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BCG (Bacillus of Calmette and Guerin)

Trade/other name(s): TICE® BCG, TheraCys®, live attenuated Mycobacterium bovis

Why would this drug be used?

BCG is a strain of live bacteria that has been weakened (attenuated). It is an immunotherapy that is used for people with localized bladder cancer, to help treat the cancer and to keep it from coming back.

Because the bacteria used in BCG is very much like the one that causes tuberculosis (TB), a different form of BCG is used as a vaccine against TB. That use is not discussed here.

How does this drug work?

Exactly how BCG works is not precisely known. It is thought to cause the immune system to become more active against cancer cells in the bladder.

Before taking this medicine

Tell your doctor…

  • If you are allergic to any medicines, dyes, additives, or foods.
  • If you have any immune deficiencies or diseases such as AIDS, leukemia, or lymphoma.
  • If you are taking any other cancer treatment (chemo, radiation), or drugs that suppress the immune system (such as steroids).
  • If you have a fever, infection, or blood in your urine. Your doctor may want to put off treatment.
  • If you are being treated for tuberculosis.
  • If you have had a biopsy, surgery on the urethra, or had problems getting a catheter in the urethra in the past 2 weeks.
  • If you have any medical problems or if you have any man-made body parts (such as heart valves, pacemakers, joint replacements, or synthetic blood vessels)
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. BCG should not be used during pregnancy unless it is clearly needed. Talk with your doctor about what kind of birth control to use during treatment.
  • If you are breast-feeding. Talk with your doctor about the possible risks of breast-feeding while taking BCG.
  • 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.

Interactions with other drugs

Any medicines that suppress the immune system, such as steroids (prednisone, dexamethasone, etc.) can increase the risk of infection with BCG.

Certain antibiotics may make BCG not work properly.

Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements, and whether alcohol can cause problems with BCG.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods or alcohol may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

A tube is put into the bladder to empty it and let the BCG-containing liquid flow in. The liquid is left in the bladder for 2 hours before emptying the bladder. You may be asked to change position every few minutes to be sure BCG can reach all parts of the bladder.

Avoid drinking liquids for 4 hours before BCG is scheduled.

BCG is usually put into the bladder every week for 6 weeks. After that, it may be given monthly. The doctor may change the schedule if you have an infection or any problems with the BCG.

Precautions

For about 6 hours after each treatment, the urine can contain live germs, which you don’t want to spread around. Sit on the toilet (rather than standing) when passing urine to avoid splashing the BCG liquid. After passing urine, pour liquid bleach (about the same amount as the urine) into the toilet and let it sit for 15 minutes before flushing. Wash your hands carefully after urinating. Drink extra fluids after the BCG is given to help flush out the bladder.

BCG is a weakened germ but it can cause infection. This is rare, but your doctor will watch you closely. You may have certain blood tests to detect BCG-related problems so they can be treated early. Always call your doctor right away if you have fever, chills, joint pain or aches, lower back pain, belly pain, skin rash, or swelling in the scrotum. Call your doctor if you have burning when passing urine or blood in the urine that lasts longer than a few hours. BCG infection may require long-term, treatment with antibiotics.

Your doctor may check your TB skin test before you have BCG. After the BCG is given, your skin test will likely be positive. This can make doctors think you have been exposed to the TB germ, so it is important to tell anyone who is testing you for TB after your BCG treatment that you have had BCG.

In rare cases, BCG may cause allergic reactions. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), hives, rash, itching, headache, coughing, trouble breathing, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after you get BCG.

Possible side effects

You will probably not have most of the following side effects, but if you have any, talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Burning when passing urine the first few hours after the BCG is given
  • Having to pass urine more often than usual in the first day or two after BCG
  • Painful urination*
  • Flu-like symptoms*

Less common

  • Blood in the urine*
  • Fever*
  • Having to rush to the bathroom because of the strong urge to empty the bladder
  • Nausea and/or vomiting

Rare

  • Shaking chills*
  • Rash*
  • Tiredness
  • Losing control of urine (incontinence)
  • Cramps or pain in the bladder area (pelvis)
  • Infection requiring antibiotic treatment*
  • Yellowing of the skin or eyes
  • Abnormal blood tests suggesting that the liver is affected (your doctor will discuss the significance of these tests with you)
  • Headache, dizziness
  • Loss of appetite
  • Body or joint aches*
  • Eye problems, such as redness or pain
  • Allergic reaction*
  • Death due to infection or other problems*

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1990.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 06/29/2011
Last Revised: 06/29/2011