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ibritumomab

Generic Name: ibritumomab (ib ri TYOO mo mab)
Brand Name: In-111 Zevalin, Y-90 Zevalin

What is ibritumomab?

Ibritumomab is a protein that targets white blood cells in the body. When ibritumomab is attached to a radioactive chemical, the radiation is delivered directly to the tumor (lymphoma).

Ibritumomab is used in combination with other medicines to treat non-Hodgkin's lymphoma.

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

What is the most important information I should know about ibritumomab?

Life-threatening reactions may occur during the injection or within 24 hours afterward. Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when ibritumomab is injected. Get emergency medical help if you feel itchy, light-headed or short of breath, or if you have chest tightness or pain spreading to your jaw or shoulder.

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Ibritumomab can lower blood cells that help your body fight infections and help your blood to clot. You may get an infection or bleed more easily.

Serious and sometimes fatal infections or skin reactions may occur during treatment with ibritumomab, and up to 4 months afterward. Call your doctor right away if you have: redness, ulcers, or skin changes where the medicine was injected; or if you have swelling in your face or tongue, burning in your eyes, skin pain, or a skin rash that spreads and causes blistering and peeling.

What should I discuss with my healthcare provider before receiving ibritumomab?

You should not receive this medicine if you are allergic to ibritumomab, or to radioactive chemicals or mouse proteins.

To make sure ibritumomab is safe for you, tell your doctor if you have:

  • liver disease;

  • kidney disease;

  • any type of infection;

  • lung or breathing problems;

  • bleeding or blood clotting problems;

  • low platelet counts;

  • low blood pressure;

  • a history of heart disease, heart attack, angina (chest pain), or irregular heart beats; or

  • if you take a blood thinner (warfarin, Coumadin) or other medicine to prevent blood clots.

Using ibritumomab may increase your risk of developing other types of cancer, such as leukemia. Ask your doctor about your specific risk.

Ibritumomab is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

FDA pregnancy category D. Do not use ibritumomab if you are pregnant. It could harm the unborn baby. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medicine and for at least 12 months after your treatment ends.

Ibritumomab can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How is ibritumomab given?

Ibritumomab is used in combination with rituximab (Rituxan) and a radioactive chemical. Ibritumomab is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting.

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when ibritumomab is injected.

You may be given medicine to prevent certain side effects while you are receiving ibritumomab. Take all of the medicines your doctor has prescribed.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with ibritumomab may cause you to bruise or bleed easily.

Ibritumomab can lower blood cells that help your body fight infections and help your blood to clot. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Your blood may need to be tested often.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your ibritumomab injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving ibritumomab?

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Do not receive a "live" vaccine while using ibritumomab, and for at least 12 months after your treatment ends. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Ibritumomab can pass into body fluids (including urine, feces, vomit, semen, vaginal fluid). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Patients and caregivers should wear rubber gloves while cleaning up body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Body fluids should not be handled by a woman who is pregnant or who may become pregnant. Use condoms during sexual activity to avoid exposure to body fluids.

Ibritumomab side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Life-threatening reactions may occur during the injection or within 24 hours afterward. Get emergency medical help if you feel itchy, light-headed or short of breath, or if you have chest tightness or pain spreading to your jaw or shoulder. These reactions can occur during the injection or within 24 hours afterward.

Call your doctor at once if you have:

  • pain, burning, redness, or skin changes where the medicine was injected;

  • fever, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough, trouble breathing;

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • jaw pain or numbness, red or swollen gums, problems with your teeth, trouble eating or swallowing, hoarse voice;

  • slow wound healing, skin ulcers; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • nausea, stomach pain, diarrhea;

  • fever, cough;

  • stuffy nose, sore throat, sinus pain; or

  • feeling weak or tired.

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.

See also: Side effects (in more detail)

Ibritumomab dosing information

Usual Adult Dose for non-Hodgkin's Lymphoma:

Day 7, 8, or 9 following initial rituximab infusion:
-Within 4 hours of rituximab, administer Y-90 ibritumomab 0.4 mCi/kg (14.8 MBq/kg) actual body weight intravenously over 10 minutes for patients with normal platelet count (Platelet count greater than 150,000/mm3).

Maximum dose: 32 mCi (1184 MBq) Y-90 ibritumomab dose regardless of actual body weight.

Comments:
-Do not treat if platelets less than 100,000/mm3
-Initiate the regimen following recovery of platelet counts to at least 150,000/mm3 at least 6 weeks, but not more than 12 weeks, following the last dose of first-line chemotherapy

What other drugs will affect ibritumomab?

Other drugs may interact with ibritumomab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about ibritumomab.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.03. Revision Date: 2014-03-16, 8:27:29 PM.

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