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Uracil Mustard
Pronunciation
Generic Available
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(YOOR a sil MUS tard)

Generic Available

No


Pharmacological Index

Antineoplastic Agent, Alkylating Agent


Use

Palliative treatment in symptomatic chronic lymphocytic leukemia; non-Hodgkin's lymphomas, chronic myelocytic leukemia, mycosis fungoides, thrombocytosis, polycythemia vera, ovarian carcinoma


Pregnancy Risk Factor

X


Contraindications

Severe leukopenia, thrombocytopenia, aplastic anemia; in patients whose bone marrow is infiltrated with malignant cells; hypersensitivity to any component; pregnancy


Warnings/Precautions

The U.S. Food and Drug Administration (FDA) currently recommends that procedures for proper handling and disposal of antineoplastic agents be considered. Impaired kidney or liver function. The drug should be discontinued if intractable vomiting or diarrhea, precipitous falls in leukocyte or platelet count, or myocardial ischemia occurs. Use with caution in patients who have had high-dose pelvic radiation or previous use of alkylating agents. Patient should be hospitalized during initial course of therapy; may impair fertility in men and women; use with caution in patients with pre-existing marrow suppression.


Adverse Reactions

>10%:

Gastrointestinal: Nausea, vomiting, diarrhea

Hematologic: Myelosuppressive; leukopenia and thrombocytopenia nadir: 2-4 weeks, anemia

1% to 10%:

Central nervous system: Mental depression, nervousness

Dermatologic: Hyperpigmentation, alopecia

Endocrine & metabolic: Hyperuricemia

<1%: Pruritus, stomatitis, hepatotoxicity


Overdosage/Toxicology

Symptoms of overdose include diarrhea, vomiting, severe marrow suppression

No specific antidote to marrow toxicity is available


Mechanism of Action

Polyfunctional alkylating agent. The basic reaction of uracil mustard, like that of any alkylating agent, is the replacement of the hydrogen in a reacting chemical with an alkyl group; cell cycle-phase nonspecific antineoplastic agent; exact site of drug action within the cell is not known, but the nucleoproteins of the cell nucleus are believed to be involved.


Pharmacodynamics/Kinetics

Absorption: Oral

Elimination: <1% detected in urine


Usual Dosage

Oral (do not administer until 2-3 weeks after maximum effect of any previous x-ray or cytotoxic drug therapy of the bone marrow is obtained):

Adults: 0.15 mg/kg in a single weekly dose for 4 weeks

Thrombocytosis: 1-2 mg/day for 14 days


Mental Health: Effects on Mental Status

May cause nervousness or depression


Mental Health: Effects on Psychiatric Treatment

Myelosuppression is common; avoid clozapine and carbamazepine


Patient Information

This drug may take weeks or months for effectiveness to become apparent. Do not discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). For nausea or vomiting, loss of appetite, or dry mouth, small frequent meals, chewing gum, or sucking lozenges may help. You may experience hair loss (reversible); diarrhea (if persistent, consult prescriber); nervousness, irritability, shakiness, amenorrhea, altered sperm production (usually reversible). Report persistent nausea or vomiting, fever, sore throat, chills, unusual bleeding or bruising, consistent feelings of tiredness or weakness, or yellowing of skin or eyes. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not get pregnant during or for 1 month following therapy. Male: Do not cause a female to become pregnant. Male/female: Consult prescriber for instruction on appropriate barrier contraceptive measures. This drug may cause severe fetal defects. Do not breast-feed.


Nursing Implications

Notify physician of persistent or severe nausea, diarrhea, fever, sore throat, chills, bleeding, or bruising


Dosage Forms

Capsule: 1 mg


References

Berry DH, Fernbach DJ, Sutow WW, et al, "Uracil Mustard (NSC-34462) Therapy in Uncommon Malignant Neoplasms in Children," Cancer Chemother Rep, 1968, 52(3):441-3.

Berry DH, Sutow WW, Vietti TJ, et al, "Evaluation of Uracil Mustard in Children With Hodgkin's Disease, Lymphosarcoma, and Soft Tissue Sarcoma," J Clin Pharmacol New Drugs, 1972, 12(4):169-73.

Fernbach DJ, Haddy TB, Holcomb TM, et al, "Uracil Mustard (NSC-34462) Therapy for Children With Metastatic Neuroblastoma," Cancer Chemother Rep, 1968, 52(2):287-91.

Jeffrey LP, Chairman, National Study Commission on Cytotoxic Exposure. Position Statement. "The Handling of Cytotoxic Agents by Women Who Are Pregnant, Attempting to Conceive, or Breast-Feeding," January 12, 1987.


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