FAQs

TICE® BCG is a bacterial preparation of a strain called Bacillus Calmette-Guerin (BCG). It contains live, attenuated bacteria. The medication was developed as a vaccine against tuberculosis but has been found to be useful in treating certain bladder cancers. Doctors have been using TICE® BCG for many years to treat and help prevent recurrence of tumors in patients with bladder CIS. It is also used following TUR to help prevent recurrence of Ta and T1 papillary tumors.

How BCG works to treat bladder cancer is not completely understood. A partial explanation may be that it appears to produce an inflammation in the lining of the bladder but the precise mechanism is not known.

In order to work, BCG must be in direct contact with the tumor cells. That’s why it is instilled -- administered directly into the bladder -- instead of being given by injection.

BCG can be effective in treating and helping to prevent the return of bladder CIS. It also can be considered to be effective in helping prevent papillary tumors from coming back following TUR. For BCG to work most successfully, you must actively cooperate with your doctor. This Web site describes TICE® BCG treatment in general; however, if you need more specific information about your treatment or side effects, please speak with your doctor.

The instillation -- pouring the medicine into your bladder -- takes only a few minutes. However, the medicine must stay in your bladder for 2 hours. The process itself is simple.

• Your genital area is cleaned with a sterile solution and you are draped with a sterile sheet.
• A tube (a catheter) is passed through your urethra and into your bladder. Any urine that remains in your bladder can then be removed so that the BCG can easily touch all of the bladder lining.
• The TICE® BCG mixture is administered into your bladder through the catheter.
• The medication stays in your bladder for 2 hours. During that time, you will be lying down. Your position will be changed from time to time to make sure that the BCG is in contact with all parts of the lining of the bladder long enough to be effective.
• Lying down and changing position may also help to reduce the urge to urinate during the treatment period.

The exact scheduling of treatment depends on the individual to be treated. These are the steps that are commonly followed:

Initial treatment: Once a week for 6 weeks (if necessary, this schedule may be repeated once)

Follow-up treatment: Once a month for at least 6 to 12 months

You will be given specific information about the use of TICE® BCG in your medical facility. The four points given here are important for treatment no matter where it is given.

• Be on time for your appointments. Your TICE® BCG is mixed for you just before your appointment and can only be kept for a short time.
• Do not drink any liquids for 4 hours before your appointment time.
• Just before your treatment time, urinate to empty your bladder.
• Tell your doctor how you have felt between treatments, especially if you have had a fever, been unusually tired, had chills, or if your urine has contained bright red blood or there have been any blood clots in your urine.

You should talk to your doctor about possible side effects associated with TICE® BCG treatment. Some reactions such as painful or frequent urination can be related to irritation of the bladder. These symptoms typically begin 4 to 6 hours after instillation and last 24-72 hours. They are usually seen after the third treatment and tend to increase in severity after each administration. Other symptoms, such as flu-like symptoms, fever, fatigue, and chills may affect your whole body. These symptoms also may get more frequent or worse with subsequent treatments.

>Report Side Effects

Notify your doctor at once if you experience any problems, particularly severe urinary symptoms such as burning or painful urination, an urgent or frequent need to urinate, or blood in the urine. Also report joint pain, coughing, or rash. It is especially important to report these symptoms to your doctor before you receive the next treatment of BCG. They may be a sign that you have an infection requiring immediate attention. You should be aware that infections associated with TICE® BCG treatment have led to death on rare occasions. Symptoms lasting longer than 48 hours or a fever of 101.3°F (or higher) should be reported to your physician immediately.

Once outside your body, the TICE® BCG fluid may be unsafe for you or others to touch. With proper and simple precautions, the bacteria are not likely to be passed along to other people. After treatment, there are some important steps you must follow.

After the TICE® BCG treatment, drink plenty of fluids to wash out your bladder as instructed by your doctor.

For the 6 hours after each treatment, follow all the steps below each time you urinate.

• To get the medicine out of your bladder and avoid splashing, sit down on the toilet to pass your urine. Touching the medicine outside the bladder may be unsafe for you and others.
  
• After you urinate, add two cups of chlorine bleach to the toilet, close the lid, and wait 15 minutes before flushing.
  
• Wash your genital area and your hands carefully with soap each time you urinate.
  

Once outside your body, the TICE® BCG fluid may be unsafe for you or others to touch. With proper and simple precautions, the bacteria are not likely to be passed along to other people. After treatment, there are some important steps you must follow.

After the TICE® BCG treatment, drink plenty of fluids to wash out your bladder as instructed by your doctor.

For the 6 hours after each treatment, follow all the steps below each time you urinate.

• To get the medicine out of your bladder and avoid splashing, sit down on the toilet to pass your urine. Touching the medicine outside the bladder may be unsafe for you and others.
  
• After you urinate, add two cups of chlorine bleach to the toilet, close the lid, and wait 15 minutes before flushing.
  
• Wash your genital area and your hands carefully with soap each time you urinate.
  

For patients with financial need, Schering Corporation has developed Schering's COMMITMENT TO CARE® program. This service can help eligible patients find alternative sources of reimbursement, and may be contacted by calling 1-800-521-7157 (Weekdays, 9 am to 8 pm EST).