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Dactinomycin information from DrugsUpdate  

See Available Brands of Dactinomycin in India

P - Caution when used during pregnancy
L - Contraindicated in lactation
LI - Lab *

The actinomycins are a class of polypeptide antibiotics isolated from soil bacteria of the genus Streptomyces, of which the most significant is actinomycin D. It was the first antibiotic isolated by Selman Waksman and his co-worker H. B. Woodruff in 1940.

Pharmacodynamics

Pharmacokinetics

Dactinomycin binds to the guanine portion of DNA forming a complex which interferes with DNA and RNA synthesis as well as protein synthesis. It may also enhance the cytotoxic effects of radiotherapy.


Distribution Rapidly distributed with high concentrations in bone marrow and nucleated cells.


Metabolism Minimal metabolism.


Excretion Slowly excreted in urine and bile. Plasma half-life: about 36 hr.

Dactinomycin Indications / Dactinomycin Uses

Information Not Available

Dactinomycin Adverse Reactions / Dactinomycin Side Effects

Cheilitis, dysphagia, oesophagitis, ulcerative stomatitis, pharyngitis; anorexia, nausea, vomiting, abdominal pain, diarrhoea, GI tract ulceration; liver toxicity including ascites, hepatomegaly, hepatitis, LFT abnormalities; anaemia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, reticulopenia, alopoecia; skin eruptions, acne, flare-up of erythema or increased pigmentation of previously irradiated skin. If extravasation occurs during IV use, it leads to severe damage of soft tissues. Malaise, fatigue, lethargy, fever, myalgia, proctitis and hypocalcaemia. Potentially Fatal: Veno-occlusive disease (primarily hepatic) may result in fatality especially in children <48 mth.

Precautions

Warnings Dactinomycin is extremely corrosive to soft tissue. If extravasation occurs during IV use, severe damage to soft tissues will occur. In at least one instance, this has led to contracture of the arms. Avoid use in pregnancy. Dactinomycin is also carcinogenic, mutagenic, and teratogenic. Monitor Ensure liver function (ie, transaminases, bilirubin) and renal function (ie, Scr, BUN) are evaluated before starting therapy and frequently thereafter during treatment. Notify health care provider if abnormalities develop. Ensure CBC with differential and platelet count are evaluated daily. Monitor patient for signs or symptoms of infection or bleeding. Monitor patient closely for toxic adverse reactions of therapy, especially when multiple chemotherapy is being used. Monitor IV injection site for signs or symptoms of extravasation. Chickenpox or herpes zoster Do not give at or about the time of infection with chickenpox or herpes zoster; severe generalized disease may occur. GI toxicity and marrow suppression Increased incidence. Radiation With combined dactinomycin-radiation therapy, the normal skin, as well as the buccal and pharyngeal mucosa, may show early erythema. A smaller than usual x-ray dose, when given with dactinomycin, causes erythema and vesiculation, which progress more rapidly through the tanning and desquamation stages. Erythema from previous x-ray therapy may be reactivated by dactinomycin alone, even when irradiation occurred many months earlier, and especially when the interval between the 2 forms of therapy is brief. When the nasopharynx is irradiated, the combination may produce severe oropharyngeal mucositis. Severe reactions may appear if high doses are used or if the patient is particularly sensitive to such combined therapy. Second primary tumors Increased incidence. Toxic effects Note that toxic effects (with exception of nausea and vomiting) usually do not become apparent until 2 to 4 days after a course of therapy is stopped, and may not peak until 1 to 2 wk have elapsed. Overdosage Nausea, vomiting, diarrhoea, mucositis, GI ulceration, skin disorders (e.g. exanthema, desquamation and epidermolysis), severe haematopoietic depression, veno-occlusive disease, acute renal failure and death. Treatment of toxicity is mainly symptomatic and supportive. Monitor skin and mucous membrane integrity, renal, hepatic and bone marrow functions frequently.

Special Precautions

Admin drug with care to avoid extravsasation. GI toxicity and bone marrow suppression has been reported when given with x-ray therapy. Increased risk of hepatomegaly and elevated SGOT levels when administering within 2 mth of irradiation for the treatment of right-sided Wilms' tumor. Discontinue drug if stomatitis, diarrhoea or severe haematopoietic depression results, until patient recovers. Monitor renal, hepatic and bone marrow functions regularly. Pregnancy.

Other Drug Interactions

Information Not Available

Other Interactions

Information Not Available

Dosage

Intravenous Ewing's sarcoma Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days. Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle. Intravenous Wilm's tumour Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days. Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle. Intravenous Childhood rhabdomyosarcoma Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days. Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle. Intravenous Gestational trophoblastic tumours Adult: 12 mcg/kg/day for 5 days as a single agent or 500 mcg/day on days 1 and 2 of combination regimens. Intravenous Metastatic nonseminomatous testicular cancer Adult: 1 mg/m2 on day 1 of combination regimens. Reconstitution Reconstitute with sterile water for inj without preservatives under aseptic conditions because preservatives may cause precipitation. Incompatibility Y-site incompatibility: Filgrastim.

Food(before/after)

Information Not Available

List of Contraindications

Dactinomycin and Pregnancy

Caution when used during pregnancy. Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Dactinomycin and Lactation

Contraindicated in lactation

Dactinomycin and Children

Information Not Available

Dactinomycin and Geriatic

Information Not Available

Dactinomycin and Other Contraindications

Infection with chicken pox or herpes zoster; hypersensitivity; infants <12 mth. Lactation

Storage

Intravenous Store at 25 ℃

Lab interference

Intravenous Store at 25 ℃

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