Gallium

Gallium Brand Name– Ganite

What is Gallium

Gallium nitrate is a hydrated nitrate salt of the group IIIa element, gallium; the drug functions as a bone resorption inhibitor.

Gallium was initially investigated as an antineoplastic drug during which time its hypocalcemic effects were discovered. As compared with calcitonin or etidronate, the effect of gallium nitrate on serum calcium concentration reduction is similar but the duration of normocalcemia is longer.

Gallium nitrate efficacy for hypercalcemia associated with epidermoid (squamous) cancers appears to be unique.

Gallium nitrate is being investigated for the treatment of low- or intermediate-grade Non-Hodgkin’s Lymphoma (NHL) that has progressed after standard chemotherapy. Gallium nitrate may have a beneficial effect on the survival of patients with advanced-stage multiple myeloma.

Gallium nitrate should not be used with other potentially nephrotoxic drugs due to the possible development of severe renal insufficiency; the risk of nephrotoxicity associated with gallium nitrate, calcitonin, or etidronate appears to be similar; adequate fluid hydration during gallium treatment helps minimize this risk.

The FDA first approved gallium nitrate decades ago; however, the drug was discontinued from marketing in 2000 by the former manufacturer (Solopak).

A new manufacturer (Genta, Inc.) acquired the rights to gallium nitrate in 2000. In January 2003, the FDA reactivated the new drug application (NDA) for gallium nitrate injection.

In September 2003, the FDA approved the intravenous formulation of gallium nitrate (Ganite™) for cancer-related hypercalcemia.

An oral formulation for the prevention of bone loss in patients with bone metastases is under development.

Indications

  1. bladder cancer
  2. bone metastases
  3. hypercalcemia
  4. non-Hodgkin’s lymphoma (NHL)
  5. Paget’s disease

For the treatment of symptomatic cancer-related hypercalcemia that has not responded to adequate hydration

Side Effects

  1. anemia
  2. azotemia
  3. confusion
  4. constipation
  5. diarrhea
  6. dyspnea
  7. edema
  8. fever
  9. hallucinations
  10. hearing loss
  11. hypocalcemia
  12. hypophosphatemia
  13. hypotension
  14. hypothermia
  15. injection site reaction
  16. lethargy
  17. leukopenia
  18. nausea
  19. nephrotoxicity
  20. optic neuritis
  21. paresthesias
  22. pleural effusion
  23. rash
  24. renal failure (unspecified)
  25. tinnitus
  26. visual impairment
  27. vomiting

Monitoring Parameters

  • serum calcium
  • serum creatinine/BUN

Contraindications

  • breast-feeding
  • children
  • dehydration
  • hypocalcemia
  • hypovolemia
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment

Interactions

  • Amikacin
  • Aminoglycosides
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium; Vitamin D
  • Chromium
  • Cisplatin
  • Foscarnet
  • Ganciclovir
  • Gentamicin
  • Hetastarch; Dextrose; Electrolytes
  • Kanamycin
  • Paromomycin
  • Pentamidine
  • Plazomicin
  • Streptomycin
  • Tobramycin
  • Vancomycin