Dactinomycin
Cytostatic · Cytotoxic antibiotic
Indications
Wills tumour, rhabdomyosarcoma carcinoma of testis or uterus.
Dosage
Adults: 2.5 mg/m² in divided doses, over 1 wk, repeated every 2 wk or 0.75-2 mg/m² every 1-4 wk or 400-600 mg/m²/day for 5 days, repeated every 3-6 wk. Refer to individual protocol. Children: Not recommended.
Administration
IV: Infuse over 10-15 min. Avoid extravasation. Extremely damaging to soft tissue and will cause a severe local reaction if extravasation occurs. Administer slow IV push over 10-15 min. An in line cellulose membrane filter should not be used during administration of Dactinomycin soln. Do not give IM or SC. Dilute with 1.1 mL of preservative-free SWFI to yield a final concentration of 500 mcg/mL; do not use preservative diluent as precipitation may occur. Compatibility: Stable in D5W, NS, SWFI. Stability: Store intact vials in a dry place at controlled room temp (20-25°C), with excursions permitted to 15-30°C. Reconst solns must be used within 4-6 hrs from the time of reconst when stored at room temp. Diluted solns at conc of 10 mcg/mL or higher in 5% dextrose or 0.9% NaCl inj are chemically stable for up to 10 hrs at room temp, but should be used within 4 hrs because of the risk of…
Adverse Effects
Fatigue, fever, acne, alopecia (reversible), increased pigmentation, Stevens-Johnson syndrome, growth retardation, hyperuricaemia, abdominal pain, anorexia, diarrhoea, GI ulceration, nausea, vomiting, anaemia, increased bilirubin, hepatotoxicity, liver function test abnormality, erythema, oedema, myalgia.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Patients with concurrent or recent chickenpox or herpes zoster. Precautions: Use with caution in patients who have received radiation therapy. Avoid use within 2 months of radiation treatment for right-sided Wilms' tumour, may increase the risk of hepatotoxicity. Discontinue treatment with severe myelosuppression, diarrhoea or stomatitis. Avoid use in infants <6 months of age.
Interactions
BCG; clozapine; natalizumab; pimecrolimus; tacrolimus (topical); live vaccines (avoid), leflunomide, roflumilast, trastuzumab.
Advice to Patient
This medication is administered by infusion. Before infusion, limit oral intake for 4-6 hours. Inform prescriber immediately if there is redness/swelling/burning/pain at infusion site. Contact prescriber if there is unrelieved nausea, vomiting, diarrhoea, abdominal pain, loss of appetite, difficulty in swallowing or breathing, rash. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Take small, frequent meals to maintain good nutritional status. Avoid highly crowded places to prevent infection. Do not get vaccinated without consulting prescriber.
Pharmacokinetics
Absorption: IV: Rapidly distributed with high conc in bone marrow and nucleated cells. Metabolism: Minimal (hepatic). Half-life elimination: Terminal: 36 hrs. Excretion: Slowly excreted in urine and bile.
Brands with this active ingredient
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