Uses of Ribomustine

Ribomustin also known by its common name Treanda, Treakisym, is a chemotherapy drug used in the treatment of multiple myeloma, chronic leukemia, and non-Hodgkin lymphoma.

1. What is Ribomustin?

Ribomustin has the main ingredient Bendamustin hydrochloride 25mg or 100mg, belongs to the group of anti-cancer drugs. It works by acting on the genetic factors (DNA and RNA) of cancer cells, preventing the growth and replication of the virus. Ribomustin is prescribed by doctors in the following cases:
Treatment of chronic lymphocytic leukemia : Using the drug to treat chronic lymphocytic leukemia at stage B or C for patients who are not suitable for use. chemotherapy in combination with fludarabin. Treatment of Non-Hodgkin's Lymphoma: Non-Hodgkin's lymphoma can progress slowly in patients after treatment with Rituximab drug or using chemotherapy in combination with Rituximab. Treatment of multiple myeloma: Use in combination with prednisone for the treatment of multiple myeloma in patients over 65 years of age (not suitable for autologous stem cell transplantation) and in patients with the above neurological disease clinical practice that cannot be treated with Bortezomib or Thalidomide.

2. Dosage and how to take Ribomustin

How to use:
Ribomustin is used in intravenous infusion. Dosage:
For chronic lymphocytic leukemia: Use Bendamustine hydrochloride injection dose of 100mg/m2 over body surface area on day 1 and day 2 of cycles, each cycle is 4 weeks, maximum 6 cycles period. Non-Hodgkin Lymphoma: Apply a dose of Bendamustin hydrochloride 120 mg/m2 to body surface area on day 1 and day 2 of cycles, every 3 weeks, for at least 6 to 8 cycles. Patients should only use a maximum of 8 cycles. Multiple myeloma: Bendamustin hydrochloride 120-150 mg/m2 body surface area on day 1 and day 2, in combination with prednisone 60 mg/m intravenously or orally from day 1 to day 4 of each cycle cycle lasts 4 weeks for at least 3 cycles. Note:
Treatment should be delayed or discontinued if the patient has a leukocyte count of 3,000/uL or a platelet count of less than 75,000/HL. Drug therapy may be continued after the white blood cell count rises again above 4,000/uL and the platelet count rises to 100,000/uL. It is recommended that patients closely monitor blood counts during and after discontinuation of therapy. If the patient wants to adjust the dose of the drug, the reduced dose is calculated separately on the first and second day of the treatment cycle, respectively. For patients with hepatic impairment: No dose adjustment is currently required in patients with mild hepatic impairment with serum bilirubin <1.2 mg/dL. For patients with moderate hepatic impairment with serum bilirubin 1.2 ~ 3 mg/dL, the physician recommends a 30% reduction in the usual dose. In patients with renal impairment: No dose adjustment is necessary in patients with creatinine clearance > 10 mL/min. When used in patients with severe renal impairment, consult a doctor. In children: There are not enough data to prove that the drug is safe in this case, it is necessary to consult a doctor before taking the drug Elderly patients: Use the same dosage as normal people. Contraindications:
Do not use Ribomustin for people who are allergic to Bendamustin hydrochloride or any of its excipients. Do not use the drug in patients with severe liver failure with serum bilirubin > 3 mg/dL. Contraindicated to use the drug for patients with jaundice. Ribomustin should not be used in patients with severe bone marrow failure and severe blood cell counts (leukocyte count <3,000/HL and/or platelet count <75,000/0L). Do not administer the drug to patients undergoing major surgery for 30 days before starting treatment. It is not recommended for use in patients with sepsis accompanied by leukopenia and in patients receiving yellow fever vaccination.

3. Ribomustin side effects

The most common side effects when using Bendamustin hydrochloride are hematological reactions with manifestations such as leukopenia, thrombocytopenia, skin toxicity (allergic reactions), systemic symptoms ( fever), gastrointestinal symptoms (nausea, vomiting). Skin and subcutaneous tissue disorders with manifestations such as alopecia, dermatitis, pruritus, erythema, increased sweating. Reproductive system and breast disorders: Amenorrhea, infertility - this is rarer. Systemic disorders and infusion site conditions; mucositis, fatigue, fever, pain, chills, dehydration, anorexia, multi-organ failure. Effects on laboratory parameters: Decrease in hemoglobin, increase in creatinine/ urea/ bilirubin/ alkaline phosphatase. Cardiac Disorders: Cardiac dysfunction such as palpitations, angina, atrial fibrillation, pericardial effusion, myocardial infarction, heart failure. Vascular disorders: Hypotension, acute circulatory failure, phlebitis. Respiratory dysfunction with pulmonary dysfunction and pulmonary fibrosis. Digestive disorders: Constipation, vomiting, nausea, stomatitis, hemorrhagic esophagitis, gastrointestinal bleeding. Nervous system disorders: Insomnia, somnolence, dysesthesia, dysgeusia, peripheral sensory neuropathy, ataxia.

4. Be careful when taking Ribomustin

Patients with possible myelosuppression : Patients treated with Bendamustin hydrochloride may develop bone marrow failure. During the use of the drug, the patient should monitor the ratio of white blood cells, platelets, hemoglobin, neutrophils and re-evaluate the above indicators before starting the next treatment cycle. Patients should not take Ribomustin with severe myelosuppression or severe changes in blood cell counts. Infections: There have been reports that patients taking the drug have developed infections, including pneumonia and sepsis. In some more serious cases, there have been patients requiring hospitalization, septic shock and death. In particular, patients with myelosuppression after treatment with Bendamustine hydrochloride are susceptible to infections. Patients with myelosuppression following treatment with Ribomustin should notify their physician if they develop symptoms or signs of infection, including accompanying symptoms such as fever or respiratory symptoms. Skin reactions: Some skin reactions include rash, toxic skin reactions and bullous skin rash. When side effects appear on the skin, if the patient continues to take the drug, these reactions can become more serious. Therefore, it is necessary to closely monitor the patient when present. If the skin reaction does not subside, treatment with Ribomustin should be interrupted or discontinued. Patients with heart disorders; Blood potassium levels should be regularly monitored during treatment with bendamustin hydrochloride and potassium supplementation is recommended when K+<3.5 mEq/L and ECG is needed. Anaphylaxis: Most symptoms of an anaphylactic reaction are mild, with symptoms such as fever, chills, itching, and rash. The incidence of severe anaphylaxis is usually low. Precautions should be taken to prevent serious reactions, including the use of antihistamines, antipyretics, and corticosteroids in subsequent cycles in patients with prior infusion reactions. For pregnant women: Research has proven that Bendamustin hydrochloride is mutagenic and teratogenic. Therefore, women should use contraception during treatment. If you are pregnant, you should absolutely not take the drug. Fertility: For men, the drug can affect sperm quality. Other Malignancies: Cases of patients with secondary tumor-associated diseases, including syndromes of myeloproliferative disorders, myeloproliferative disorders, acute myeloid leukemia, and bronchial carcinoma have been reported.

5. Drug interactions

Drugs that cause myelosuppression: When taken at the same time with Ribomustin may affect the bone marrow. Any drug that reduces bone marrow function can increase the toxicity of Ribomustin. Combining Ribomustin with Cyclosporin or Tacrolimus may lead to excessive immunosuppression with a risk of lymphoproliferative disease. CYP1A2 inhibitors such as Fluvoxamine, Ciprofloxacin, Acyclovir, Cimetidine: Causes more serious side effects. The basic information about the drug Ribomustin in the article is for reference only. Because this is a prescription drug, patients should not arbitrarily use Ribomustin, but need to contact a specialist directly for a suitable prescription to ensure safety for health.

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