Dactinomycin

CLINICAL USE

Antineoplastic antibiotic

DOSE IN NORMAL RENAL FUNCTION

Dose varies according to patient tolerance, size and location of neoplasmMaximum dose: 15 mcg/kg or 400–600 mcg/m2 daily for 5 days per 2 week cycle

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :1255.4

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :5

%Excreted unchanged in urine &nbsp &nbsp : 30

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :>12.1

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :36/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Use with caution Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Use with caution Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

1.1 mL water for injection without preservative

Route

Rate of Administration

15 minutes

Comments

Add to 50 mL glucose 5% or sodium chloride 0.9% (maximum concentration 10 mg/mL) or to a fast running

IV infusion

Avoid direct contact with the skin

OTHER INFORMATION

Nadir for platelet and white cell count usually occurs after 14–21 days, with recovery in 21–25 days15% eliminated by hepatic metabolism. Approximately 30% of the dose was recovered in the urine and faeces in 1 week. Can cause renal abnormalities

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