VALRUBICIN

VALRUBICIN
(val-roo'bi-sin)
Valstar
Classifications: antineoplastic; antibiotic;
Therapeutic: antineoplastic

Prototype: Doxorubicin hydrochloride
Pregnancy Category: C

Availability

40 mg/mL solution

Action

Semisynthetic analog of doxorubicin. It is a cytotoxic antibiotic agent that inhibits the incorporation of nucleosides in DNA and RNA, resulting in extensive chromosomal damage. Valrubicin interferes with DNA topoisomerase II, which is responsible for the normal DNA separation of strands and the resealing of those DNA strands.

Therapeutic Effect

Valrubicin has higher antitumor efficacy and lower toxicity than doxorubicin.

Uses

Intravesical therapy of BCG-refractory carcinoma in situ of the urinary bladder.

Contraindications

Hypersensitivity to valrubicin, doxorubicin, anthracyclines, or castor oil; patients with a perforated bladder, concurrent UTI, active infection; severe irritable bladder symptoms; severe myelosuppression; pregnancy (category C); lactation.

Cautious Use

Within 2 wk of a transureteral resection; compromised bladder mucosa; mild-to-moderate myelosuppression; concurrent use of anticoagulants, or history of bleeding disorders; GI disorders, renal impairment.

Route & Dosage

BCG-Refractory Bladder Carcinoma in situ
Adult: Intravesically 800 mg once per wk x 6 wk

Administration

Instillation
  • Avoid skin reactions by using gloves during preparation/administration.
  • Use only glass, polypropylene, or polyolefin containers and tubing.

PREPARE: Slowly warm 4 vials (5 mL each) to room temperature. When a precipitate is initially present, warm vials in hands until solution clears. Add contents of 4 vials to 55 mL of 0.9% NaCl injection to yield 75 mL of diluted solution.  

INSTILL: Aseptically insert a urethral catheter and drain the bladder. Use gravity drainage to instill valrubicin slowly over several min. Withdraw catheter; instruct patient not to void for 2 h. Note: Do not leave a clamped catheter in place.  

  • Refrigerate. Do not freeze.

Adverse Effects (≥1%)

Body as a Whole: Abdominal pain, asthenia, back pain, fever, headache, malaise, myalgia. CNS: Dizziness. CV: Vasodilation. GI: Diarrhea, flatulence, nausea, vomiting. Urogenital: Urinary frequency, urgency, dysuria, bladder spasm, hematuria, bladder pain, incontinence, cystitis, UTI, nocturia, local burning, urethral pain, pelvic pain, gross hematuria, urinary retention. Respiratory: Pneumonia. Skin: Rash. Other: Anemia, hyperglycemia, peripheral edema.

Pharmacokinetics

Absorption: Not absorbed. Distribution: Penetrates bladder wall. Metabolism: Not metabolized. Elimination: Almost completely excreted by voiding the instillate.

Nursing Implications

Assessment & Drug Effects

  • Therapeutic effectiveness: Indicated by regression of the bladder tumor.
  • Notify physician if bladder spasms with spontaneous discharge of valrubicin occur during/shortly after instillation.

Patient & Family Education

  • Expect red-tinged urine during the first 24 h after administration.
  • Report prolonged passage of red-colored urine or prolonged bladder irritation.
  • Drink plenty of fluids during 48 h period following administration.
  • Use reliable contraception during therapy period (approximately 6 wk).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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