Dactinomycin Actinomycin D Brand Name– Cosmegen
What is Dactinomycin Actinomycin D
Dactinomycin is a cytotoxic antitumor antibiotic that is indicated for the treatment of adult and pediatric patients with Wilms tumor, rhabdomyosarcoma, Ewing sarcoma, and testicular cancer in combination with chemotherapy.
It is also indicated in postmenarchal patients with gestational trophoblastic neoplasia and in adult patients with locally recurrent or locoregional solid malignancies as a component of palliative or adjunctive regional perfusion.
Hepatotoxicity has been reported with dactinomycin therapy, including fatal sinusoidal obstruction syndrome previously termed veno-occlusive disease.
Indications
- Kaposi’s sarcoma
- malignant melanoma
- osteogenic sarcoma
- rhabdomyosarcoma
- testicular cancer
- trophoblastic disease
- Wilms’ tumor
For the treatment of gestational trophoblastic disease
for the treatment of nonmetastatic or low-risk metastatic gestational trophoblastic disease, as a single-agent
Side Effects
- abdominal pain
- acne vulgaris
- agranulocytosis
- alopecia
- anemia
- anorexia
- aplastic anemia
- ascites
- bleeding
- cheilitis
- diarrhea
- disseminated intravascular coagulation (DIC)
- dysphagia
- edema
- elevated hepatic enzymes
- erythema
- erythema multiforme
- esophagitis
- fatigue
- fever
- growth inhibition
- hepatic failure
- hepatitis
- hepatomegaly
- hyperbilirubinemia
- hypocalcemia
- impaired wound healing
- infection
- injection site reaction
- lethargy
- leukemia
- leukopenia
- malaise
- myalgia
- nausea
- nephrotoxicity
- neutropenia
- new primary malignancy
- oral ulceration
- pancytopenia
- peptic ulcer
- peripheral neuropathy
- pharyngitis
- phlebitis
- pneumonitis
- pneumothorax
- proctitis
- radiation recall reaction
- rash
- renal failure (unspecified)
- sinusoidal obstruction syndrome (SOS)
- skin hyperpigmentation
- skin ulcer
- Stevens-Johnson syndrome
- stomatitis
- thrombocytopenia
- thrombosis
- tissue necrosis
- toxic epidermal necrolysis
- tumor lysis syndrome (TLS)
- veno-occlusive disease (VOD)
- visual impairment
- vomiting
- weight gain
Monitoring Parameters
- CBC with differential
- LFTs
- pregnancy testing
- serum creatinine/BUN
- serum electrolytes
- weight
Contraindications
- accidental exposure
- anemia
- bone marrow suppression
- breast-feeding
- children
- contraception requirements
- extravasation
- geriatric
- hepatotoxicity
- herpes infection
- infants
- infection
- laboratory test interference
- male-mediated teratogenicity
- nephrotoxicity
- neutropenia
- new primary malignancy
- ocular exposure
- pregnancy
- pregnancy testing
- radiation therapy
- reproductive risk
- requires an experienced clinician
- serious rash
- sinusoidal obstruction syndrome (SOS)
- thrombocytopenia
- vaccination
- veno-occlusive disease (VOD)
Interactions
- Alpha interferons
- Amlodipine; Celecoxib
- Antithymocyte Globulin
- Azelastine; Fluticasone
- Bacillus Calmette-Guerin Vaccine, BCG
- Beclomethasone
- Betamethasone
- Budesonide
- Budesonide; Formoterol
- Carbamazepine
- Celecoxib
- Ciclesonide
- Clozapine
- Corticosteroids
- Corticotropin, ACTH
- Cortisone
- Deflazacort
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Echinacea
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Febuxostat
- Fenoprofen
- Fludrocortisone
- Flunisolide
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Influenza Virus Vaccine
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Intranasal Influenza Vaccine
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Live Vaccines
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methylprednisolone
- Mometasone
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Oxaprozin
- Palifermin
- Pegfilgrastim
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Penicillamine
- Piroxicam
- Prednisolone
- Prednisone
- Rofecoxib
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Sulindac
- Tolmetin
- Triamcinolone
- Tuberculin Purified Protein Derivative, PPD
- Typhoid Vaccine
- Valdecoxib
- Varicella-Zoster Virus Vaccine, Live
- Yellow Fever Vaccine, Live