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• Very bad and sometimes deadly liver problems have happened with this drug. You will need to have your liver checked while you take this drug. Call your doctor right away if you have signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.

• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take this drug?

• A very bad and sometimes deadly brain problem called posterior reversible encephalopathy syndrome (PRES) has happened with this drug. Call your doctor right away if you have signs like feeling confused, lowered alertness, change in eyesight, loss of eyesight, seizures, or very bad headache.

• This drug may lower blood sugar levels. This may lead to passing out or the need to go to the hospital. Call your doctor right away if you have signs of low blood sugar like anxiety, sweating, feeling weak, dizziness, feeling sleepy, fast heartbeat, change in eyesight, headache, chills, shakiness, confusion, or hunger.

• Very bad and sometimes deadly heart problems like heart failure and heart attack have happened with this drug. Call your doctor right away if you have a heartbeat that does not feel normal, chest pain or pressure, shortness of breath, a big weight gain, or swelling in the arms or legs.

• This drug may cause a bad and sometimes deadly health problem called tumor lysis syndrome (TLS). Call your doctor right away if you have a fast heartbeat or a heartbeat that does not feel normal; any passing out; trouble passing urine; muscle weakness or cramps; upset stomach, throwing up, loose stools or not able to eat; or feel sluggish.

• Very bad skin reactions (Stevens-Johnson syndrome/toxic epidermal necrolysis) and tissue damage (necrotizing fasciitis) have happened with this drug. Sometimes, these have been deadly. Get medical help right away if you have a rash; red, swollen, blistered, or peeling skin (with or without fever); warm skin with red or purple areas of swelling that spread quickly; or any other skin changes that concern you. Get medical help if you have black spots on your skin; red or irritated eyes; or sores or ulcers in your mouth, throat, nose, or eyes.

• If you are a man and have sex with a female who could get pregnant, protect her from pregnancy during care and for 7 weeks after care ends. Use birth control that you can trust. If your sex partner gets pregnant while you take this drug or within 7 weeks after your last dose, call your doctor right away.

What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

• Signs of bleeding like throwing up blood or throw up that looks like coffee grounds; coughing up blood; blood in the urine; black, red, or tarry stools; bleeding from the gums; vaginal bleeding that is not normal; bruises without a reason or that get bigger; or any bleeding that is very bad or that you cannot stop.

• Signs of thyroid problems like a change in weight without trying, feeling nervous and excitable, feeling restless, feeling very weak, hair thinning, low mood (depression), neck swelling, not able to focus, not able to handle heat or cold, period (menstrual) changes, shakiness, or sweating.

• Very bad and sometimes deadly blood problems like thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) have happened with this drug in some people. Call your doctor right away if you feel very tired or weak or have any bruising or bleeding; dark urine or yellow skin or eyes; pale skin; change in the amount of urine passed; change in eyesight; change in strength on 1 side is greater than the other, trouble speaking or thinking, or change in balance; or fever.

What are some other side effects of this drug? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to your national health agency. How is this drug best taken? Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Consumer Information Use and Disclaimer This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Last Reviewed Date