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FDA Box Warning
Give under supervision of physician experienced in cancer chemotherapy.
Hematopoietic depression is most common toxicity; hepatic necrosis has also occurred.
Drug is carcinogenic and teratogenic in animals.
Prescriber must weigh potential benefit against toxicity risk.
Unclear. Thought to inhibit DNA synthesis by acting as purine analog. Also causes alkylation and may interact with sulfhydryl groups.
Injection: 100-mg and 200-mg vials
Indications and dosages
➣ Hodgkin's disease
Adults: 150 mg/m2 I.V. daily for 5 days in combination with other drugs, repeated q 4 weeks. Or 375 mg/m2 I.V. on first day of combination therapy, repeated q 15 days.
➣ Metastatic malignant melanoma
Adults: 2 to 4.5 mg/kg I.V. daily for 10 days, repeated q 4 weeks. Or 250 mg/m2 I.V. daily for 5 days, repeated q 3 weeks.
• Malignant pheochromocytoma
• Hypersensitivity to drug
Use cautiously in:
• hepatic dysfunction, impaired bone marrow function
• pregnant or breastfeeding patients
• Follow facility procedures for safe handling, administration, and disposal of chemotherapeutic drugs.
• Reconstitute with sterile water for injection according to manufacturer's directions.
• Further dilute reconstituted drug with 5% dextrose in water or normal saline solution.
Administer over 30 to 60 minutes by I.V. infusion only.
Take steps to prevent extravasation, which may cause tissue damage and severe pain.
CNS: malaise, paresthesia
GI: nausea, vomiting, dyspepsia, anorexia
Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression
Skin: dermatitis, erythematous or urticarial rash, alopecia, flushing, photosensitivity
Others: flulike symptoms, fever, hypersensitivity reactions including anaphylaxis
Drug-diagnostic tests. Platelets, red blood cells, white blood cells: decreased counts
Drug-behaviors. Sun exposure: photosensitivity reaction
Frequently monitor CBC with white cell differential and platelet count. Know that hematopoietic depression is the most common toxicity and can be fatal.
• Assess infusion site closely for extravasation.
Instruct patient to immediately report pain, burning, or swelling at infusion site; numbness in arms or legs; gait changes; respiratory distress; difficulty breathing; rash; or easy bruising or bleeding.
• Advise patient to minimize GI distress by eating small, frequent servings of healthy food and drinking plenty of fluids.
• 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 tests and behaviors mentioned above.