amifostine


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amifostine

 [am″ĭ-fos´tēn]
a chemoprotectant used to prevent renal toxicity in cisplatin chemotherapy and to reduce esophagitis, xerostomia, and loss of taste in patients receiving radiation therapy for head, neck, or lung cancer.

amifostine

Ethyol

Pharmacologic class: Organic thiophosphate cytoprotective drug

Therapeutic class: Cytoprotectant

Pregnancy risk category C

Action

Undergoes conversion to free thiol, an active metabolite that reduces toxic effects of cisplatin on renal tissue

Availability

Powder for injection: 500-mg anhydrous base and 500 mg mannitol in 10-ml vials

Indications and dosages

To reduce cumulative renal toxicity of cisplatin therapy in patients with ovarian cancer or non-small-cell lung

Adults: 910 mg/m2 I.V. daily as a 15-minute infusion, starting 30 minutes before chemotherapy

To reduce moderate to severe xerostomia in patients undergoing postoperative radiation treatment for head or neck cancer

Adults: 200 mg/m2 I.V. daily as a 3-minute infusion, starting 15 to 30 minutes before standard fraction radiation therapy

Off-label uses

• Protection against cisplatin- and paclitaxel-induced neurotoxicity

Contraindications

• Hypersensitivity to drug
• Hypotension

Precautions

Use cautiously in:
• arrhythmias, heart failure, ischemic heart disease, renal impairment, hearing impairment, hypocalcemia, myasthenia gravis, nausea, vomiting, hypotension, obesity
• history of cerebrovascular accident or transient ischemic attacks
• concurrent antihypertensive therapy that can't be discontinued for 24 hours before amifostine therapy (not recommended)
• definitive radiotherapy (not recommended)
• elderly patients
• pregnant patients (safety and efficacy not established)
• breastfeeding patients
• children (safety and efficacy not established).

Administration

• Ensure that patient is adequately hydrated before starting drug.
• Give antiemetics before and during therapy.
• Reconstitute single-dose vial with 9.7 ml of sterile normal saline injection. May be further diluted with normal saline solution up to a concentration of 40 mg/ml.
• Don't mix with other drugs or solutions.
• Know that drug also can be prepared in polyvinyl chloride bags.
• Don't infuse longer than 15 minutes; doing so increases risk of adverse reactions.

Keep patient supine during administration.

Adverse reactions

CNS: dizziness, drowsiness, rigors

CV: hypotension

GI: nausea, vomiting

Metabolic: hypocalcemia

Respiratory: dyspnea, sneezing

Skin: flushing, rash, urticaria, erythema multiforme

Other: chills, warm sensation, hiccups, allergic reactions

Interactions

Drug-drug.Antihypertensives: increased risk of hypotension

Drug-diagnostic tests.Calcium: decreased level

Patient monitoring

• Monitor blood pressure every 5 minutes during infusion and immediately after infusion as clinically indicated.
• Assess for severe nausea and vomiting.
• Monitor fluid intake and output.
• Monitor blood calcium level. Give calcium supplements as ordered.

Patient teaching

• Emphasize importance of remaining supine during drug administration to prevent hypotension.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Provide dietary counseling. Refer patient to dietitian if adverse GI effects significantly limit food intake.
• Inform patient that sneezing is a normal effect of drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

amifostine

/am·i·fos·tine/ (am″ĭ-fos´tēn) a chemoprotectant used to prevent renal toxicity in cisplatin chemotherapy.

amifostine

a cytoprotective agent for cisplatin.
indications This drug is used to reduce renal toxicity when cisplatin is given to treat ovarian carcinoma. It also reduces xerostomia in radiotherapy for head and neck cancer.
contraindications Known hypersensitivity to mannitol or aminothiol, hypotension, dehydration, and lactation prohibit the use of this drug.
adverse effects Dizziness, somnolence, sneezing, flushing, hiccups, hypocalcemia, rash, and chills are among this drug's side effects. Common side effects include hypotension, nausea, and vomiting.

amifostine

A drug used to reduce the side effects of anticancer treatments, especially the dangers of infection and of damage to the kidneys. A brand name is Ethyol.
References in periodicals archive ?
announced a wide ranging agreement with the University of Chicago for the acquisition of its technology and intellectual property rights for the development of a compound, amifostine, to prevent genomic instability caused by a variety of sources of ionizing radiation exposure including common Computer Tomography (CT) scans.
Objective: Amifostine (AMI) has been used for the prevention of doxorubicin-induced cardiotoxicity in several experimental and a few clinical studies.
Amifostine, which is given by injection, works because it is a potent antioxidant and thus can protect normal tissue from the damaging effects of free radicals, which is how radiation and some chemo drugs exert their cell-killing effects.
bolus 5-fluorouracil, melphalan) * Palifermin for autologous hematopoietic stem cell transplantation for hematologic malignancies Effectiveness Not Established * Allopurinol * Aloe vera * Amifostine * Anti-inflammatory rinses * Antimicrobial agents * Benzydamine hydrochloride * Flurbiprofen tooth patch * Granulocyte-colony-stimulating factor (subcutaneous) * Granulocyte macrophage-colonystimulating factor (subcutaneous) * Immunoglobin * L-alanyl-l-glutamine * Low-level laser therapy * Multiagent ("magic") rinses * Pilocarpine * Povidone-iodine * Tetracaine * Zinc supplements Effectiveness Unlikely * Iseganan Not Recommended for Practice * Chlorhexidine * Granulocyte macrophage-colony-stimulating factor mouthwash * Sucralfate Note.
Reducing normal tissue sensitivity to radiation--the only agent currently licensed for this use is amifostine and the results, unfortunately, have been disappointing.
3]); he was treated with a course of amifostine in November 2001, but he did not respond.
IN VITRO PROTECTIVE EFFECTS OF AMIFOSTINE ON HUMAN MESENCHYMAL STEM CELLS AND HEMATOPOIETIC PROGENITORS EXPOSED TO RADIATION.
Doxorubicin induces apoptosis in germ line stem cells in the immature rat testis and amifostine cannot protect against this cytotoxicity.
Currently Pinnacle commercializes ETHYOL(R), brand of Amifostine in Western Europe.
Likely to Be Effective None Benefits Balanced With Harms Assistive devices such as canes Effectiveness Not Established Pharmacologic interventions * Oral acetyl-L-carnitine * Alpha lipoic acid * Amifostine * Calcium gluconate and magnesium sulfate * Carbamazepine * Glutamine * Glutathione * Nortriptyline * Vitamin E * Recombinant human leukemia inhibitory factor (rhuLIF) Nonpharmacologic interventions * Acupuncture * Capsaicin ointment (topical) * Exercise regimens * Pulsed infrared light therapy * Transcutaneous nerve stimulation * High-frequency external muscle stimulation * Spinal cord stimulation Effectiveness Unlikely None Not Recommended for Practice None Note.