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Pharmacologic class: Organic thiophosphate cytoprotective drug
Therapeutic class: Cytoprotectant
Pregnancy risk category C
Undergoes conversion to free thiol, an active metabolite that reduces toxic effects of cisplatin on renal tissue
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
• Protection against cisplatin- and paclitaxel-induced neurotoxicity
• Hypersensitivity to drug
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).
• 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.
CNS: dizziness, drowsiness, rigors
GI: nausea, vomiting
Respiratory: dyspnea, sneezing
Skin: flushing, rash, urticaria, erythema multiforme
Other: chills, warm sensation, hiccups, allergic reactions
Drug-drug.Antihypertensives: increased risk of hypotension
Drug-diagnostic tests.Calcium: decreased level
• 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.
• 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.