Pharmacologic class: Alkylating agent, nitrogen mustard
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDA Box Warning
• Give under supervision of physician experienced in using cancer chemotherapy, in facility with adequate diagnostic and treatment resources. Adverse urotoxic effects (especially hemorrhagic cystitis) and CNS toxicities (such as confusion and coma) have occurred; these effects may warrant drug discontinuation.
• Severe myelosuppression may occur.
Alkylates DNA, interfering with replication and synthesis of susceptible cells and ultimately causing cell death
Injection: 1 g or 3 g in single-dose vials
Indications and dosages
➣ Germ-cell testicular cancer
Adults: 1.2 g/m2/day by I.V. infusion over 30 minutes for 5 days. May repeat q 3 weeks or after recovery from hematologic toxicity.
• Acute leukemia
• Breast, lung, ovarian, and pancreatic cancer
• Malignant lymphomas
• Hypersensitivity to drug
• Severe bone marrow depression
• Pregnancy or breastfeeding
Use cautiously in:
• impaired renal or hepatic function, mild to moderate bone marrow depression.
• Follow facility policy for handling antineoplastic agents.
• Know that drug is usually given with other antineoplastics and hemorrhagic cystitis agent.
• To reconstitute, add sterile water or bacteriostatic water to vial, and shake gently.
• Mix 20 ml of diluent with 1-g vial or 60 ml of diluent with 3-g vial, to yield a concentration of 50 mg/ml. For smaller concentrations, dilute solution further with normal saline solution, dextrose 5% in water, lactated Ringer's solution, or sterile water.
• Administer I.V. slowly over at least 30 minutes.
CNS: drowsiness, confusion, ataxia, hallucinations, depressive psychosis, dizziness, disorientation, cranial nerve dysfunction, coma, seizures
GI: nausea, vomiting, diarrhea, anorexia, stomatitis
GU: hematuria, bladder fibrosis, gonadal suppression, nephrotoxicity, hemorrhagic cystitis
Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression
Metabolic: metabolic acidosis
Other: infection, secondary neoplasms
Drug-diagnostic tests. Hepatic enzymes, uric acid: increased levels
Platelets, white blood cells: decreased counts
• Monitor hematopoietic function tests (such as CBC with white cell differential) before therapy and weekly during therapy.
• Assess fluid intake and output. Ensure fluid intake of at least 2 L daily to prevent bladder toxicity.
☞ Monitor urine output for hematuria and hemorrhagic cystitis. Administer mesna (protective drug), as indicated and prescribed.
☞ Tell patient to immediately report jaundice, unusual bleeding or bruising, bloody urine, pain on urination, fever, chills, sore throat, cough, difficulty breathing, unusual lumps or masses, mouth sores, or pain in flank, stomach, or joints.
• Instruct patient to maintain adequate hydration and nutrition. Advise him to drink 10 to 12 glasses of fluid each day.
• Inform patient that drug may cause hair loss.
• Advise both male and female patients to use reliable contraception during and immediately after therapy, because drug may cause severe birth defects.
• Urge patient to keep regular follow-up appointments for blood tests and monitoring of drug effects.
• As appropriate, review other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.