were you aware [1%:<75,000/mm 3 White blood cell count> <2000/mm 3 or granulocyte count> <1000/mm 3 Progressive neurotoxicity Gastrointestinal intolerance not responsive to antiemetic regimens Discontinue if neurotoxicity does not stabilize at 200 mg/m 2 /day. Dosing: Obesity ASCO Guidelines for appropriate chemotherapy dosing in obese adults with cancer: Utilize patient s actual body weight (full weight) for calculation of body surface area- or weight-based dosing, particularly when the intent of therapy is curative; manage regimen-related toxicities in the same manner as for nonobese patients; if a dose reduction is utilized due to toxicity, consider resumption of full weight-based dosing with subsequent cycles, especially if cause of toxicity (eg, hepatic or renal impairment) is resolved (Griggs, 2012). Administration Altretamine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Dupuis, 2011; Roila, 2010) Administer total daily dose orally as 4 divided doses after meals and at bedtime. Storage Store at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Drug Interactions BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Consider therapy modification Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Consider therapy modification Monoamine Oxidase Inhibitors: Altretamine may enhance the orthostatic hypotensive effect of Monoamine Oxidase Inhibitors. Exceptions: Linezolid; Tedizolid. Monitor therapy Multivitamins/Fluoride (with ADE): May diminish the therapeutic effect of Altretamine. Specifically, vitamin B6 (pyridoxine) supplementation may diminish the response to altretamin/cisplatin treatment. Management: In spite of its beneficial effects on altretamine-associated neurotoxicity, the potential reduction in response duration may warrant consideration of not using multivitamins containing pyridoxine (vitamin B6) with an altretamine/cisplatin regimen. Consider therapy modification Multivitamins/Minerals (with ADEK, Folate, Iron): May diminish the therapeutic effect of Altretamine. Management: Consider avoiding use of multivitamins that contain vitamin B6 in combination with altretamine. Consider therapy modification Multivitamins/Minerals (with AE, No Iron): May diminish the therapeutic effect of Altretamine. Management: Consider avoiding use of multivitamins that contain vitamin B6 in combination with altretamine. Consider therapy modification Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapy Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Consider therapy modification Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Monitor therapy Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy Pyridoxine: May diminish the therapeutic effect of Altretamine. Specifically when altretamine is used in combination with Cisplatin the response duration may be diminished. Consider therapy modification Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapy Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Consider therapy modification Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy Tricyclic Antidepressants: Altretamine may enhance the orthostatic hypotensive effect of Tricyclic Antidepressants. Monitor therapy Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination Adverse Reactions> 10%: Central nervous system: Peripheral sensory neuropathy (31%; mild: 9%; moderate-to-severe: 9%) Gastrointestinal: Nausea and vomiting (33%; severe 1%) Hematologic & oncologic: Anemia (33%), leukopenia (5% to 15%, grade 4: <1%) 1% to 10%: Central nervous system: Fatigue, seizure Gastrointestinal: Anorexia Hematologic & oncologic: Thrombocytopenia Hepatic: Increased serum alkaline phosphatase Renal: Increased blood urea nitrogen, increased serum creatinine> <1% (Limited to important or life-threatening): Alopecia, ataxia, depression, dizziness, hepatotoxicity, mood disorder, neurotoxicity, pruritus, skin rash, vertigo ALERT: U.S. Boxed Warning Experienced physician: Administer only under the supervision of a physician experienced in the use of antineoplastic agents. Bone marrow suppression: Monitor peripheral blood counts at least monthly, prior to the initiation of each course of altretamine and as clinically indicated. Neurotoxicity: Because of the possibility of altretamine-related neurotoxicity, neurologic examination should be performed regularly during altretamine administration. Warnings/Precautions Concerns related to adverse effects: Bone marrow suppression: [US Boxed Warning]: Peripheral blood counts should be monitored at least monthly, prior to each cycle, and as clinically indicated. Mild to moderate dose-related hematological toxicity has been reported; may require dosage modification. With an intermittent dosing schedule, WBC and platelet nadirs occur at 3 to 4 weeks, with recovery by 6 weeks. Gastrointestinal toxicity: Altretamine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Dupuis 2011; Roila 2010). Neurotoxicity: [US Boxed Warning]: Due to the potential for altretamine-associated neurologic toxicity, neurologic examinations should be done regularly during altretamine treatment. Mild to moderate neurotoxicity, including peripheral neuropathy and CNS symptoms (ataxia, dizziness, vertigo, mood disorders, and disorders of consciousness) have been reported; may require dosage modification. Neurotoxicity is generally reversible upon discontinuation. Peripheral neuropathy and CNS symptoms are more common in patients receiving a continuous high-dose daily schedule (compared to an intermittent schedule). Altretamine has been administered safely in patients with preexisting cisplatin-associated neuropathy; close monitoring is required. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. MAO inhibitors: Concurrent use of altretamine and MAO inhibitors may cause severe orthostatic hypotension. Symptomatic orthostatic hypotension has been reported 4 to 7 days after concurrent administration. Other warnings/precautions: Experienced physician: [US Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician. Monitoring Parameters CBC with differential (prior to treatment initiation, before each cycle, and regularly during treatment), neurologic examination (before each cycle and regularly during treatment) Pregnancy Risk Factor D Pregnancy Considerations Adverse effects were observed in animal reproduction studies. Altretamine may cause fetal harm if administered during pregnancy. Women of childbearing potential should avoid becoming pregnant while on therapy. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Have patient report immediately to prescriber signs of infection, signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding), pharyngitis, shortness of breath, severe nausea, vomiting, severe loss of strength and energy, burning or numbness feeling, change in balance, mood changes, dizziness, or abnormal gait (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about altretamine Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 1 Review Add your own review/rating Drug class: miscellaneous antineoplastics Consumer resources Altretamine Altretamine (Advanced Reading) Professional resources Altretamine (AHFS Monograph) Other brands: Hexalen Related treatment guides Ovarian Cancer> ]} Drug Status Rx Availability Prescription only D Pregnancy Category Positive evidence of risk N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Altretamine Rating 1 User Review 7.5 /10 1 User Review 7.5 Rate it! Drug Class Miscellaneous antineoplastics Related Drugs miscellaneous antineoplastics tretinoin , Revlimid , Zytiga , Accutane , isotretinoin , irinotecan Ovarian Cancer Avastin , carboplatin , Taxol , cisplatin , cyclophosphamide , paclitaxel , gemcitabine , Gemzar , Cytoxan , bevacizumab , etoposide , Adriamycin , doxorubicin , Doxil , topotecan , Lynparza , olaparib , melphalan , Zejula , niraparib , thiotepa , Platinol , rucaparib , Hycamtin , Toposar , More...} } most luxurious
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