Icatibant

How it works

It competitively blocks the bradykinin B2 receptor, preventing bradykinin-mediated vasodilation and increased vascular permeability that drive the swelling of hereditary angioedema attacks.

Prescribing in practice

• It treats acute attacks and does not prevent them, so laryngeal or airway involvement still requires urgent assessment and airway management; patients with airway attacks should seek emergency care even after dosing.
• Administered by subcutaneous injection, typically into the abdominal area, and may be given as a self-administered or carer-administered dose after appropriate training.
• A repeat dose may be needed if the attack persists or recurs; injection-site reactions are very common. Consult the SPC for details.

Monitoring

Monitor the clinical response of the attack, watching especially for airway compromise in laryngeal attacks, and observe injection-site reactions.

Counselling the patient

• This injection treats an attack as it happens and does not stop future attacks.
• Always seek emergency help for any throat or tongue swelling or difficulty breathing, even after injecting.
• Redness, swelling, or burning at the injection site is common and usually settles within hours.

Evidence & guidelines

Icatibant is licensed for acute hereditary angioedema attacks based on randomised controlled trials demonstrating faster symptom relief versus comparator, and is recommended in international angioedema management guidance.