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siltuximab

( sil TUX i mab )
Funding:
New Drug Funding Program
  • Siltuximab - Multicentric Castleman’s Disease (MCD)
Other Name(s): Sylvant (Janssen Inc.)
Appearance: solution mixed into larger bags of fluids

Medication Information Sheet
siltuximab (sil TUX i mab)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Sylvant

Appearance:
solution

mixed into larger bags of fluids

What is this medication for?
  • For treating multicentric Castleman's disease (MCD) in patients who do not have HIV (virus that causes AIDS) or HHV-8 (human herpes virus-8).

What should I do before I have this medication?
  • Tell your doctor and pharmacist if you have or had significant medical condition(s), especially if you have or had:
     
    • infections, including a history of hepatitis B, HIV or herpes,
    • if you have high blood pressure or high cholesterol,
    • or if you have any allergies.

       

How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding
     
  • If there is any chance that you or your partner may become pregnant, you and your partner together must: 

    Use 2 effective forms of birth control at the same time while receiving this drug. Birth control pills may be less effective when taken with siltuximab. Consider using a different method of birth control like condoms. Keep using birth control until at least 3 months after the last dose. Discuss with your healthcare team.

  • Do not breastfeed while using this drug.
     
  • This medication does not normally affect fertility (ability to get pregnant)
How is this medication given?
  • This drug is given by injection into a vein.

  • You may be given drug(s) before siltuximab to prevent a reaction.

What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your doctor and pharmacist know about all your medicines (prescription, over-the-counter, herbals and supplements), especially cyclosporine, tacrolimus or warfarin. Check with your doctor or pharmacist before starting or stopping any of them.
     
  • For mild aches and pain:
     
    • You may take acetaminophen (Tylenol®) tablets. Ask your doctor or pharmacist about the right dose for you. 
    • Talk to your doctor first before starting ibuprofen (Advil®), naproxen (Aleve®) or aspirin, since these may increase your chance of bleeding.
    • If you are already taking aspirin regularly, such as for heart conditions, talk to your doctor.
    • If you feel unwell, take your temperature before using any of these drugs, since they may hide a fever.
       
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.
What are the side effects of this medication?

You may not have all of the side effects below. You may have side effects that are not listed.

 

 

 

 

Side effects and what to do When to contact doctor?
Common Side Effects (25 to 49 out of 100 people)

Fever, chills, infection (may be severe)

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (or 100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.


If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

 

Contact your health care team if no improvement or if severe

Mild swelling in arms and legs; puffiness

To help prevent swelling :

  • Eat a low-salt diet.
  • Avoid tight fitting clothing.
  • If you have swelling in your legs, keep your feet up when sitting.
Contact your health care team if no improvement or if severe

 

 

Side effects and what to do When to contact doctor?
Less Common Side Effects (10 to 24 out of 100 people)

Rash; dry or itchy skin

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

To prevent and treat dry skin,

  • Use skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and a SPF of at least 30.
Contact your health care team if no improvement or if severe

Tingling, numb fingers and toes

  • May slowly get better after your treatment ends.
  • Contact your health care team if you have trouble doing up buttons, writing, picking up small objects, have pain or trouble moving.
Contact your health care team if no improvement or if severe

Nausea and vomiting (generally mild)

May occur in hours to days after your treatment. It is easier to prevent nausea than to treat it if it happens. 

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Contact your healthcare team if no improvement or if severe

Night sweats

  • Avoid triggers such as spicy food, alcohol and caffeine (tea, coffee, and soft drinks),
  • Exercise regularly. Ask your health care team what exercises are appropriate for you before you start any new exercise.
  • Quitting smoking may also help.
  • Keep cool; dress lightly or in layers that you can easily remove and drink plenty of liquids unless you have been told otherwise.
Contact your health care team if no improvement or if severe

Pains or cramps in the belly

  • If you have constipation or diarrhea it may be causing the pain in your belly.
  • If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.
Contact your health care team if no improvement or if severe

Rapid killing of cells when you start treatment

  • If mild, this may cause gout and joint pains. In some more severe cases, it may cause fevers, kidney problems, confusion and be life-threatening.
  • Your doctor may prescribe medication to prevent these effects.
  • Drink plenty of liquids (6 to 8 cups per day, unless you have been told otherwise) and pee frequently.
Get emergency medical help right away

Abnormal cholesterol or fat levels in the blood

Your doctor may check your cholesterol levels regularly with a blood test.

Contact your health care team if no improvement or if severe

Salt imbalances

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Get emergency medical help right away

High blood pressure

  • Check your blood pressure regularly. Your doctor may prescribe medication to treat high blood pressure.
  • If you have a severe headache, severe dizziness, or if you faint get emergency help right away as it may be a sign your blood pressure is too high or too low.
Contact your health care team if no improvement or if severe

Unusual bleeding or bruising (may be severe)

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

Get emergency medical help right away

Constipation

To help treat constipation :

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative. Ask your health care team what to do.

See the Constipation Pamphlet for more information.

Contact your health care team if no improvement or if severe

Abnormal kidney lab tests

  • Signs of a kidney problem include swelling, passing very little or no pee, or new unusual weight gain. If you have these signs, call your health team or go to your closest emergency department.
  • To prevent bladder or kidney problems, drink lots of water or other liquids. Your doctor may ask you to drink at least 6 to 8 cups (2 L) per day on treatment days, unless you have been told otherwise.
  • Your doctor may check your kidney function regularly.
Contact your health care team if no improvement or if severe

Headache, dizziness; mild joint or muscle pain

  • Take your pain medication as prescribed by your doctor.
  • You can take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Talk to your doctor or pharmacist first before taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin. These medication may increase bleeding risk.
  • Rest often and try light exercise as it may help.
Contact your health care team if no improvement or if severe

Abnormal liver lab tests

  • You may have yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. Talk to your health care team if this happens.
  • Your doctor may monitor your liver regularly with a blood test.
Contact your health care team if no improvement or if severe

 

 

 

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • Signs of an allergic reaction like fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness
  • Shortness of breath
  • Sudden, severe pain or feeling of fullness in your belly


For more links on how to manage your symptoms go to https://www.cancercareontario.ca/en/symptom-management.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.