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The urinary bladder, or the bladder, is a hollow organ present in the pelvis. Most of it lies behind the pubic bone of the pelvis but when full it can extend up into the lower part of the abdomen. Its primary function is to store urine that drains into it from the kidney through tube-like structures called the ureters. The ureters from both the kidneys open into the urinary bladder. The bladder forms a low-pressure reservoir which gradually stretches out as urine fills into it. In males, the prostate gland is located adjacent to the base of the bladder where urethra joins the bladder. From time to time, the muscular wall of the bladder contracts to expel urine through the urinary passage (urethra) into the outside world.
The bladder consists of three layers of tissue. The innermost layer of the bladder which comes into contact with the urine stored inside the bl...
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Approximately 84% of patients who received intravesical VALSTAR (valrubicin) in clinical studies experienced local adverse events, but approximately half of the patients reported irritable bladder symptoms prior to treatment. The local adverse reactions associated with VALSTAR (valrubicin) usually occur during or shortly after instillation and resolve within 1 to 7 days after the instillate is removed from the bladder.
TABLE 1 displays the frequency of the local adverse experiences at baseline and during treatment among 170 patients who received 800 mg doses of VALSTAR®(valrubicin) Sterile Solution for Intravesical Instillation in a multiple-cycle treatment regimen. Only 7 of 143 patients who were scheduled to receive six doses failed to receive all of the planned doses because of the occurrence of local bladder symptoms.
TABLE 1 - Occurrence of Local Adverse Reactions Before and
During Treatment with Intravesical VALSTAR (valrubicin) (% of Patients)
| Reaction | Patients Who Received Multiple-Cycle Treatment
Regimen at 800 mg/dose (N = 170) |
|
| Before Treatment | During 6-week Course of Treatment | |
| ANY LOCAL BLADDER SYMPTOM | 45% | 88% |
| Urinary Frequency | 30% | 61% |
| Dysuria | 11% | 56% |
| Urinary Urgency | 27% | 57% |
| Bladder Spasm | 3% | 31% |
| Hematuria | 11% | 29% |
| Bladder Pain | 6% | 28% |
| Urinary Incontinence | 7% | 22% |
| Cystitis | 4% | 15% |
| Nocturia | 2% | 7% |
| Local Burning Symptoms-Procedure Related | 0% | 5% |
| Urethral Pain | 0% | 3% |
| Pelvic Pain | 1% | 1% |
| Hematuria (Gross) | 0% | 1% |
Most systemic adverse events associated with use of VALSTAR (valrubicin) have been mild in nature and self-limited, resolving within 24 hours after drug administration. TABLE 2 displays the adverse events other than local bladder symptoms that occurred in 1% or more of the 230 patients who received at least one dose of VALSTAR (valrubicin) (200 to 900 mg) in a clinical trial. It cannot be determined whether these events are drug-related.
TABLE 2 - Most Commonly Reported Systemic Adverse Reactions
Following Intravesical Administration of VALSTAR (valrubicin) (% of Patients)
| Body System Preferred Term |
All Patients Who Received VALSTAR (N = 230) |
| Body as a Whole | |
| Abdominal Pain | 5% |
| Asthenia | 4% |
| Back Pain | 3% |
| Chest Pain | 3% |
| Fever | 2% |
| Headache | 4% |
| Malaise | 4% |
| Cardiovascular | |
| Vasodilation | 2% |
| Digestive | |
| Diarrhea | 3% |
| Flatulence | 1% |
| Nausea | 5% |
| Vomiting | 2% |
| Hemic and Lymphatic | |
| Anemia | 2% |
| Metabolic and Nutritional | |
| Hyperglycemia | 1% |
| Peripheral Edema | 1% |
| Musculoskeletal | |
| Myalgia | 1% |
| Nervous | |
| Dizziness | 3% |
| Respiratory | |
| Pneumonia | 1% |
| Skin and Appendages | |
| Rash | 3% |
| Urogenital | |
| Hematuria (microscopic) | 3% |
| Urinary Retention | 4% |
| Urinary Tract Infection | 15% |
Adverse reactions other than local reactions that occurred in less than 1% of the patients who received VALSTAR (valrubicin) intravesically in clinical trials are listed below. This list includes only adverse reactions that were suspected of being related to treatment.
Digestive System: Tenesmus.
Metabolic and Nutritional: Nonprotein nitrogen increased.
Skin and Appendages: Pruritus.
Special Senses: Taste loss.
Urogenital System: Local skin irritation, poor urine flow, and urethritis.
Inadvertent paravenous extravasation of VALSTAR (valrubicin) was not associated with skin ulceration or necrosis.
Because systemic exposure to VALSTAR (valrubicin) is negligible following intravesical administration, the potential for drug interactions is low. No drug interaction studies were conducted.
Last reviewed on RxList: 11/24/2008
This monograph has been modified to include the generic and brand name in many instances.
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