• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have any type of kidney disease or liver disease (including hepatitis). Reduced kidney or liver function might result in more drug than expected staying in the body, which could lead to unwanted side effects. If you have liver or kidney problems, your doctor may need to monitor you more closely. This drug is not recommended for people with severe liver or kidney disease.

• If you have any other medical conditions such as heart disease, congestive heart failure, diabetes, gout, or infections.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. You should use some kind of birth control during treatment and for at least 3 months afterward. Check with your doctor about what kinds of birth control can be used with this medicine.

• If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby. Breast-feeding is not recommended during treatment with this drug.

• If you think you might want to have children in the future. This drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

• fluvoxamine (Luvox),
• stomach acid blockers cimetidine (Tagamet) and omeprazole (Prilosec)
• antibiotics such as ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin)
• the blood thinner ticlopidine (Ticlid)
• tobacco smoke (cigarettes, pipes, cigars)

Other drugs may have this effect as well, which is why it's very important that your doctor is aware of all drugs and supplements you are taking.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with bendamustine. These include:

• vitamin E
• non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
• warfarin (Coumadin)
• ticlopidine (Ticlid)
• clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what is in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

You may be given another drug called allopurinol before and during treatment to help prevent a severe side effect known as tumor lysis syndrome (see "Precautions"). Allopurinol may be given IV or taken as a pill.

Bendamustine can cause the rapid killing of tumor cells within the first 24 hours of treatment, causing their contents to spill into the blood. In some cases this can lead to serious kidney damage (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this. If you notice pain in the back or sides of your chest, or see blood in your urine, let your doctor know right away.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all appointments for lab work and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your red blood cell count. If this occurs, it is usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Bendamuistine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get live virus vaccines during treatment or for some time afterward. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

This drug can cause skin reactions, which may range from mild rashes to more severe skin problems. Tell your doctor right away if you start to get a rash while taking this drug. More serious reactions may require that this drug be stopped.

• low white blood cell count with increased risk of infection*
• low platelet count with increased risk of bleeding*
• low red blood cell count (anemia), with tiredness, weakness, other symptoms*
• fever
• nausea
• vomiting
• abnormal blood tests that suggest the drug is affecting the liver or kidneys (Your doctor will discuss the importance of these findings, if any.)

• skin rash*
• trouble breathing or shortness of breath
• diarrhea
• constipation
• feeling tired
• feeling weak
• feeling sleepy
• weight loss
• dry mouth
• cough
• headache
• mouth sores
• pain in chest, back, belly, bones, or joints
• infections in the lungs (pneumonia), sinuses, bladder, kidneu

• tumor lysis syndrome with risk of kidney damage*
• allergic reactions*
• increased blood pressure
• cough
• death due to tumor lysis syndrome, skin reactions, bleeding, infection, and other causes

*See "Precautions" section for more detailed information.