Warnings for special population
Pregnancy
This medicine is not recommended for use in pregnant women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before receiving this medicine.
Breast-feeding
This medicine is not recommended for use in breastfeeding women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before receiving this medicine. Your doctor may advise you to discontinue breastfeeding or to discontinue the drug based on your clinical condition.
General warnings
Other medicines
This medicine may interact with many other medicines and may cause severe adverse effects. Hence, it is advised that your report to the doctor all your current medicines, including any herbs and supplements, before receiving therapy with this medicine.
Blood cell count
Use of this medicine is known to lower the count of white blood cells (neutrophils) and platelets. Close monitoring of complete blood cell counts is necessary before and during therapy with this medicine. Appropriate corrective measures, dose adjustments, or replacement with a suitable alternative may be required in some cases based on the clinical condition of the patient.
Cardiovascular diseases
This medicine should be used with extreme caution in patients with a history of cardiovascular diseases due to the increased risk of worsening of the patient's condition. Close monitoring of clinical condition, appropriate dose adjustments, or replacement with a suitable alternative may be necessary in some cases.
Lung diseases
This medicine should be used with caution in patients with a history of lung diseases due to the increased risk of worsening of the patient's condition. Report any unusual symptoms to the doctor immediately. Close monitoring of clinical condition, appropriate dose adjustments, or replacement with a suitable alternative may be necessary in some cases.
Infections
Use of this medicine may increase the risk of infections including pneumonia, hepatitis B, tuberculosis, sepsis, etc. This risk is especially higher in patients with a history of these infections. Report any unusual symptoms to the doctor immediately. Close monitoring of clinical condition, appropriate dose adjustments, or replacement with a suitable alternative may be necessary in some cases.
Liver diseases
This medicine should be used with caution in patients with a history of liver diseases due to the increased risk of severe adverse effects. Close monitoring of liver function tests is necessary during treatment with this medicine. Replacement with a suitable alternative may be necessary if the patient has severe liver function impairment.
Kidney diseases
This medicine should be used with caution in patients with a history of kidney diseases due to the increased risk of severe adverse effects. Close monitoring of kidney function tests is necessary during treatment with this medicine. Replacement with a suitable alternative may be necessary if the patient has severe kidney function impairment.
Hematologic toxicity
Use of this medicine should be delayed in the event of grade 4 hematologic toxicity or clinically significant toxicity equal to or above grade 2. Appropriate dose adjustments and clinical monitoring are advised based on the grade of toxicity identified clinically.
Infusion reaction and severe allergy
Use of this medicine may cause severe allergic reactions resulting in fever, chills, skin rashes, especially in the second and subsequent cycles of therapy. Close monitoring of clinical condition is advised during treatment with this medicine. Use should be discontinued if the allergic reaction is severe or life-threatening.
Tumor lysis syndrome
Use of this medicine may cause tumor lysis syndrome, a condition where a large number of cancer cells are killed and their contents are released into the bloodstream. This may cause acute kidney failure and death. Close clinical monitoring is advised, especially during the first cycle of treatment. Appropriate corrective and preventive measures, dose adjustments, or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.