Tishtha 40mg Injection consists of the active substance Nivolumab. It is indicated to treat cancers of the skin, lungs, kidney, lymph node, bladder, esophagus, and urinary tract. This medicine is indicated when the cancer has recurred after treatment using medicines, surgery, and radiation. It is a medication that helps the immune system fight cancer more effectively. It works by targeting and inhibiting specific molecules that can suppress or weaken the immune system's ability to recognize and attack cancer cells. By blocking these molecules, it helps to enhance the immune response against cancer and potentially shrink or slow the growth of tumors. 

One of the benefits of it and other immunotherapy drugs is that they can produce long-lasting responses in some patients, even after the treatment is stopped. This contrasts traditional chemotherapy and radiation therapy, which typically only provide temporary benefits and can have significant side effects. It is contraindicated in patients with a severe allergic reaction to the drug or its components. It is also contraindicated in patients with certain autoimmune disorders, such as lupus or rheumatoid arthritis because the drug can further stimulate the immune system and exacerbate these conditions. Additionally, it should be used cautiously in patients with a history of organ transplants.

• Advanced skin cancer (melanoma)

• Skin cancer that recurs after surgery

• Advanced non-small cell lung cancer

• Advanced kidney cancer

• Hodgkin’s lymphoma (lymph node disease)

• Advanced cancer of the head and neck

• Advanced urinary tract and bladder cancer

• Advanced oesophageal cancer

The therapeutic effect of Tishtha 40mg Injection is to enhance the body's natural immune response to cancer cells. Cancer cells can often evade the immune system by producing proteins that bind to immune cells and prevent them from recognizing and attacking the cancer cells. It works by blocking the interaction between a protein called programmed death-1 (PD-1), found on the surface of immune cells, and its corresponding ligands. Doing so enables the immune system to recognize and attack cancer cells more effectively, helping to slow down or even stop cancer progression. In some cases, treatment with it can lead to long-lasting remission, even after treatment has ended. This is because the drug can stimulate the immune system to "remember" the cancer cells and continue to attack them even after the drug has been cleared from the body.

• Systemic corticosteroids (Oral/Injection Route) Moderate
  Use with caution unless advised by a doctor.
  Concomitant use may reduce the effectiveness of nivolumab by suppressing the immune system.

• Other immunosuppressants (Oral/Injection Route) Moderate
  Use only if clearly prescribed.
  Concomitant use may decrease the immune response and reduce the anticancer effect of nivolumab.

• Other immune checkpoint inhibitors (Injection Route) Moderate
  Use only under specialist supervision.
  Concomitant use may increase immune-related side effects such as inflammation of organs.

• Live vaccines (Injection Route) Moderate
  Avoid during treatment.

Concomitant use may increase the risk of infection because immune responses can be altered during therapy.

• Tishtha 40mg Injection is typically supplied in vials or pre-filled syringes and should be stored at controlled room temperature between 20-25°C (68-77°F).

• The drug should be protected from light and should not be frozen.

• Once the vial or syringe is opened, any unused portion should be discarded. It is important to follow the manufacturer's instructions for handling and storage of it to ensure that the drug is effective and safe for use.

• Keep it out of reach from children and pets.

Tishtha 40mg Injection is a medication a healthcare professional administers, typically in a hospital or clinic setting. The medication is given as an intravenous (IV) infusion by healthcare professional. The infusion typically takes several hours. You will be closely monitored during and after the infusion to ensure the medication works effectively and to watch for any side effects. The dosage and frequency of administration will depend on the condition being treated and your circumstances. Your healthcare provider will determine the appropriate dosage and schedule for you.

Side effects are unwanted symptoms caused by medicines. Even though all drugs cause side effects, not everyone gets them.

Serious:

• Pneumonitis (inflammation of lung tissue)

• Colitis (inflammation of the colon)

• Hepatitis (inflammation of the liver)

• Hypothyroidism

• Hyperthyroidism

• Adrenal insufficiency (a condition in which the adrenal glands do not produce enough hormones).

• Severe allergic reactions

• Infusion-related reactions

• Confusion

• Seizures

• Neuropathy

• Eye disorders (such as uveitis or iritis)

Common:

• Fatigue

• Nausea

• Skin rash

• Itching

• Loss of appetite

• Diarrhea

• Constipation

• Joint pain

• Headache

• Discuss the potential risks and benefits of Tishtha 40mg Injection with your healthcare provider before or during treatment.
  

• Follow all safety precautions and guidelines given by your healthcare provider to reduce possible risks.
  

• Report any new or worsening symptoms to your healthcare provider immediately, as some side effects may be serious.
  

• Women of reproductive age should use effective contraception during treatment and for at least 5 months after the last dose to prevent harm to a developing fetus.
  

• Take care of your overall health during treatment.
  

• Eat a balanced diet, get enough rest, and seek support from family, friends, or support groups.

1. Harrison's Principles of Internal Medicine. 20th edition, 2018, 929-932

2. Bristol-Myers Squibb, U.S. Food and Drug Administration, Nivolumab, [ Last updated, 4 April 2023]. [ Accessed on 4 April] https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125554s114lbl.pdf.

3. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th edition, 2011,1655-1660

4. Takeda UK Ltd, Electronic Medicines Compendium (emc), Opdivo 10 mg/mL concentrate for solution for infusion, [Last updated: 30 October 2020], [Accessed on 4 April 2023],https://www.medicines.org.uk/emc/product/6154/smpc