Bendamustine (patient information)

# Why is this medication prescribed?
Bendamustine injection is used to treat chronic lymphocytic leukemia (CLL; a type of cancer of the white blood cells). Bendamustine injection is also used to treat a type of non-Hodgkins lymphoma (NHL: cancer that begins in a type of white blood cell that normally fights infection) that is slow spreading, but has continued to worsen during or after treatment with another medication. Bendamustine is in a class of medications called alkylating agents. It works by killing existing cancer cells and limiting the growth of new cancer cells.

# How should this medicine be used?
Bendamustine comes as a powder to be added to fluid and injected intravenously (into a vein) over 30 minutes by a doctor or nurse in a medical office or hospital outpatient clinic. When bendamustine injection is used to treat CLL, it is usually injected once a day for 2 days, followed by 26 days when the medication is not given. This treatment period is called a cycle, and the cycle may be repeated every 28 days for as long as 6 cycles. When bendamustine injection is used to treat NHL, it is usually injected once a day for 2 days, followed by 19 days when the medication is not given. This treatment cycle may be repeated every 21 days for up to 8 cycles.
Your doctor may need to delay your treatment and adjust your dose if you experience certain side effects. Your doctor may also give you other medication(s) to prevent or treat certain side effects. Be sure to tell your doctor how you are feeling during your treatment with bendamustine injection.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow?
Before receiving bendamustine injection,
- tell your doctor and pharmacist if you are allergic to bendamustine, mannitol (Osmitrol), or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the  ollowing: cimetidine (Tagamet); fluoroquinolones such as ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin); fluvoxamine (Luvox); omeprazole (Prilosec); and ticlopidine (Ticlid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had kidney or liver disease.
- tell your doctor if you are pregnant or plan to become pregnant, or if you plan to father a child. You or your partner should not become pregnant while you are receiving bendamustine injection. You should use birth control to prevent pregnancy in yourself or your partner during your treatment with bendamustine injection and for 3 months afterwards. Talk to your doctor about birth control methods that will work for you. If you or your partner becomes pregnant while receiving bendamustine injection, call your doctor. Bendamustine injection can harm the fetus.
- tell your doctor if you are breast-feeding.
- you should know that bendamustine injection may make you tired. Do not drive a car or operate machinery until you know how this medication affects you.
- tell your doctor if you use tobacco products. Smoking may decrease the effectiveness of this medication.

# What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose?
Call your doctor right away if you are unable to keep an appointment to receive a dose of bendamustine injection.

# What side effects can this medication cause?
Bendamustine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- nausea
- vomiting
- diarrhea
- heartburn
- constipation
- stomach pain or swelling
- sores or white patches in the mouth
- dry mouth
- bad taste in the mouth or difficulty tasting food
- loss of appetite
- weight loss
- headache
- anxiety
- depression
- difficulty falling asleep or staying asleep
- back, bone, joint, arm or leg pain
- dry skin
- sweating
- night sweats
- pain in the place where the medication was injected
- Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- hives
- rash
- itching
- blistering or peeling skin
- difficulty breathing or swallowing
- swelling of the eyes, face, lips, tongue, arms, hands, feet, ankles, or lower legs
- shortness of breath
- chest pain
- fast heartbeat
- excessive tiredness or weakness
- pale skin
- fever, chills, cough, or other signs of infection
- unusual bleeding or bruising
Bendamustine injection may cause infertility in some men. This infertility may end after treatment, may last for several years, or may be permanent. Talk to your doctor about the risks of receiving this medication.
Some people developed other types of cancer while they were using bendamustine injection. There is not enough information to tell whether bendamustine injection caused these cancers to develop. Talk to your doctor about the risks of receiving this medication.
Bendamustine injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- drowsiness
- uncontrollable shaking of a part of the body
- problems with coordination
- seizures
- difficulty breathing
- rapid, irregular, or pounding heartbeat

# What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to bendamustine injection.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

# Brand names
Treanda