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Amifostine Brand Name- Ethyol
What is Amifostine
Amifostine (WR-2721, ethiofos) is a phosphorylated sulfhydryl-containing prodrug that protects tissues from the cytotoxic actions of radiation and chemotherapy.
It was originally developed by the military for use as a radioprotectant in the event of nuclear warfare.
Amifostine has selective cytoprotective effects for normal tissues. In the pivotal US trial, amifostine reduced the incidence and severity of myelosuppression, nephrotoxicity and peripheral neuropathies seen with cisplatin and cyclophosphamide combination therapy.
Studies examining the myeloprotective effects of amifostine show a higher white blood cell nadir, shorter duration of neutropenia, and a decreased incidence of neutropenia-related adverse events as compared to controls. These chemoprotective effects seem to be additive with repeated cycles and do not affect antitumor efficacy.
Preliminary trials indicate enhanced response rates but no effect on survival in patients treated with radiation and amifostine.
In head and neck cancer patients, amifostine administered prior to radiation therapy significantly reduced the incidence of acute- and late-onset xerostomia as compared to patients who received radiation alone.
Amifostine is being studied to see if it is efficacious at preventing toxicities due to paclitaxel, melphalan and mitomycin-C in pediatric patients. Initial studies have shown that treatment with amifostine may increase platelet, red blood cell, and neutrophil counts and decrease transfusion requirements in patients with myelodysplastic syndromes.
Amifostine has been in use in Europe since 1994. Amifostine was FDA-approved on December 8, 1995 for prevention of cisplatin-induced nephrotoxicity in ovarian cancer patients and in March 1996 was given FDA approval for use in patients with non-small cell lung cancer receiving cisplatin based chemotherapy; this indication was removed in April 2006.
In June 1998, the FDA designated Ethyol as an orphan drug for reducing the incidence and severity of radiation-induced xerostomia.
In June 1999, the FDA approved Ethyol for this use.
Indications
- bone marrow suppression prophylaxis
- myelodysplastic syndrome (MDS)
- nephrotoxicity prophylaxis
- neurotoxicity prophylaxis
- xerostomia prophylaxis
For nephrotoxicity prophylaxis in patients receiving cisplatin for advanced ovarian cancer
Side Effects
- anaphylactoid reactions
- angina
- apnea
- atrial fibrillation
- atrial flutter
- blurred vision
- bradycardia
- cardiac arrest
- chest pain (unspecified)
- chest pressure syndrome
- chills
- diarrhea
- diplopia
- dizziness
- drowsiness
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- dyspnea
- erythema
- erythema multiforme
- exfoliative dermatitis
- fever
- flushing
- hiccups
- hypertension
- hypocalcemia
- hypotension
- hypotension
- hypoxia
- injection site reaction
- laryngeal edema
- malaise
- myocardial infarction
- nausea
- pruritus
- rash
- renal failure (unspecified)
- respiratory arrest
- seizures
- sinus tachycardia
- sneezing
- Stevens-Johnson syndrome
- supraventricular tachycardia (SVT)
- syncope
- toxic epidermal necrolysis
- urticaria
- vomiting
Monitoring Parameters
- blood pressure
- pregnancy testing
- serum calcium
Contraindications
- angina
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- cerebrovascular disease
- chemotherapy
- children
- dehydration
- exfoliative dermatitis
- geriatric
- heart failure
- hypocalcemia
- hypotension
- infants
- myocardial infarction
- neonates
- pregnancy
- pregnancy testing
- radiation therapy
- renal disease
- serious rash
- stroke
Interactions
- Acebutolol
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alpha-blockers
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Atenolol
- Atenolol; Chlorthalidone
- Azilsartan
- Azilsartan; Chlorthalidone
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Beta-blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brimonidine; Timolol
- Calcium-channel blockers
- Candesartan
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Carteolol
- Carvedilol
- Central-acting adrenergic agents
- Chlorothiazide
- Chlorthalidone
- Chlorthalidone; Clonidine
- Clevidipine
- Diazoxide
- Diltiazem
- Dorzolamide; Timolol
- Doxazosin
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Eplerenone
- Epoprostenol
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Esmolol
- Felodipine
- Fenoldopam
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Hydralazine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Iloprost
- Irbesartan
- Isradipine
- Labetalol
- Levobetaxolol
- Levobunolol
- Lisinopril
- Losartan
- Mecamylamine
- Methyclothiazide
- Metolazone
- Metoprolol
- Minoxidil
- Moexipril
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Nitroprusside
- Olmesartan
- Penbutolol
- Perindopril
- Perindopril; Amlodipine
- Phenoxybenzamine
- Phentolamine
- Pindolol
- Potassium-sparing diuretics
- Prazosin
- Propranolol
- Quinapril
- Ramipril
- Reserpine
- Sacubitril; Valsartan
- Sotalol
- Spironolactone
- Telmisartan
- Terazosin
- Thiazide diuretics
- Timolol
- Trandolapril
- Trandolapril; Verapamil
- Treprostinil
- Triamterene
- Valsartan
- Vasodilators
- Verapamil
