bendamustine

Contraindicated in:

Hypersensitivity to bendamustine or mannitol;
Hypersensitivity to polyethylene glycol 400, propylene glycol, or monothioglycerol (in multidose vial);
Severe renal impairment (CCr <30 mL/min);
Moderate or severe hepatic impairment;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Patients at risk for tumor lysis syndrome (concurrent allopurinol recommended);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may be more susceptible to adverse reactions.

Adv. Reactions/Side Effects

⬆ ⬇

Derm: drug reaction with eosinophilia and systemic symptoms (dress), stevens-johnson syndrome, toxic epidermal necrolysis, bullous exanthema, rash

GI: hepatotoxicity, nausea, vomiting, diarrhea

GU: ↓fertility (males)

Hemat: anemia, leukopenia, neutropenia, thrombocytopenia

Metab: hyperuricemia

Neuro: fatigue, PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, weakness

Resp: cough

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), INFECTION (INCLUDING REACTIVATION OF TUBERCULOSIS, HEPATITIS B, CYTOMEGALOVIRUS, AND HERPES ZOSTER), infusion reactions, SECONDARY MALIGNANCY, TUMOR LYSIS SYNDROME

Interactions

⬆ ⬇

Drug-drug:

CYP1A2 inhibitors, including fluvoxamine and ciprofloxacin may ↑ levels of bendamustine and ↓ levels of active metabolites; consider alternative treatments.
CYP1A2 inducers, including omeprazole and smoking may ↓ levels of bendamustine and ↑ levels of its active metabolites; consider alternative treatments.

Availability

⬆ ⬇

(Generic available)

Powder for injection: 25 mg/vial; 100 mg/vial
Solution for injection: 25 mg/mL

Route/Dosage

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Chronic Lymphocytic Leukemia

IV (Adults ): 100 mg/m² on Days 1 and 2 of a 28-day cycle, up to 6 cycles.

Non-Hodgkin's Lymphoma

IV (Adults ): 120 mg/m² on Days 1 and 2 of a 21-day cycle, up to 8 cycles.

US Brand Names

⬆ ⬇

Belrapzo, Bendeka, Treanda, Vivimusta

Action

⬆ ⬇

Damages DNA resulting in death of rapidly replicating cells.

Therapeutic effects:

Decreased proliferation of leukemic cells.
Death of lymphoma cells.

Classifications

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Therapeutic Classification: antineoplastics

Pharmacologic Classification: benzimidazoles

Pharmacokinetics

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Absorption: IV administration results in complete bioavailability.

Distribution: Distributes freely into red blood cells.

Protein Binding: 94–96%.

Metabolism/Excretion: Mostly metabolized (partially by the CYP1A2 enzyme system); 90% excreted in feces; some renal elimination. Although metabolites have antineoplastic activity, levels are extremely low.

Half-Life: 40 min.

Time/Action Profile

⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	unknown

Patient/Family Teaching

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Instruct patient to notify health care professional if fever; chills; sore throat; signs of infection; lower back or side pain; difficult or painful urination; shortness of breath; fatigue; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patients to avoid alcoholic beverages and products containing aspirin or NSAIDs; may precipitate gastric bleeding.
Instruct patient to notify health care professional immediately if symptoms of allergic reactions (rash, facial swelling, or difficulty breathing), hepatotoxicity (jaundice, anorexia, bleeding, bruising), progressive multifocal leukoencephalopathy (confusion, memory loss, trouble thinking, difficulty talking or walking, vision loss, other neurological or cognitive symptoms), or nausea, vomiting or diarrhea occur.
May cause tiredness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
May cause secondary malignancies. Advise patient to have regular dermatologic evaluations.
Instruct patient not to receive any vaccinations without advice of health care professional.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for at least 6 mo after last dose of bendamustine. Advise males with partners of reproductive potential to use effective contraceptions for at least 3 mo following completion of therapy. Advise women to avoid breastfeeding during therapy and for at least 1 wk after last dose of therapy. May impair male fertility.
Emphasize need for periodic lab tests to monitor for side effects.

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆

Indications

Contraind./Precautions