zaltrap are listed below. Tell your health care provider if you have any of these side effects that bother you.

• Low neutrophil levels (see below)
• Diarrhea (see below)
• Mouth sores
• Protein in urine (see below)
• Tiredness
• Low platelet levels
• Increased blood pressure (see below)
• Weight loss
• Loss of appetite
• Nosebleed
• Stomach pain
• Voice changes
• Headache

There may be other side effects of Zaltrap that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Zaltrap?

While less common, the most serious side effects of Zaltrap are described below, along with what to do if they happen.

Severe Allergic Reactions. Zaltrap may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives that can be red, pink, white, or brown, depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Severe Bleeding. Zaltrap can increase your risk of severe bleeding that can lead to death. Some people with serious bleeding may need a blood transfusion or surgery. Call your health care provider right away if you have any of the following signs of severe bleeding while using Zaltrap.

• Pink, red, or brown urine (pee)
• Vomit with blood that looks like coffee grounds
• Red or black stools (look like tar)
• Coughing up blood or blood clots

Stomach Bleeding. Zaltrap can increase your risk of tears (perforation) in your gut. Get emergency help if you have any of the following symptoms.

• Vomit blood
• Black or tarry poop
• Stomach pain that does not go away
• Upset stomach
• Feel faint

Wound Healing Problems. Zaltrap can make it difficult for your body to heal wounds. Tell your health care provider if you have any planned or emergency surgeries or if you have any injuries that happen while using Zaltrap.

Fistula. Zaltrap can cause fistulas, which are tunnels that can form between an organ or type of skin and the tissue surrounding it. Zaltrap can cause several types of fistulas, including anal fistulas. Tell your health care provider right away if you have any new lumps or have pain, redness, or swelling around your anus or while you are pooping. 

Increased Blood Pressure (Hypertension). Zaltrap may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while taking this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical help right away. Increases in blood pressure may not be noticeable, but look out for it and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

• Sudden severe headache
• Chest pain
• Dizziness or confusion
• Trouble breathing
• Nausea or vomiting
• Blurry or other changes to vision
• Anxiety
• Buzzing in the ears
• Nosebleed
• Feeling of skipped heartbeats

Heart Attack and Stroke. Zaltrap can increase your risk of a heart attack or stroke that can lead to death. This risk may be higher in people who already have heart disease. Do not use Zaltrap if you have had a recent heart attack without talking to your health care provider. This could increase your risk of having another heart attack. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

• Chest pain or pressure
• Fast or abnormal heartbeat
• Trouble breathing
• Pain in your back, jaw, throat, or arm
• Sweating, upset stomach, vomiting, or dizziness
• Sudden weakness on one side of your body
• Sudden and severe headache
• Slurred speech or trouble understanding speech

Protein in Urine (proteinuria). Zaltrap can cause a high amount of protein in your pee (urine), which can be a sign of kidney damage. Keep all appointments to have your urine checked. Tell your health care provider if you have the following symptoms.

• Foamy or bubbly pee
• Swelling in your hands, feet, belly, or face
• Peeing more often than usual
• Shortness of breath
• Tiredness
• Loss of appetite

Low Neutrophil Levels (Neutropenia). Zaltrap may cause low levels of a type of white blood cell (called neutrophils), which is known as neutropenia. Neutrophils help prevent infection. Having a low level of neutrophils may increase your risk of infection. Zaltrap can also cause neutropenia with a fever (febrile neutropenia), which can cause very dangerous infections. Keep all appointments to have your blood checked. Tell your health care provider right away if you have any of the following symptoms.

• Fever, chills, or sweats
• Tiredness
• Sore throat, cough, or shortness of breath
• Mouth or throat sores
• Swollen lymph nodes

Diarrhea. Diarrhea can happen with Zaltrap. Call your health care provider right away if you get diarrhea or if you have more than two bowel movements in one day. You should also drink plenty of fluids to prevent dehydration. Dehydration may lead to low blood pressure, especially when you stand up (orthostatic hypotension), or kidney damage. If you are given medicine to prevent or treat diarrhea, take it exactly as your health care provider tells you. Call your health care provider right away if you have any of the following.

• Severe diarrhea
• Diarrhea that does not go away
• Diarrhea with weakness, dizziness, or fever

Posterior Reversible Encephalopathy Syndrome (PRES). Zaltrap may cause a rare but serious brain condition called PRES. PRES involves swelling and narrowing of blood vessels in your brain. If PRES is not treated, it can lead to a stroke. Call your health care provider right away if you have the following symptoms of PRES.

• Changes in thinking or behavior
• Confusion or hallucinations
• Sudden decrease or change in vision
• Sudden severe headache
• Seizures