Cyclophosphamide (as Cyclophosphamide monohydrate)
1 gramCyclophosphamide 1 g powder for solution for injection vials|
1 vialP£ 17. 06 (Hospital only)| 1 vialP£ 17. 91
Cyclophosphamide (as Cyclophosphamide monohydrate)
2 gramCyclophosphamide 2 g powder for solution for injection vials
| 1 vialP£ 34. 12 (Hospital only)Dacarbazine
lINDICATIONS AND DOSE
Hodgkin’s disease|Paediatric solid tumours
▶BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lCAUTIONSCaution in handling—irritant to tissues
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAnaemia.appetite decreased.
leucopenia.nausea.thrombocytopenia.vomiting
▶UncommonAlopecia.infection.influenza like illness.
photosensitivity reaction.skin reactions
▶Rare or very rareAgranulocytosis.confusion.diarrhoea.
flushing.headache.hepatic disorders.lethargy.
pancytopenia.paraesthesia.renal impairment.seizure.
visual impairment
lCONCEPTION AND CONTRACEPTIONEnsure effective
contraception during and for at least 6 months after
treatment in men or women. See alsoPregnancy and
reproductive functionin Cytotoxic drugs p. 531.
lPREGNANCYAvoid (carcinogenic and teratogenic in
animalstudies). See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsDose reduction may be required in
combined renal and hepatic impairment.
lRENAL IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsDose reduction may be required in
combined renal and hepatic impairment.
lPRESCRIBING AND DISPENSING INFORMATIONDacarbazine
is a component of a commonly used combination for
Hodgkin’s disease (ABVD—doxorubicin [previously
Adriamycin®], bleomycin, vinblastine, and dacarbazine).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
▶Dacarbazine (Non-proprietary)
Dacarbazine (as Dacarbazine citrate) 500 mgDacarbazine 500 mg
powder for solution for infusion vials| 1 vialP£ 37. 50
Dacarbazine (as Dacarbazine citrate) 1 gramDacarbazine 1 g
powder for solution for infusion vials| 1 vialP£ 70. 00
Powder for solution for injection
▶Dacarbazine (Non-proprietary)
Dacarbazine (as Dacarbazine citrate) 100 mgDacarbazine^100 mg
powder for solution for injection vials| 10 vialP£ 90. 00
Dacarbazine (as Dacarbazine citrate) 200 mgDacarbazine 200 mg
powder for solution for injection vials| 10 vialP£ 160. 00Ifosfamide
lINDICATIONS AND DOSE
Rhabdomyosarcoma|Soft-tissue sarcomas|Ewing tumour
|Germ cell tumour|Osteogenic sarcoma
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lCONTRA-INDICATIONSAcute infection.urinary-tract
infection.urinary-tract obstruction.urothelial damage
lCAUTIONSAvoid in Acute porphyrias p. 603lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAlopecia.appetite decreased.
bone marrow disorders.haemorrhage.hepatic disorders.
infection.leucopenia.nausea.reactivation of infection.
renal impairment.thrombocytopenia.vascular disorders.
vomiting
▶UncommonCardiotoxicity.diarrhoea.hypotension.oral
disorders
▶Rare or very rareSkin reactions
▶Frequency not knownAbdominal pain.agranulocytosis.
amenorrhoea.anaemia.angina pectoris.angioedema.
arrhythmias.arthralgia.asterixis.behaviour abnormal.
blood disorders.bone disorders.cancer progression.
cardiac arrest.cardiomyopathy.chills.conjunctivitis.
constipation.cough.delirium.delusions.disseminated
intravascular coagulation.dysarthria.dyspnoea.
electrolyte imbalance.embolism and thrombosis.
encephalopathy.eye irritation.fatigue.fever.flushing.
gait abnormal.gastrointestinal disorders.growth
retardation.haemolytic anaemia.hearing impairment.
heart failure.hyperglycaemia.hyperhidrosis.
hyperphosphaturia.hypertension.hypoxia.
immunosuppression.infertility.malaise.mania.memory
loss.metabolic acidosis.movement disorders.mucosal
ulceration.multi organ failure.muscle complaints.
myocardial infarction.nail disorder.neoplasms.nephritis
tubulointerstitial.nephrogenic diabetes insipidus.
neurotoxicity.oedema.ovarian and fallopian tube
disorders.pain.pancreatitis.panic attack.peripheral
neuropathy.polydipsia.premature menopause.
psychiatric disorders.pulmonary hypertension.
pulmonary oedema.radiation recall reaction.respiratory
disorders.rhabdomyolysis.secondary malignancy.
sensation abnormal.sepsis.severe cutaneous adverse
reactions (SCARs).SIADH.sinusoidal obstruction
syndrome.sperm abnormalities.status epilepticus.
tumour lysis syndrome.urinary disorders.vasculitis.
vertigo.visual impairment
SIDE-EFFECTS, FURTHER INFORMATION
Urothelial toxicityMesna is routinely given with
ifosfamide to reduce urothelial toxicity.
Secondary malignancyUse of ifosfamide is associated
with an increased incidence of acute leukaemia.
Fluid retentionAlkylating drugs can causefluid retention
with oedema and dilutional hyponatraemia in younger
children; the risk of this complication is higher in thefirst
2 days and also when given with concomitant vinca
alkaloids.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
adequate contraception during and for at least 6 months
after treatment in men or women. See alsoPregnancy and
reproductive functionin Cytotoxic drugs p. 531.
lPREGNANCYAvoid (teratogenic and carcinogenic in
animals). See alsoPregnancy and reproductive functionin
Cytotoxic drugs p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENTAvoid.
lRENAL IMPAIRMENTAvoid.
lMONITORING REQUIREMENTSEnsure satisfactory
electrolyte balance and renal function before each course
(risk of tubular dysfunction, Fanconi’s syndrome or
diabetes insipidus if renal toxicity not treated promptly).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for injection
▶Ifosfamide (Non-proprietary)
Ifosfamide 1 gramIfosfamide 1 g powder for concentrate for solution
for injection vials| 1 vialP£ 115. 79536 Cytotoxic responsive malignancy BNFC 2018 – 2019
Immune system and malignant disease8