pentostatin

pentostatin /pen·to·stat·in/ (pen″to-stat´in) an antineoplastic used in the treatment of hairy cell leukemia.

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pentostatin Warning - Hazardous drug!

Nipent

Pharmacologic class: Antimetabolite

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Boxed Warning

• Give under supervision of physician experienced in cancer chemotherapy, in facility with adequate diagnostic and treatment resources.
• Use of higher dosages than those specified isn't recommended, as dose-limiting severe renal, liver, pulmonary, and CNS toxicities may occur.
• In study of patients with refractory chronic lymphocytic leukemia receiving drug at recommended dosage in combination with fludarabine, four of six patients had severe or fatal pulmonary toxicity. Use in combination with fludarabine isn't recommended.

Action

Unknown. Thought to inhibit adenosine deaminase, thereby increasing levels of deoxyadenosine triphosphate in cells, blocking DNA synthesis, and inhibiting ribonucleotide reductase.

Availability

Powder for injection: 10-mg vials

⊘Indications and dosages

➣ Hairy cell leukemia

Adults: 4 mg/m² I.V. every other week

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:
• renal disease, bone marrow depression
• pregnant or breastfeeding patients
• children.

Administration

• Before giving, hydrate patient with 500 to 1,000 ml of dextrose 5% and normal saline solution (or its equivalent). After administering, give 500 ml of dextrose 5% in water (D₅W) or its equivalent.
☞ Follow facility protocol for handling, administering, and disposing of chemotherapeutic drugs.
• Give by direct I.V. bolus injection or dilute with 25 to 50 ml of D₅W or normal saline solution; infuse over 20 to 30 minutes.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache, malaise, anxiety, confusion, depression, dizziness, insomnia, nervousness, paresthesia, drowsiness, abnormal thinking, fatigue, asthenia, hallucinations, hostility, amnesia

CV: peripheral edema, cellulitis, vasculitis, hypotension, angina, tachycardia, bradycardia, phlebitis, thrombophlebitis, cardiac arrest, heart failure, hemorrhage, ventricular asystole, pericardial effusion, sinus arrest

EENT: abnormal vision, nonreactive pupils, photophobia, retinopathy, eye pain, conjunctivitis, dry or watery eyes, hearing loss, tinnitus, ear pain, epistaxis, pharyngitis, rhinitis

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, ileus, flatulence, stomatitis, glossitis, anorexia

GU: amenorrhea, breast lump, erectile dysfunction, decreased libido, renal calculi, renal dysfunction, renal insufficiency, renal failure

Hematologic: ecchymosis, anemia, hemolytic anemia , agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia

Metabolic: hyperuricemia, hypercalcemia, hyponatremia

Musculoskeletal: myalgia, joint pain

Respiratory: cough, dyspnea, respiratory tract infection, pulmonary embolism

Skin: rash, eczema, petechiae, dry skin, pruritus, skin disorder, furunculosis, acne, alopecia, diaphoresis, photosensitivity

Other: unusual taste, gingivitis, fever, chills, pain, facial edema, lymphadenopathy, herpes simplex or herpes zoster infection, flulike symptoms, viral or bacterial infection, allergic reaction, sepsis, neoplasm

Interactions

Drug-drug. Allopurinol: hypersensitivity vasculitis

Carmustine, cyclophosphamide, etoposide: potentially fatal acute pulmonary edema and hypotension

Fludarabine: severe or fatal pulmonary toxicity

Vidarabine: increased risk and severity of adverse reactions

Drug-diagnostic tests. Calcium, liver function tests, serum uric acid: increased values

Granulocytes, platelets, sodium, white blood cells: decreased levels

Patient monitoring

☞ Monitor CBC (including platelet count). Watch for evidence of blood dyscrasias.
• Assess kidney and liver function tests. Stay alert for evidence of organ dysfunction.
• Monitor temperature. Watch for signs and symptoms of bacterial and viral infection.
• Closely monitor vital signs and ECG, particularly for life-threatening arrhythmias, heart failure, and pulmonary edema.

Patient teaching

☞ Tell patient drug lowers resistance to infection. Instruct him to avoid crowds and to immediately report fever, cough, sore throat, and other infection symptoms.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct female patient of childbearing age to avoid pregnancy during drug therapy and to seek medical advice before becoming pregnant.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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pentostatin

Nipent^® Oncology An antimetabolic anticancer agent