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COVID-19: Obtenez les dernières mises à jour ou faites une autoévaluation.

Les traitements par chimiothérapie et autres traitements systémiques pourraient être modifiés en raison de la COVID-19. Vous trouverez de plus amples renseignements à la page Traitements systémiques pendant la pandémie de la COVID-19.

Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

BEND+RITU Patient Information

This page gives general information about this cancer treatment.

You Will Learn:

  • who to contact for help
  • what the treatment is
  • how it is given
  • what to expect while on treatment

This information was created by Cancer Care Ontario together with patients and their caregivers who, like you, have gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your healthcare team. Always talk to your healthcare team about your treatment.

What Is This Treatment?

BEND+RITU is the code name of your lymphoma treatment regimen.

A regimen is a combination of medications to treat cancer.

This regimen name is made up of 1 or more letters from the names of the 2 medications in your treatment.   

Here are the names of the medications in this regimen:

BEND = BENDamustine

+   

RITU = RITUximab

For most people, treatment lasts 24 weeks. The treatment is divided into 6 cycles. Each cycle is 4 weeks long.

Here is a picture of the schedule for BEND+RITU treatment:

BEND+RITU Treatment Schedule

During each 4 week cycle, you will have treatment on day 1 and day 2 at the hospital.

Each cycle looks like this:

Day 1
Treatment Day:
Go to the hospital for BEND+RITU Treatment
2
Treatment Day:
Go to the hospital for BEND Treatment
3
No
BEND+RITU Treatment
4
No
BEND+RITU Treatment
5
No
BEND+RITU Treatment
6
No
BEND+RITU Treatment
7
No
BEND+RITU Treatment
8
No
BEND+RITU Treatment
9
No
BEND+RITU Treatment
10
No
BEND+RITU Treatment
11
No
BEND+RITU Treatment
12
No
BEND+RITU Treatment
13
No
BEND+RITU Treatment
14
No
BEND+RITU Treatment
15
No
BEND+RITU Treatment
16
No
BEND+RITU Treatment
17
No
BEND+RITU Treatment
18
No
BEND+RITU Treatment
19
No
BEND+RITU Treatment
20
No
BEND+RITU Treatment
21
No
BEND+RITU Treatment
22
No
BEND+RITU Treatment
23
No
BEND+RITU Treatment
24
No
BEND+RITU Treatment
25
No
BEND+RITU Treatment
26
No
BEND+RITU Treatment
27
No
BEND+RITU Treatment
28
No
BEND+RITU Treatment

Remember To:

Important Icon

  • Tell your healthcare team about all of the other medications you are taking.
  • Keep taking other medications that have been prescribed for you, unless you have been told not to by your healthcare team.

How Is This Treatment Given?

Cycle 1: For the first cycle in your treatment these medications will be given through an IV (injected into a vein) at the hospital:

BEND = BENDamustine

+   

RITU = RITUximab

Other cycles: If your first cycle of Rituximab goes well you may get this medication under your skin (subcutaneously or Subcut) for the rest of your cycles. This will happen on day 1 at the hospital or clinic. Getting the Rituximab under your skin instead of through an IV will make your treatment visit at the hospital go faster.

You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.

What Other Medications Are Given With This Treatment?

To prevent nausea and vomiting

You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.

  • These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), dexamethasone or others.

To prevent allergic reaction

You will be given medications before your treatment to help prevent allergic reactions before they start.

  • There are different types of medications to stop allergic reactions. They are called:
    • antihistamines (such as diphenhydramine or Benadryl®)
    • analgesics/antipyretics (such as acetaminophen or Tylenol®)
    • H2 blockers (such as ranitidine or famotidine)
    • corticosteroids (such as dexamethasone)

To prevent Tumor Lysis Syndrome (TLS)

TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your healthcare team if you are at risk for TLS.

If you are at risk for TLS, you may be given medications before your BEND+RITU treatment to help prevent it.

  • These are called anti-uricemics (such as allopurinol).

To prevent hepatitis B flare-ups

If you have ever been infected with hepatitis B, there is a risk that this treatment can cause it to flare up (come back). Tell your healthcare team if you have had hepatitis B. You may need to take medication to prevent a hepatitis B flare-up.

DO This While on Treatment

Check mark Icon
  • DO tell your healthcare team about any other medical conditions that you have such as heart, liver, lung or kidney problems, or any allergies.
  • DO tell your healthcare team about any serious infections that you have now or have had in the past.
  • DO check with your healthcare team before getting any vaccinations, surgery, dental work or other medical procedures.
  • DO talk to your healthcare team about your risk of getting other cancers and heart problems after this treatment.
  • DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.

DO NOT Do This While on Treatment

Stop Icon
  • DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products, without checking with your healthcare team.
  • DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your healthcare team.
  • DO NOT smoke or drink alcohol while on treatment without talking to your healthcare team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

Will This Treatment Interact with Other Medications or Natural Health Products?

Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

Tell your healthcare team about all of your:

  • prescription and over-the-counter (non-prescription) medications
  • natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements

Check with your healthcare team before starting or stopping any of them.

If you are taking medications to help with your blood pressure, your healthcare team may ask you stop these medications 12 hours before and during your treatment.

medication icon

Talk to your healthcare team BEFORE taking or using these:

  • Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®
  • Over-the-counter products such as dimenhydrinate (Gravol®)
  • Natural health products such as St. John’s Wort
  • Supplements such as vitamin C
  • Grapefruit juice
  • Alcoholic drinks
  • Tobacco
  • All other drugs, such as marijuana (medical or recreational)

What Should I Do If I Feel Unwell, Have Pain, a Headache or a Fever?

  • Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen [Tylenol] or ibuprofen [Advil]).
    • Fever can be a sign of infection that may need treatment right away.
    • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

  • 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 (100.4°F) or higher for at least 1 hour.

medication icon

If you do have a fever

  • Try to contact your healthcare team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • Download theFever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your healthcare team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

Stop Icon
Talk to your healthcare team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Important Icon
Talk to your healthcare team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How Will This Treatment Affect Sex, Pregnancy and Breast Feeding?

Talk to your healthcare team about:

  • How this treatment may affect your sexual health.
  • How this treatment may affect your ability to have a baby, if this applies to you.

This treatment may harm an unborn baby. Tell your healthcare team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

  • If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time starting 2 weeks before BEND+RITU treatment, during treatment and for until 12 months after your last treatment dose. Talk to your healthcare team about which birth control options are best for you
  • Do not breastfeed while on this treatment

What Are the Side Effects of This Treatment?

The following table lists side effects that you may have when getting BEND+RITU treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Keep the link to this page during your treatment so that you can refer to it if you need to.

Very Common Side Effects (50 or more out of 100 people)

Side effect and what to do

When to contact healthcare team

Allergic reaction

(May be severe; With IV rituximab)

What to look for:

  • Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness.
  • It may happen during or shortly after your treatment is given to you and may be severe.

What to do:

  • Tell your nurse right away if you feel any allergic reaction symptoms during or just after your treatment.
  • Talk to your healthcare team for advice if you have a mild skin reaction

Get emergency medical help right away for severe symptoms.

Nausea and vomiting

What to look for:

  • Nausea is feeling like you need to throw up. You may also feel light-headed.
  • You may feel nausea within hours to days after your treatment.

What to do:

To help prevent nausea:

  • It is easier to prevent nausea than to treat it once it happens.
  • Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
  • 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 (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

  • Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
  • Download theNausea & Vomiting pamphlet for more information.
  • Talk to your healthcare team if:
    • nausea lasts more than 48 hours
    • vomiting lasts more than 24 hours or if it is severe.

Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe.

Fatigue

What to look for:

  • Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.

What to do:

  • Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
  • Check with your healthcare team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Ask family or friends to help you with things like housework, shopping, and child or pet care.
  • Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your healthcare team has told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired.

Download theFatigue pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Low neutrophils (white blood cells) in the blood (neutropenia)

When neutrophils are low, you are at risk of getting an infection more easily. It is important to watch for early signs of infection and tell your healthcare team about them right away. Download theNeutropenia (Low white blood cell count) pamphlet for more information.

What to look for:

  • If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Fever may be the first sign of an infection.
  • Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
  • Do not eat or drink anything hot or cold right before taking your temperature.

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 (100.4°F) or higher for at least one hour.

What to do:

If your healthcare team has told you that you have low neutrophils:

  • Wash your hands often to prevent infection.
  • Check with your healthcare team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
  • Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your healthcare team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact your healthcare team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

Low platelets in the blood

When your platelets are low you are at risk for bleeding and bruising. Download theLow Platelet Count pamphlet for more information.

What to look for:

  • Watch for signs of bleeding:
    • Bleeding from your gums
    • Unusual or heavy nosebleeds
    • Bruising easily or more than normal
    • Black coloured stools (poo) or blood in your stools (poo)
    • Coughing up red or brown coloured mucus
    • Dizziness, constant headache or changes in your vision
    • Heavy vaginal bleeding
    • Red or pink coloured urine (pee)

What to do:

If your healthcare team has told you that you have low platelets:

  • Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
  • Check with your healthcare team before you go to the dentist.
  • Take care of your mouth and use a soft toothbrush.
  • Try to prevent cuts and bruises.
  • Ask your healthcare team what activities are safe for you.
  • Your treatment may have to be delayed if you have low platelets. Your healthcare team may recommend a blood transfusion.

If you have signs of bleeding:

  • If you have a small bleed, clean the area with soap and water or a saline (salt water) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.

Talk to your healthcare team if you have any signs of bleeding. If you have bleeding that doesn’t stop, or is severe (very heavy), you MUST get emergency medical help right away.

Common Side Effects (25 to 49 out of 100 people)

Side effect and what to do

When to contact healthcare team

Diarrhea

What to look for:

  • Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.

What to do:

If you have diarrhea:

  • Take anti-diarrhea medication if your healthcare team prescribed or told you to take it.
  • Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘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, unless your healthcare team has told you to drink more or less.
  • Talk to your healthcare team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
  • Talk to your healthcare team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in 1 day.

Download theDiarrhea pamphlet for more information.

Talk to your healthcare team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in 1 day). .

Flu-like symptoms

You may feel like you have the flu for around 2 days after your IV treatment. These flu-like symptoms may not be signs of an infection.

What to look for:

  • You may have chills, headache and muscle pain.
  • You may feel tired and have a poor appetite.
  • Symptoms may happen at any time after you receive your treatment and usually go away as your body gets used to the medication.

What to do:

  • Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”.
  • If you do have a fever, try to speak to your healthcare. If you are unable to talk to them for advice, you MUST get emergency medical help right away.

Talk to your healthcare team if it does not improve or if it is severe.

Constipation

What to look for:

  • Having bowel movements (going poo) less often than normal.
  • Small hard stools (poo) that look like pellets.
  • The need to push hard and strain to have any stool (poo) come out.
  • Stomach ache or cramps.
  • A bloated belly, feeling of fullness, or discomfort.
  • Leaking of watery stools (poo).
  • Lots of gas or burping.
  • Nausea or vomiting.

What to do:

To help prevent constipation:

  • Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains.
  • Drink at least 6 to 8 cups of liquids each day unless your healthcare team has told you to drink more or less.
  • Be Active. Exercise can help to keep you regular.
  • If you take opioid pain medication, ask your healthcare team if eating more fibre is right for you.

To help treat constipation:

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your healthcare team what to do.

Download theConstipation Pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Reactions at the injection site

(With subcut rituximab)

What to look for:

  • Your skin may become red, itchy, bruised, and/or swollen where the injection was given.
  • Site reactions are usually mild and go away within 1 to 3 days.

What to do:

  • You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction.

Talk to your healthcare team to find out which treatment is right for you.

Talk to your healthcare team if this bothers you.

Less Common Side Effects (10 to 24 out of 100 people)

Side effect and what to do

When to contact healthcare team

Headache, mild joint or muscle pain

(May be severe)

What to look for:

  • New pain in your muscles or joints or feeling achy.

What to do:

  • Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
  • Read the above section: “What should I do if I feel unwell, have pain, a headache or a fever?” before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
  • Rest often and try light exercise (such as walking) as it may help.

Download thePain Pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Mouth sores

What to look for:

  • Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
  • In more severe cases they may make it hard to swallow, eat or brush your teeth.
  • They may last for 3 days or longer.

What to do:

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often with a homemade mouthwash.
  • To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

If you have mouth sores:

  • Avoid hot, spicy, acidic, hard or crunchy foods.
  • Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection.
  • Talk to your healthcare team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Download theMouth Care pamphlet for more information.

Talk to your healthcare team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Pains or cramps in the belly

What to look for:

  • Pain or cramps in your belly.
  • Constipation and diarrhea can cause pain in your belly.

What to do:

  • If the pain is severe, gets worse or doesn’t go away, talk to your healthcare team about other possible causes.

Talk to your healthcare team if it does not improve or if it is severe.

Low Appetite, weight loss

What to look for:

  • Loss of interest in food or not feeling hungry.
  • Weight loss.

What to do:

  • Try to eat your favourite foods.
  • Eat small meals throughout the day.
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your healthcare team if you have no appetite.

Download theLoss of Appetite pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Heartburn; upset stomach; bloating

What to look for:

  • Pain or burning in the middle or top part of your chest. It may get worse when you are lying down or bending over or when you swallow.
  • A bitter or acidic taste in your mouth.

What to do:

  • Drink clear liquids and eat small meals.
  • Do not eat acidic, fatty or spicy foods.
  • Limit caffeine (like coffee, tea) and avoid alcohol.
  • Avoid smoking or being around tobacco.
  • Sit up or stand after eating. Do not lie down.
  • Raise the head of your bed 6 to 8 inches. You may need to use extra pillows to do this.

Talk to your healthcare team if it does not improve or if it is severe.

Taste changes

What to look for:

  • Food and drinks may taste different than usual.

What to do:

  • Eat foods that are easy to chew, such as scrambled eggs, pasta, soups, cooked vegetables
  • Taste foods at different temperatures, since the flavour may change.
  • Try different forms of foods, like fresh, frozen or canned.
  • Experiment with non-spicy foods, spices and seasonings.

Talk to your healthcare team if it does not improve or if it is severe.

Cough and feeling short of breath

(May be severe)

What to look for:

  • You may have a cough and feel short of breath.
  • Symptoms that commonly occur with a cough are:
    • Wheezing or a whistling breathing
    • Runny nose
    • Sore throat
    • Heartburn
    • Weight loss
    • Fever and chills
  • Rarely this may be severe with chest pain, trouble breathing or coughing up blood.

What to do:

  • Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”.
  • If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away. If you have a fever, try to talk to your healthcare team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.

Talk to your healthcare team. If you are not able to talk to your healthcare team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away.

Dizziness

What to look for:

  • You may feel light-headed and like you might faint (pass out).

What to do:

  • Lay down right away so you do not fall.
  • Slowly get up and start moving once you feel better.
  • Do not drive a motor vehicle or use machinery if you feel dizzy.

Talk to your healthcare team if it does not improve or if it is severe.

Trouble Sleeping

Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends.

What to look for:

  • You may find it hard to fall asleep or stay asleep.
  • How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep.
  • You may wake up too early or not feel well-rested after a night’s sleep.
  • You may feel tired or sleepy during the day.

What to do:

Talk to your healthcare team if it does not improve or if it is severe.

Talk to your healthcare team if it does not improve or if it is severe.

Tingling or numb feeling on the skin

What to look for:

  • Numbness or tingling that most often happens in your hands, arms, legs or feet but can happen elsewhere in the body as well.
  • Sometimes it can be painful and feel like burning sensation, which may be severe.

What to do:

  • Talk to your healthcare team if you have any of the symptoms described above.
  • Numbness and tingling may slowly get better after your treatment ends.

In rare cases, numbness and tingling may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your healthcare team for advice.

Talk to your healthcare team, especially if you have trouble doing tasks like doing up buttons, writing, moving, or if you have severe pain or numbness.

Rash; dry, itchy skin

(May be severe)

What to look for:

  • You may have cracked, rough, flaking or peeling areas of the skin.
  • Your skin may look red and feel warm, like a sunburn.
  • Your skin may itch, burn, sting or feel very tender when touched.

What to do:

To prevent and treat dry skin:

  • Use fragrance-free 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.
  • Avoid perfumed products and lotions that contain alcohol.
  • Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your healthcare team has told you to drink more or less.

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.

Talk to your healthcare team if it does not improve or if it is severe.

Mild swelling

What to look for:

  • You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.

What to do:

To help prevent swelling:

  • Eat a low-salt diet.

If you have swelling:

  • Wear loose-fitting clothing.
  • For swollen legs or feet, keep your feet up when sitting.

Talk to your healthcare team if it does not improve or if it is severe.

Too much or too little salt in your body

What to look for:

  • Muscle spasms, cramping, weakness, twitching, or convulsions.
  • Irregular heartbeat, confusion or blood pressure changes.

What to do:

Get emergency medical help right away for severe symptoms.

Get emergency medical help right away for severe symptoms.

Other Rare but Serious Side Effects Are Possible with This Treatment.

If you have any of the following, talk to your cancer healthcare team or get emergency medical help right away:

  • Trouble speaking or difficulty moving your arms or legs
  • Pain and swelling of a vein in your arm or leg
  • Any changes in your vision
  • Chest pain
  • Fainting (passing out)
  • Yellowish skin and eyes, red-brown coloured pee
  • Confusion
  • Signs of kidney problems such as pain in your lower back, unexpected swelling in your hands, ankles, feet or other areas of your body, unusual weight gain, muscle twitches and cramps, itchiness that won’t go away, changes in urination (peeing) and less urine (pee) than usual.

For more information on how to manage your symptoms, ask your healthcare provider or go to Managing Symptoms, Side Effects & Well-Being.

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.