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Y 90 Ibritumomab Tiuxetan

(ib-ri-too-muh-mab tuck-suh-tan)

Trade/other name(s): IDEC-Y2B8, Zevalin, yttrium Y 90 ibritumomab tiuxetan, 90Y ibritumomab tiuxetan, Ibritumomab (In2B8/Y2B8 Radiolabeling Kit), Ibritumomab Tiuxetan, IDEC-Y2B8 Monoclonal Antibody, Y90 Zevalin, Y90-labeled ibritumomab, tiuxetan, Yttrium-90 Ibritumomab Tiuxetan

Why would this drug be used?

This drug is used to treat some types of non-Hodgkin lymphoma.

How does this drug work?

Y 90 ibritumomab tiuxetan is in the class of drugs called radioimmunotherapy agents.

It is a monoclonal antibody that is joined to a radioactive substance called yttrium. (A monoclonal antibody is a man-made version of an immune system protein that can only link to one special receptor site.)

The monoclonal antibody of Y 90 ibritumomab tiuxetan is designed to lock onto a certain receptor (CD20) found on a type of white blood cell called B lymphocytes. This receptor can be found on some normal lymphocytes and on some lymphocytes that are cancerous, as in non-Hodgkin lymphoma. Once attached, the radiation in the antibody kills the cells. It is like a "smart bomb" in that it delivers the radiation to just the cells with this receptor. Your doctor will do a scan 2 or 3 days after your first dose to be sure the radiation is going where it needs to go. This treatment works better if rituximab, another monoclonal medicine, is given first.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods. If you have ever reacted to a drug made with mouse proteins, you may be more likely to react to rituximab, which is usually given with this drug.
  • If you have ever had chemotherapy, radiation to the bone marrow, or a stem cell/ bone marrow transplant. These may worsen the side effects of 90 Y ibritumomab.
  • 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. Men and women who are taking this drug need to use some kind of birth control for up to 12 months after treatment. Check with your doctor about what kinds of birth control can work with this medicine.
  • If you are breast-feeding. The drug is expected to pass into breast milk, and might affect the baby. Breast-feeding is not recommended during and for some time after treatment with this drug.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about 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.

Interactions with other drugs

This drug can lower your blood platelet count, which can increase your risk of uncontrolled bleeding (see “Precautions”). If your platelet count becomes low, you may need to avoid other drugs or supplements that interfere with blood clotting, because they might further raise the risk of bleeding. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • Warfarin (Coumadin)
  • Ticlopidine (Ticlid)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Clopidogrel (Plavix)
  • Any type of heparin injections

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen, and there are many types of non-steroidal anti-inflammatory drugs (NSAID). Ask your pharmacist if you aren't sure what is in the medicines you take, or whether a medicine is an NSAID.

No other serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods 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?

90 Y ibritumomab is given intravenously (IV). Treatment is usually given as an outpatient, most often along with rituximab (another cancer treatment drug). You will likely be given medicine to lower your risk of having an allergic reaction before you get these drugs. Still, your doctor or nurse will watch you closely.

Precautions

This drug can cause allergic reactions or infusion reactions in some people when the drug is given, especially with the first treatment. Serious reactions happen rarely, but can be dangerous. Symptoms can include trouble breathing, tightness or swelling in the mouth or throat, itchy welts on the skin, feeling lightheaded or dizzy (due to low blood pressure), chest pain, irregular heartbeat, and coughing. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug or its companion drug, or in the next few hours after the drug has been given.

This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing redness, pain, or even ulceration. Tell the doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.

Many people get mild symptoms, including headache, feeling "run down" and without energy, nausea, abdominal pain, and feeling tired. Ask your doctor or nurse about what to do for these symptoms.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts 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. Keep all your appointments for lab tests and doctor visits.

This drug can lower your white blood cell count, which can raise your chance of getting a serious infection. This may not happen right away, but can take months to occur. 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 platelet count, which can increase your risk of bleeding. This may not happen right away, but can take months to occur. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or other medicines (see “Drug interactions” section.) Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, vomit that is bloody or looks like coffee grounds, or black tarry stools.

This drug may lower your red blood cell count. This may not happen right away, but can take months to occur. 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.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations not work, or even lead to serious infections. 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.

A few days to 4 months after taking this medicine, there is a slight chance of a serious skin reaction. Symptoms often start as a skin rash with redness or blistering in the mouth, nose, eyes, or skin, along with fever and body aches. If this starts to happen, get help right away.

Because of the way this drug acts on cells in the body, it may increase your risk of getting a second type of cancer, such as leukemia or myelodysplastic syndrome (MDS). This is rare, but if it does occur it would likely be a year or more after the drug is used. If you are getting this drug, your doctor believes that this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Both men and women should avoid conceiving a child for a year after treatment in order to prevent harm to the fetus. Talk with your doctor about what kind of birth control you can use with this medicine.

See the information on rituximab, if you are getting it along with ibritumomab.

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

  • Mild to moderate nausea
  • Feeling "run down" and tired*
  • Flu-like illness, with fever and body aches
  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Low red blood cell count with increased risk of anemia*

Less common

  • Pain in the abdomen (belly)
  • Diarrhea
  • Cough
  • Fever
  • Poor appetite
  • Sore throat with stuffy or runny nose

Rare

  • Serious reaction with rash, hives, fever and chills, swelling of face or lips, and trouble breathing. This kind of reaction usually happens during or just after the medicine is given*
  • Severe rash with blistering of the skin that looks like a burn*
  • Leukemia (a second type of cancer), or myelodysplastic syndrome, which may happen years after treatment*
  • Death due to allergic reaction, severe skin rashes, second cancers, 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 problems not listed above.

FDA approval

Yes – first approved in 2002

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions, 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: 11/08/2013
Last Revised: 11/08/2013