Ibritumomab (Patient information)

# 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 other than those listed in this medication guide.
What is the most important information I should know about ibritumomab?
Do not receive this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.
Ibritumomab can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Contact your doctor immediately if you develop signs of infection.
Do not receive a "live" vaccine while you are being treated with ibritumomab, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.
Some people receiving ibritumomab have developed "secondary" bone marrow or blood cell cancers such as leukemia. Talk with your doctor about your individual risk while receiving this medication.
What should I discuss with my healthcare provider before receiving ibritumomab?
You should not receive this medication if you are allergic to ibritumomab, or to radioactive chemicals or mouse proteins.
Before you receive ibritumomab, tell your doctor if you are allergic to any drugs, or 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; or
- a history of heart disease, heart attack, angina (chest pain), or irregular heart beats.
If you have any of these conditions, you may need a dose adjustment or special tests to safely receive ibritumomab.
FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not receive ibritumomab if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are receiving this medication. It is not known whether ibritumomab passes into breast milk or if it could harm a nursing baby. Do not receive ibritumomab without telling your doctor if you are breast-feeding a baby.
Ibritumomab is made from human plasma (part of the blood) and may contain viruses and other infectious agents that can cause disease. Although donated human plasma is screened, tested, and treated to reduce the risk of it containing anything that could cause disease, there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.
Some people receiving ibritumomab have developed "secondary" bone marrow or blood cell cancers such as leukemia. Talk with your doctor about your individual risk while receiving this medication.

# How is ibritumomab used?
Ibritumomab is used in combination with rituximab (Rituxan) and a radioactive chemical. Ibritumomab is given as an injection through a needle placed into a vein. Your doctor, nurse, or other healthcare provider will give you this injection.
Ibritumomab is usually given every 7 to 9 days. Follow your doctor's instructions.
Ibritumomab can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

# What happens if I miss a dose?
Contact your doctor if you miss an appointment for your ibritumomab injection.
What happens if I overdose?
Seek emergency medical attention if you think you have received too much of this medicine.
Overdose symptoms may include weakness, pale skin, and easy bruising or bleeding.

# What should I avoid while using ibritumomab?
Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection.
Do not receive a "live" vaccine while you are being treated with ibritumomab, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

# Ibritumomab side effects
Some people receiving an ibritumomab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel dizzy, nauseated, light-headed, sweaty, itchy, or have a fast heartbeat, trouble breathing, chest pain or heavy feeling, or pain spreading to the arm or shoulder. These reactions can occur during the injection or within 24 hours afterward. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any of these serious side effects:
- pain, burning, redness, or skin changes where the medicine was injected;
- fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
- fever with chills, body aches, and other flu symptoms;
- easy bruising or bleeding, unusual weakness; or
- white patches or sores inside your mouth or on your lips.
Less serious side effects may include:
- nausea, vomiting, loss of appetite;
- anxiety;
- dizziness; or
- joint pain.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

# What other drugs will affect ibritumomab?
Before receiving ibritumomab, tell your doctor if you are using any type of blood thinner or medication use to prevent blood clots, such as:
- warfarin (Coumadin);
- alteplase (Activase);
- anistreplase (Eminase);
- clopidogrel (Plavix);
- dipyridamole (Persantine);
- streptokinase (Kabikinase, Streptase);
- sulfinpyrazone (Anturane);
- ticlopidine (Ticlid); or
- urokinase (Abbokinase).
This list is not complete and there may be other drugs that can interact with ibritumomab. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.