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

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 ?
Prophylactic administration of zinc or use of amifostine in the treatment of dysgeusia has limited benefits and nutritional counselling is emphasized to help with dysgeusia.23 Individuals mostly depend on vision and hearing and increasingly touch but unfortunately taste and smell are largely under-investigated and under-explored areas.
Amifostine, also known as WR-2721, is a prodrug that is dephosphorylated by alkaline phosphatase and acts as a broad-spectrum cytoprotective agent by scavenging free radicals, protecting cell membranes, and preventing DNA damage.
Amifostine demonstrates its effect by converting into WR-1065, which is its metabolite.
Amifostine is the only radioprotector that was clinically approved to palliate side effects in patients undergoing radiotherapy.
Amifostine use in radiation-induced kidney damage preclinical evaluation with scintigraphic and histopathologic parameters.
- Nashville, Tennessee-based specialty pharmaceutical company Cumberland Pharmaceuticals has expanded its medical specialties to include oncology-related medications with two initial supportive care medications: Ethyol (amifostine) injection and Totect (dexrazoxane hydrochloride) injection, the company said.
Thorsdad, "Toxicity profile of intensity-modulated radiation therapy for head and neck carcinoma and potential role of amifostine," Seminars in Oncology, vol.
Kellie, "Severe neurotoxicity, ototoxicity and nephrotoxicity following high-dose cisplatin and amifostine," Pediatric Hematology and Oncology, vol.
Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation.
Amifostine reduces the seminiferous epithelium damage in doxorubicin-treated prepubertal rats without improving the fertility status.