No

Antineoplastic Agent, Alkylating Agent

Treat metastatic islet cell carcinoma of the pancreas, carcinoid tumor and syndrome, Hodgkin's disease, palliative treatment of colorectal cancer

C

The U.S. Food and Drug Administration (FDA) currently recommends that procedures for proper handling and disposal of antineoplastic agents be considered. Renal toxicity is dose-related and cumulative and may be severe or fatal; other major toxicities include liver dysfunction, diarrhea, nausea and vomiting. There may be an acute release of insulin during treatment. Keep syringe of D₅₀W at bedside during administration.

>10%:

Gastrointestinal: Nausea and vomiting in all patients usually 1-4 hours after infusion; diarrhea in 10% of patients; increased LFTs and hypoalbuminemia

Emetic potential: High (>90%)

Time course of nausea/vomiting: Onset 1-3 hours; Duration: 1-12 hours

Renal: Renal dysfunction occurs in 65% of patients; proteinuria, decreased Cl_cr, increased BUN, hypophosphatemia, and renal tubular acidosis; use caution with patients on other nephrotoxic agents; nephrotoxicity (25% to 75% of patients)

1% to 10%:

Gastrointestinal: Diarrhea

Endocrine & metabolic: Hypoglycemia: Seen in 6% of patients; may be prevented with the administration of nicotinamide

Local: Pain at injection site

<1%: Confusion, lethargy, depression, leukopenia, thrombocytopenia, liver dysfunction, secondary malignancy

Myelosuppressive:

WBC: Mild

Platelets: Mild

Onset (days): 7

Nadir (days): 14

Recovery (days): 21

Symptoms of overdose include bone marrow suppression, nausea, vomiting

Treatment of bone marrow suppression is supportive

Decreased effect: Phenytoin results in negation of streptozocin cytotoxicity

Increased toxicity: Doxorubicin prolongs half-life and thus prolonged leukopenia and thrombocytopenia

Store intact vials under refrigeration; vials are stable for one year at room temperature

Dilute powder with 9.5 mL SWI or NS to a concentration of 100 mg/mL which is stable for 48 hours at room temperature and 96 hours under refrigeration

Further dilution in D₅W or NS is stable for 48 hours at room temperature and 96 hours under refrigeration when protected from light

Standard I.V. dilution: IVPB: Dose/100-250 mL D₅W or NS

Solution is stable for 48 hours at room temperature and 96 hours under refrigeration when protected from light

Interferes with the normal function of DNA by alkylation and cross-linking the strands of DNA, and by possible protein modification

Distribution: Concentrates in the liver, intestine, pancreas, and kidney

Metabolism: Rapidly metabolized and disappears from serum in 4 hours

Half-life: 35-40 minutes

Elimination: Majority (60% to 70%) excreted in the urine as metabolites, and smaller amounts eliminated in bile (1%) and in expired air (5%)

I.V. (refer to individual protocols):

Single agent therapy: 1-1.5 g/m² weekly for 6 weeks followed by a 4-week observation period

Combination therapy: 0.5-1 g/m² for 5 consecutive days followed by a 4- to 6-week observation period

Dosing adjustment in renal impairment:

Cl_cr 10-50 mL/minute: Administer 75% of dose

Cl_cr <10 mL/minute: Administer 50% of dose

Hemodialysis: Unknown

CAPD effects: Unknown

CAVH effects: Unknown

Dosing adjustment in hepatic impairment: Dose should be decreased in patients with severe liver disease

Monitor renal function closely

May cause lethargy, confusion, or depression

May cause leukopenia; use caution with clozapine and carbamazepine; renal dysfunction occurs commonly with streptozocin; will need to monitor and adjust lithium and gabapentin doses

No information available to require special precautions

No effects or complications reported

This drug can only be given I.V. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Avoid aspirin and aspirin-containing substances. You may experience nervousness, dizziness, confusion, or lethargy (use caution when driving or engaging in tasks requiring alertness until response to drug is known); coagulopathy (use caution with knives or sharp objects, avoid injury, use electric razor, brush teeth with soft brush or cotton swabs). You may have increased sensitivity to infection (avoid crowds and exposure to infection). Report persistent fever; chills; sore throat; unusual bleeding; blood in urine, stool, vomitus, or stool; chest pain or palpitations, or difficulty breathing. 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.

Wear gloves when preparing and administering; avoid extravasation

Injection: 1 g

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.