amifostine

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

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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.

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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 cancer

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
• 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.

Route	Onset	Peak	Duration
I.V.	5-8 min	Unknown	Unknown

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.
• 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.