Tositumomab/Iodine, Infusion

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KEY POINTS

• This medicine is given by IV to treat certain types of non-Hodgkin lymphoma.
• You may get infections more easily when you are taking this medicine.
• This medicine increases your risk of bleeding. Be careful while shaving, cutting fingernails or toenails, or when using sharp objects.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antineoplastic (anticancer)

Generic and brand names: tositumomab/iodine, infusion

What is this medicine used for?

This medicine is given by IV infusion (slow drip through a needle into a large vein) to treat certain types of non-Hodgkin lymphoma. This medicine has a radioactive substance attached to it that delivers radiation directly to cancer cells.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine or to iodine
• Bleeding problems or blood disorders
• Kidney disease
• Thyroid problems

This medicine may make you sterile (unable to have children) whether you are a man or a woman. If you plan to have children someday, talk with your healthcare provider before you start treatment.

Men should use effective birth control during treatment and for at least 1 year after the last dose. This medicine may affect sperm and lead to birth defects.

Females of childbearing age: Do not take this medicine if you are pregnant because it may harm the baby. Tell your healthcare provider if you are pregnant or if you plan to become pregnant. Use 2 effective birth control methods while you are taking this medicine and for a year after stopping it. Do not breast-feed while taking this medicine.

How do I use it?

This is a very strong medicine. Only healthcare providers experienced with this drug should prescribe it. The infusions are given by your healthcare provider.

The treatment is given in 2 steps. First you will receive an IV infusion (slow drip through a needle into a large vein). Your healthcare provider may give you acetaminophen (Tylenol) and diphenhydramine (Benadryl) before each infusion to help reduce any side effects. Before the treatment you will be given a medicine to protect your thyroid gland. Continue to take the thyroid protection medicine until your healthcare provider tells you to stop taking it.

The total number of treatments will depend on your response to the medicines.

What should I watch out for?

For about 1 week after treatment, you need to take radiation precautions to protect other people from being exposed to radiation. Minimize time spent within 6 feet of other people and delay return to work or school. Wash your hands with soap and water after handling bodily fluids. Sit while urinating and flush the toilet 2 times with the lid down. Wipe any spilled urine with tissue and flush. Take a shower daily. Wash your clothes, bed linens, and eating utensils separately from those of other people. Avoid deep kissing. Use condoms during sexual relations.

Use 2 methods of birth control while you are receiving this medicine and for 12 months after therapy is completed. This is important for men and women.

You will need to have lab tests regularly to see how this medicine affects you. Keep all appointments for tests.

This medicine may increase your long-term risk of developing other blood cancers. Talk with your healthcare provider about this.

Do not drink alcohol or take aspirin while receiving this medicine unless your healthcare provider approves. It may increase the risk of bleeding.

You may get infections more easily when you are taking this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your healthcare provider's approval first.

This medicine may increase your risk of developing thyroid disease. Talk to your healthcare provider about this.

This medicine may cause you to bleed more easily. Be careful when brushing your teeth or shaving. Report any unusual bruising or bleeding to your healthcare provider.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are receiving this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives, itching, rash, tightness in your chest, swelling of your lips, tongue or throat, trouble breathing), lightheadedness, dizziness.

Serious (Report these to your healthcare provider right away.): Unusual bruising or bleeding; severe weakness or tiredness; swelling in your arms or legs; fever; shortness of breath; cough with sputum; abdominal pain; sore throat; mouth sores; blisters; severe rash; bloody urine; black or bloody bowel movements.

Other: Nausea, vomiting, diarrhea, constipation, heartburn, decreased appetite, headache, drowsiness, dizziness, weight loss, muscle or joint pain, weakness, anxiety, sweating.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alcohol
• Anagrelide (Agrylin)
• Antidepressants such as citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), levomilnacipran (Fetzima), sertraline (Zoloft), and venlafaxine (Effexor)
• Aspirin and other salicylates
• Cilostazol (Pletal)
• Medicines to treat or prevent blood clots such as apixaban (Eliquis), clopidogrel (Plavix), dabigatran (Pradaxa), dalteparin (Fragmin), dipyridamole/aspirin (Aggrenox), enoxaparin (Lovenox), heparin, rivaroxaban (Xarelto), ticagrelor (Brilinta), and warfarin (Coumadin)
• Natural remedies such as cat's claw, dong quai, echinacea, evening primrose, fenugreek, feverfew, fish oil, garlic, ginger, ginkgo biloba, ginseng, green tea, horse chestnut, red clover, and turmeric
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Vaccines

Do not have any vaccines without getting your healthcare provider's approval first.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicines in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.