Pronunciation:

ba-SILL-us of KAL-met and GARE-in vak-SEEN, lyve

Brand Names:

• Theracys
• Tice BCG

Dosage Forms:

• Powder for Solution
• Powder for Suspension

Warnings:

Bacillus of calmette and guerin infections have been reported in health care workers, primarily from exposures resulting from accidental needle sticks or skin lacerations during the preparation of bacillus of calmette and guerin for administration. Nosocomial infections have been reported in patients receiving parenteral drugs that were prepared in areas in which bacillus of calmette and guerin was reconstituted. Bacillus of calmette and guerin is capable of dissemination when administered by the intravesical route, and serious infections, including fatal infections, have been reported in patients receiving intravesical bacillus of calmette and guerin.

• TICE® BCG
  • TICE® BCG contains live, attenuated mycobacteria. Because of the potential risk for transmission, it should be prepared, handled, and disposed of as a biohazard material .

Bacillus of calmette and guerin infections have been reported in health care workers and patients due to exposure to the vaccine during preparation and administration. Bacillus of calmette and guerin is capable of dissemination when administered by the intravesical route, and serious infections, including fatal infections, have been reported in patients receiving intravesical bacillus of calmette and guerin. THERACYS(R) and TICE(R) BCG contains live, attenuated mycobacteria and because of the potential risk for transmission, it should be prepared, handled, and disposed of as a biohazard material .

Classifications:

Therapeutic—

Vaccine

Uses of This Medicine:

Bacillus Calmette-Guérin (BCG) is used as a solution that is run through a tube (instilled through a catheter) into the bladder to treat bladder cancer. The exact way it works against cancer is not known, but it may work by stimulating the body's immune system.

BCG is to be administered only by or under the immediate supervision of your doctor.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

There is no specific information comparing use of BCG for treatment of cancer in children with use in other age groups.

Older adults—

This medicine has been tested and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Pregnancy—

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aclarubicin
• Adalimumab
• Aldesleukin
• Altretamine
• Amonafide
• Amsacrine
• Asparaginase
• Azacitidine
• Azathioprine
• Bleomycin
• Broxuridine
• Busulfan
• Capecitabine
• Carboplatin
• Carmustine
• Certolizumab Pegol
• Chlorambucil
• Cisplatin
• Cladribine
• Cyclophosphamide
• Cytarabine
• Cytarabine Liposome
• Dacarbazine
• Dactinomycin
• Daunorubicin
• Daunorubicin Citrate Liposome
• Decitabine
• Docetaxel
• Doxifluridine
• Doxorubicin Hydrochloride
• Doxorubicin Hydrochloride Liposome
• Edatrexate
• Eflornithine
• Epirubicin
• Estramustine
• Etanercept
• Etoposide
• Floxuridine
• Fludarabine
• Fluorouracil
• Fotemustine
• Gallium Nitrate
• Gemcitabine
• Hydroxyurea
• Idarubicin
• Ifosfamide
• Interferon Alfa
• Interferon Alfacon-1
• Interferon Beta
• Interferon Beta-1a
• Interferon Beta-1b
• Interferon Gamma
• Irinotecan
• Lomustine
• Mechlorethamine
• Melphalan
• Mercaptopurine
• Methotrexate
• Mitolactol
• Mitomycin
• Mitotane
• Mitoxantrone
• Mycophenolic Acid
• Oxaliplatin
• Paclitaxel
• Pegaspargase
• Pentostatin
• Pipobroman
• Pirarubicin
• Plicamycin
• Procarbazine
• Raltitrexed
• Rilonacept
• Rituximab
• Sirolimus
• Streptozocin
• Tacrolimus
• Teceleukin
• Tegafur
• Temsirolimus
• Teniposide
• Thioguanine
• Thiotepa
• Topotecan
• Treosulfan
• Trimetrexate
• Trofosfamide
• Uracil Mustard
• Vinblastine
• Vincristine
• Vincristine Liposome
• Vindesine
• Vinorelbine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Fever—Infection may be present and could cause problems

• Immunity problems—BCG treatment is less effective and there is a risk of infection

• Urinary tract infection—Infection and irritation of the bladder may occur

Proper Use of This Medicine:

Your doctor will ask you to empty your bladder completely before the solution is instilled into it.

Follow your doctor's instructions carefully about how long to hold the solution in your bladder:

• The solution should be held in your bladder for 2 hours. If you think you cannot hold it, tell your health care professional.
• During the first hour, your doctor may have you lie for 15 minutes each on your stomach, back, and each side.
• When you do empty your bladder, you should be sitting down.

It is important that you drink extra fluids for several hours after each treatment with BCG so that you will pass more urine. Also, empty your bladder frequently. This will help prevent bladder problems.

BCG is a live product. In other words, it contains active bacteria that can cause infection. Some bacteria will be present for several hours in urine that you pass after each treatment with BCG. Any urine that you pass during the first 6 hours after each treatment should be disinfected with an equal amount (usually about 1 cup) of undiluted household bleach. After the bleach is added to the urine, it should be allowed to sit for 15 minutes before it is flushed. If you have any questions about this, check with your doctor.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Precautions While Using This Medicine:

While you are being treated with BCG, and for 6 to 12 weeks after you stop treatment with it, avoid contact with people who have tuberculosis. If you think you have been exposed to someone with tuberculosis, tell your doctor.

While you are being treated with BCG and for a few weeks after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Blood in urine

fever and chills

frequent urge to urinate

increased frequency of urination

joint pain

nausea and vomiting

painful urination (severe or continuing)

Rare

Cough

skin rash

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Burning during first urination after treatment

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

Cough

fever

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.