Home Drug Guide Ibritumomab Tiuxetan

Drug Guide

Generic Name

Ibritumomab Tiuxetan

Brand Names Zevalin

Classification

Therapeutic: Antineoplastic agent, immunotherapy

Pharmacological: Monoclonal antibody targeting CD20

FDA Approved Indications

  • Treatment of relapsed or refractory follicular non-Hodgkin's lymphoma (NHL)

Mechanism of Action

Ibritumomab binds to the CD20 antigen on B lymphocytes, and when conjugated with the radioisotope yttrium-90, it delivers targeted radiotherapy to malignant B cells, leading to cell death.

Dosage and Administration

Adult: Initial dose of 0.4 mCi (14.8 MBq) for each of the first 2 doses, administered intravenously over 10 to 30 minutes, with a 7-day interval between doses. Pre-treatment with rituximab is recommended.

Pediatric: Not approved for pediatric use.

Geriatric: Similar dosing as adults; monitor renal and hepatic function.

Renal Impairment: Adjustment not specified; use caution and monitor renal function.

Hepatic Impairment: Adjustment not specified; use caution and monitor hepatic function.

Pharmacokinetics

Absorption: Administered intravenously, no oral absorption.

Distribution: Binds to CD20-positive B cells, localized primarily to lymphoid tissues.

Metabolism: Catabolized by cellular processes similar to other antibodies.

Excretion: Renal and hepatic clearance of breakdown products.

Half Life: Approximately 36 hours for the antibody component.

Contraindications

  • Hypersensitivity to ibritumomab or murine proteins.
  • Active infections.

Precautions

  • Use in patients with compromised immune systems.
  • Pre-treatment with rituximab reduces circulating B cells, increasing infection risk. Risk of myelosuppression, tumor lysis syndrome, and infusion reactions.

Adverse Reactions - Common

  • neutropenia (Common)
  • thrombocytopenia (Common)
  • anemia (Common)
  • infusion reactions (Common)

Adverse Reactions - Serious

  • tumor lysis syndrome (Serious but less common)
  • severe cytopenias (Serious)
  • febrile neutropenia (Serious)

Drug-Drug Interactions

  • Other myelosuppressive agents
  • Immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts regularly; assess for infusion reactions; evaluate for signs of infection or bleeding.

Diagnoses:

  • Risk for infection
  • Impaired tissue perfusion related to cytopenias

Implementation: Administer premedications as per protocol; observe during and after infusion; monitor blood counts and vital signs.

Evaluation: Ensure blood counts recover; monitor for adverse reactions and effectiveness.

Patient/Family Teaching

  • Report any signs of infection, fever, bleeding, or unusual symptoms immediately.
  • Follow guidelines for infection prevention.
  • Avoid live vaccines during and for a period after treatment.

Special Considerations

Black Box Warnings:

  • Severe infusion reactions, tumor lysis syndrome, and myelosuppression.

Genetic Factors: None specific.

Lab Test Interference: May cause lymphopenia and cytopenias, affecting laboratory results.

Overdose Management

Signs/Symptoms: Severe cytopenias, infusion reactions.

Treatment: Supportive care, blood transfusions if needed, corticosteroids, and interventions for tumor lysis syndrome.

Storage and Handling

Storage: Refrigerate at 2°C to 8°C (36°F to 46°F).

Stability: Stable until the expiration date on the package when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.