Ibritumomab Tiuxetan (Generic Name)

Other Names: Yttrium-90 Zevalin™

 
About This Drug

Ibritumomab tiuxetan is used to treat cancer. It is used in combination with another agent called rituximab, a special type of antibody used to treat cancer, and yttrium-90, a radioactive element that has been shown to fight cancer. This drug is given in the vein (IV).

Possible Side Effects (More Common)

  • Bone marrow depression (may last for a long time, for example, up to 12 weeks or longer). This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Nausea and throwing up (vomiting). These symptoms may happen within a few hours after your treatment and may last up to 24 hours. Medicines are available to stop or lessen these side effects.
  • Fever
  • Stomach pain
  • Loose bowel movements (diarrhea) that may last for a few days
  • Generalized weakness and discomfort (aches or pains)
  • Tiredness
  • Swelling of the nasal passages
  • Cough
  • Infections

Possible Side Effects (Less Common)

  • Decreased appetite (decreased hunger)
  • High blood pressure. Your doctor will check your blood pressure as needed.
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Feeling dizzy
  • Rash
  • Skin and tissue irritation may involve redness, pain, warmth, or swelling at the IV site. This happens if the drug leaks out of the vein and into nearby tissue.
  • Serious infusion reactions
  • Severe skin reactions (may occur within a few days to up to 4 months)
  • Radiation injury
  • This drug may raise your risk of getting a second cancer
  • Urinary tract infection.  Symptoms may include:
    • pain or burning when you pass urine
    • feeling like you have to pass urine often, but not much comes out when you do
    • tender or heavy feeling in your lower abdomen
    • cloudy urine and/or urine  that smells bad.
    • pain on one side of your back under your ribs. This is where your kidneys are.
    • fever, chills, nausea and/or throwing up

Infusion Reactions

  • While you are getting this drug in your vein (IV), you may have a reaction to rituximab or to this drug.  Your nurse will check you closely for these signs: fever or shaking chills, flushing, facial swelling, feeling dizzy, headache, trouble breathing, rash, itching, chest tightness, or chest pain. These reactions may happen for 24 hours after your infusion.  If this happens, call 911 for emergency care.
  • Less serious reactions to this drug may happen if you are taking scheduled pre-medications before your drug infusions.  You will be given medicines to help stop or lessen these symptoms.  Your vital signs will be checked during the infusion and for 1-2 hours after the infusion.  Tell your doctor or nurse right away if you have any of these symptoms any time during the infusion and/or for the first 24 hours after getting this drug.
    • fever, chills, or shaking chills
    • feeling dizzy or lightheaded
    • headache
    • nausea or throwing up

Treating side effects

  • Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
  • Ask your doctor or nurse about medicine that is available to help stop or lessen the loose bowel movements.
  • Ask your doctor or nurse about medicine that is available to help stop or lessen fever, headache, muscle and joint aches.
  • If you are dizzy, get up slowly after sitting or lying.
  • If you get symptoms of a bladder infection, please call your doctor or nurse right away. You may be given antibiotics to treat the infection and/or medicines to help the symptoms.
  • Serious allergic reactions including anaphylaxis are rare.  While you are getting this drug in your vein (IV), tell your nurse right away if you have any of these symptoms of an allergic reaction:
    • trouble catching your breath
    • feeling like your tongue or throat are swelling
    • feeling your heart beat quickly  or in a not normal way (palpitations)
    • feeling dizzy or lightheaded
    • flushing, itching, rash, and/or hives 

Other instructions

Radiation from yttrium-90 does not go outside of the body, but a small amount of radiation may be present in body fluids, such as blood and urine, for about a week after the treatment. Wash your hands very well after passing urine and use a condom during sex for 1 week after the treatment. You do not have to avoid contact with friends or family during this time. Patients usually can go back to work and other activities following treatment. Your doctor will give you more instructions.

Food and drug interactions

There are no known interactions of ibritumomab tiuxetan with food. This drug may interact with other medicines, especially with other medications that decrease your immune system’s ability to fully protect you. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to call the doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Easy bleeding or bruising
  • Wheezing or trouble breathing
  • Rash or itching
  • Feeling dizzy or lightheaded
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • Blurred vision or other changes in eyesight
  • Pain when passing urine; blood in urine
  • Pain in your lower back or side
  • Confusion or agitation
  • Nausea that stops you from eating or drinking
  • Throwing up more than 3 times a day
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause.  If you have any of these symptoms for 2 minutes, call 911. 
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin.

Call your doctor or nurse as soon as possible if you have any of these symptoms:

  • Change in hearing, ringing in the ears
  • Decreased urine
  • Unusual thirst or passing urine often
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Nausea that is not relieved by prescribed medicines
  • Rash that is not relieved by prescribed medicines
  • Heavy menstrual period that lasts longer than normal
  • Numbness, tingling, decreased feeling or weakness in fingers, toes, arms, or legs
  • Trouble walking or changes in the way you walk, feeling clumsy when buttoning clothes, opening jars, or other routine hand motions
  • Swelling of legs, ankles, or feet
  • Weight gain of 5 pounds in one week (fluid retention)
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Headache that does not go away
  • Painful, red, or swollen areas on your hands or feet
  • No bowel movement for 3 days or if you feel uncomfortable
  • Extreme weakness that interferes with normal activities

Sexual Problems and Reproduction Concerns

  • Sexual problems and reproduction concerns may happen. In men and women both, this drug may affect your ability to have children. This cannot be determined before your therapy. Talk with your doctor or nurse if you plan to have children.  Ask for information on sperm or egg banking.
    • In men, this drug may interfere with your ability to make sperm, but it should not change your ability to have sexual relations.
    • In women, menstrual bleeding may become irregular or stop while you are getting this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.
    • Women may go through signs of menopause (change of life) like vaginal dryness or itching. Vaginal lubricants can be used to lessen vaginal dryness, itching, and pain during sexual relations.
    • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Pregnancy warning: This drug may have harmful effects on the unborn baby, so effective methods of birth control should be used by both men and women during your cancer treatment and for at least 12 months after treatment.
  • Breast feeding warning: Women should not breast feed during treatment because this drug could enter the breast milk and badly harm a breast feeding baby.

Revised November 2014

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