Classifications: antineoplastic; antibiotic; Therapeutic: antineoplastic; antibiotic
Pregnancy Category: X
5 mg, 20 mg, 40 mg injection
Potent antibiotic antineoplastic compound. Effective in certain tumors unresponsive to surgery, radiation, or other chemotherapeutic
agents. Action mechanism unclear but reportedly combines with DNA, thereby interfering with cellular and enzymatic RNA and
Highly destructive to rapidly proliferating cells and slowly developing carcinomas.
In combination with other chemotherapeutic agents in palliative, adjunctive treatment of disseminated adenocarcinoma of
breast, pancreas, or stomach, squamous cell carcinoma of head, neck, lung, and cervix. Not recommended to replace surgery
or radiotherapy or as a single primary therapeutic agent.
Hypersensitivity or idiosyncrasy reaction; severe bone marrow suppression; thrombocytopenia; coagulation disorders or bleeding
tendencies; pregnancy (category X), lactation.
Renal impairment; myelosuppression; pulmonary disease or respiratory insufficiency.
Route & Dosage
Adult/Child: IV 1020 mg/m2/d as a single dose q68wk, additional doses based on hematologic response
Clcr <10 mL/min: use 75% of dose
- Note: Verify correct IV concentration and rate of infusion/injection for administration to children with physician.
PREPARE: Direct: Dilute each 5 mg with 10 mL sterile water for injection. Shake to dissolve. If product does not clear immediately, allow
to stand at room temperature until solution is obtained. Reconstituted solution is purple. IV Infusion: May be further diluted to concentrations of 2040 mcg in D5W, NS, or RL.
ADMINISTER: Direct: Give reconstituted solution over 510 min or longer. IV Infusion: ??Give over 10 min or longer as determined by total volume of solution. ??D5W IV solutions must be infused within 3 h of preparation (see STORAGE).??Monitor IV site closely. Avoid extravasation to prevent extreme tissue reaction (cellulitis) to the toxic drug.
INCOMPATIBILITIES Solution/additive: dextrose-containing solutions, bleomycin. Y-site: Aztreonam, cefepime, etoposide, filgrastim, gemcitabine, piperacillin/tazobactam, sargramostim, topotecan, vinorelbine.
- Store drug reconstituted with sterile water for injection (0.5 mg/mL) for 14 d refrigerated or 7 d at room temperature.
- Drug diluted in D5W (2040 mcg/mL) is stable at room temperature for 3 h.
Adverse Effects (≥1%)CNS:
Stomatitis, nausea, vomiting,
anorexia, hematemesis, diarrhea. Hematologic: Bone marrow toxicity
occurring 48 wk after treatment onset), thrombophlebitis, anemia. Respiratory: Acute bronchospasm,
hemoptysis, dyspnea, nonproductive cough, pneumonia
, interstitial pneumonitis. Skin:
Desquamation; induration, pain, necrosis, cellulitis at injection site; reversible alopecia, purple discoloration of nail
beds. Body as a Whole:
Pain, headache, fatigue
, edema. Urogenital: Hemolytic uremic syndrome,
Metabolized rapidly in liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Perform WBC with differential, platelet count, PT, INR, aPTT, Hgb, Hct, and serum creatinine frequently during
and for at least 7 wk after treatment.
- Do not administer if serum creatinine is >1.7 mg/dL or if platelet count falls below 150,000/mm3 and WBC is down to 4000/mm3 or if prothrombin or bleeding times are prolonged.
- Monitor I&O ratio and pattern. Report any sign of impaired kidney function: Change in ratio, dysuria, hematuria, oliguria,
frequency, urgency. Keep patient well hydrated (at least 20002500 mL orally daily if tolerated). Drug is nephrotoxic.
- Observe closely for signs of infection. Monitor body temperature frequently.
- Inspect oral cavity daily for signs of stomatitis or superinfection (see Appendix F).
Patient & Family Education
- Report respiratory distress to physician immediately.
- Report signs of common cold to physician immediately.
- Understand that hair loss is reversible after cessation of treatment.