topotecan hydrochloride

topotecan hydrochloride Warning - Hazardous drug!

Hycamtin

Pharmacologic class: DNA topoisomerase inhibitor

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.
• Don't administer to patients with baseline neutrophil counts below 1,500 cells/mm³. Obtain frequent peripheral blood cell counts on all patients to monitor for bone marrow depression.

Action

Regulates DNA replication and repair of broken DNA strands, relieving torsional strain; exerts cytotoxic effects during DNA synthesis

Availability

Injection: 4 mg in single-dose vials

⊘Indications and dosages

➣ Metastatic ovarian cancer or small-cell lung cancer after first-line chemotherapy fails

Adults: 1.5 mg/m² daily by I.V. infusion given over 30 minutes for 5 consecutive days, starting on day 1 of 21-day cycle

Dosage adjustment

• Renal impairment
• Neutropenia

Contraindications

• Hypersensitivity to drug or its components
• Severe bone marrow depression
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• children (safety and efficacy not established).

Administration

☞ Before starting therapy, check blood counts. Patient must have baseline neutrophil count above 1,500 cells/mm³ and platelet count above 100,000 cells/mm³ to receive drug.
☞ Prepare drug under vertical laminar-flow hood, wearing gloves and protective clothing. Follow facility policy for discarding used drug containers and I.V. equipment.
• If skin contacts drug, wash immediately with soap and water.
• To reconstitute, add 4 ml of sterile water to 4-mg vial. Dilute further in normal saline solution or dextrose 5% in water. Give immediately over 30 minutes using infusion pump.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: asthenia, headache, fatigue, paresthesia

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, stomatitis, anorexia

Hematologic: anemia, leukopenia, thrombocytopenia, neutropenia

Musculoskeletal: back pain, skeletal pain

Respiratory: coughing, dyspnea

Skin: erythematous or maculopapular rash, pruritus, urticaria, dermatitis, bullous eruption, alopecia

Other: fever, body pain, sepsis

Interactions

Drug-drug. Cisplatin: severe bone marrow depression

Granulocyte colony-stimulating factor: prolonged neutropenia

Live-virus vaccines: increased risk of infection from vaccine

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin: increased levels

Patient monitoring

• Closely monitor CBC with white cell differential.
• Assess for signs and symptoms of bleeding tendency.
• Monitor closely for sepsis, other infections, and increased hepatic enzyme levels.

Patient teaching

☞ Advise patient to immediately report unusual bleeding or bruising, sore throat, fever, or chills.
• Teach patient safety measures to avoid bruising and bleeding.
• Tell patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
☞ Advise female patient to notify prescriber of suspected pregnancy. Caution her not to breastfeed during therapy.
• Inform patient that drug may cause hair loss.
• Tell patient he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.