dosage adjustment of Dactinomycin in renal failure




Dactinomycin.JPG

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                           :1255.4
  • %Protein binding                           :5
  • %Excreted unchanged in urine     : 30
  • Volume of distribution (L/kg)       :>12.1
  • half-life – normal/ESRD (hrs)      :36/–

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Use with caution Dose as in normal renal function
  • <10           : Use with caution Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HD                     :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD      :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

    IV

    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