Onco bcg insert
with analgesics until symptoms disappear.
For the use only of a Registered Medical Practitioner or a Hospital or a Laboratory
Malaise and low-medium grade fever and/ or a flu like syndrome. These symptoms usually
occur after 4 hours of instillation and disappear within 24-48 hours.
RARE ADVERSE EFFECTS:
Fever more than 39°C. The fever resolves within 24-48 hours with antipyretics and
Systemic BCG infections due to traumatic catheterization, perforation of bladder or early BCG instillation after extensive TUR which may be manifested by pneumonitis, hepatitis or cytopenia. Patients with such symptoms should be treated with tuberculostatic drugs as per treatment schedules used. Triple drug therapy with or without Cycloserine for some weeks should be used.
WARNING : This preparation is not to be used as a vaccine against tuberculosis.
Arthritis, Arthralgia, Haematuria, Orchitis, Transient urethral obstruction, Epididymitis or bladder contraction may occur.
SII-ONCO-BCG (Bacillus Calmette-Guerin (BCG) Vaccine) for intravesical instillation is a live
lyophilized preparation derived from attenuated strain of Mycobacterium bovis (Bacillus Calmette
Bacillus Calmette-Guerin (BCG) Vaccine for intravesical instillation carcinoma in situ of bladder
should not be used in:Impaired immune response irrespective of whether this impairment is congenital or caused by
Bacillus Calmette-Guerin strain : 40mg/ml
Between 1-8 x10 Colony Forming Units (CFU)
Positive tuberculin reaction in conjunction with clinical evidence of existing active tuberculosis.
Urinary tract infections: treatment should be withheld till urine culture is negative and antibiotic
Reconstitute each vial with 50 ml of sodium chloride injection.
therapy is stopped.
Trauma to urinary bladder.
A patient with fever needs careful evaluation before therapy is instituted.
Carcinoma in situ of Urinary bladder (CIS):
Safety of the mode of therapy in pregnant women, nursing mothers and children has not been
The treatment schedule includes weekly repeated instillation with SII-ONCO-BCG during the first 6
On going treatment with antitubercular treatment.
Followed by induction treatment, periodic repeated instillations for a period of at least 12 months.
Bacillus Calmette-Guerin (BCG) Vaccine should not be administered intravenously, subcutaneously
Adjunctive therapy after TUR (Trans-urethral resection) of superficial carcinoma of Urinary
The vaccine is not intended for immunisation.
Treatment should be started 10-15 days after performing TUR. The treatment schedule is- a weekly
The preparation contains live attenuated mycobacterium (BCG) and should be used with aseptic
repeated instillation with the drug during first 6 weeks, followed by an instillation in the 8th week
technique. All equipment, supplies and receptacles in contact with BCG should be handled and
and 12th week and then monthly instillations for 4 months.
disposed off as biohazardous. Urine voided for 6 hours after instillation also needs to be properly
The duration of maintenance treatment should be evaluated on the basis of tumour classification
SPECIAL PRECAUTIONS FOR USE:
Do not expose the vaccine to light before and after reconstitution. Use the vaccine
For the treatment of flat urothelial cell carcinoma in situ of urinary bladder and as adjunctive
immediately after reconstitution and discard unused portion.
therapy following transurethral resection of primary or relapsing superficial noninvasive papillary
SII-ONCO-BCG should not be administered I.V., S.C., I.M.
tumors that are limited to the bladder mucosa (stage Ta/T1- Grade 1,2 or3).
Reconstitution, preparation and administration should be performed under aseptic conditions.
DOSAGE AND METHOD OF ADMINISTRATION :
Before the first instillation Tuberculin test should be performed, in case positive, the drug is
contraindicated only if there is an evidence of active tuberculosis infection.
The following procedures are recommended under aseptic precautions prior to use:
Delay treatment in-patients who experience traumatic catheterization till mucosal damage has healed.
Adequate HIV assays are recommended in-patients who are at risk of HIV infection.
Add 1 ml of a sterile isotonic preservative free saline (0.9 % NaCl) by means of a sterile syringe to the
It is recommended to refrain from intercourse for one week after instillation or use a condom.
contents of 1 vial of SII-ONCO-BCG and allow stand for a few minutes. Then gently swirl the vial until a homogenous suspension is obtained (caution: avoid forceful agitation). The above procedure may
be repeated to reconstitute each subsequent vial/s used.
SII-ONCO-BCG is sensitive to most antibiotics specially to anti-tubercular drugs like Streptomycin, Isoniazid, Ethambutol, Rifampicin and PAS (Para-amino Salicylic Acid). It is not known whether
PREPARATION OF SOLUTION FOR INSTILLATION:
interactions occur during intra-vesical instillation of SII-ONCO-BCG or whether the interactions
Transfer the reconstituted suspension from the vial/s into a 50 ml syringe. Rinse the empty vial/s
result in clinically relevant reduction of multiplication activity of SII-ONCO-BCG. Hence, it is not
with 1 ml each of sterile isotonic saline. Add the rinse fluid to the reconstituted suspension in the 50
clear whether activity of SII-ONCO-BCG is influenced by concomitant therapy with antibiotics. If a
ml syringe. Finally dilute the contents of the 50 ml syringe (by adding sterile physiological saline
patient is receiving antibiotics treatment then intra-vesical instillation should be postponed till
solution) up to a total volume of 50 ml. Mix the suspension carefully. The suspension is now ready for
completion of antibiotics treatment (Also see the "Contraindications"). Studies on interaction with
Insert a catheter by aseptic technique through urethra into bladder and drain completely. Attach
SII-ONCO-BCG should be stored in dark at 2° to 8°C. Do not expose the vaccine to light before and
the syringe containing the prepared solution to the catheter and instill in to the bladder. On
after reconstitution. Use immediately after reconstitution. Discard unused portion.
completion of instillation, remove the catheter. The prepared SII-ONCO-BCG suspension should be retained in the bladder for 2 hours. Care should be taken that instilled suspension is in contact with
the whole mucosal surface of the bladder. Once retained in the bladder for 2 hours, the patient
SII-ONCO-BCG has a shelf life of 24 months provided it is stored in dark at 2° to 8°C and protected
should be made to void the instilled contents in a sitting position. The patient should not ingest any
fluid 4 hours before and 2 hours after instillation. Ensure proper cleansing of genital area and hands.
One carton containing 1 vial of SII-ONCO-BCG.
Per instillation, the content of SII-ONCO-BCG (80-120 mg) i.e. 2-3 vials reconstituted and diluted as indicated above for instillation in to the urinary bladder.
Adverse effects are generally mild and transient. They appear to be directly related to cumulated
CFU count of BCG administered in various instillations. Common side effects are:
Frequency, urgency of micturition and dysuria- these symptoms usually occur from 2nd or 3rd instillation onwards.
Cystitis and typical granulomatous inflammatory reactions which occur in the mucosa of
Urinary bladder may be an essential component of anti-tumour activity of the drug. The symptoms usually disappear within 2 days and do not require treatment. Cystitis may be more
SERUM INSTITUTE OF INDIA LTD.
prolonged during maintenance treatment and if severe, Isoniazid 300 mg daily can be given
Editorial How Can We Know Whether Antidepressants Increase Suicide Risk? In this issue of the Journal , Gibbons and colleagues use pharmacy records and mortal-ity data to examine the association between rates of antidepressant use and rates of sui-cide death in children and younger adolescents. They find that U.S. counties with higherrates of SSRI antidepressant use had lower rates of
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