Pentostatin

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Pentostatin Brand Name– Nipent

What is Pentostatin

Pentostatin is a synthetic purine nucleoside antimetabolite. It is indicated for the treatment of hairy-cell leukemia in patients with active disease that is previously untreated or refractory to alpha-interferon therapy.

Using a dose that is higher than the FDA-approved dosage is not recommended due to the potential for severe renal, hepatic, pulmonary, and nervous system toxicity.

Additionally, the use of pentostatin in combination with fludarabine resulted in severe or fatal pulmonary toxicity in patients with refractory chronic lymphocytic leukemia; therefore, the use of pentostatin and fludarabine is not recommended.

Indications

  1. chronic lymphocytic leukemia (CLL)
  2. cutaneous T-cell lymphoma (CTCL)
  3. graft-versus-host disease (GVHD)
  4. graft-versus-host disease (GVHD) prophylaxis
  5. hairy-cell leukemia
  6. mycosis fungoides
  7. stem cell transplant preparation

For the treatment of hairy-cell leukemia

NOTE: Pentostatin has been designated as an orphan drug by the FDA for the treatment of hairy-cell leukemia.

for the treatment of hairy-cell leukemia in patients with active disease that is previously untreated or refractory to alpha-interferon therapy

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. agranulocytosis
  4. alopecia
  5. amblyopia
  6. amenorrhea
  7. amnesia
  8. anemia
  9. angina
  10. anorexia
  11. anxiety
  12. aplastic anemia
  13. arthralgia
  14. asthenia
  15. ataxia
  16. AV block
  17. bleeding
  18. bradycardia
  19. bronchospasm
  20. cardiac arrest
  21. chest pain (unspecified)
  22. chills
  23. confusion
  24. conjunctivitis
  25. constipation
  26. cough
  27. depression
  28. diarrhea
  29. dizziness
  30. drowsiness
  31. dysarthria
  32. dysgeusia
  33. dyspepsia
  34. dysphagia
  35. dyspnea
  36. elevated hepatic enzymes
  37. emotional lability
  38. erythema
  39. exfoliative dermatitis
  40. fatigue
  41. fever
  42. flatulence
  43. furunculosis
  44. gingivitis
  45. glossitis
  46. gout
  47. hallucinations
  48. headache
  49. hearing loss
  50. heart failure
  51. hemolytic anemia
  52. hemolytic-uremic syndrome
  53. hepatotoxicity
  54. hostility
  55. hypercalcemia
  56. hyperhidrosis
  57. hyperkinesis
  58. hypertension
  59. hyponatremia
  60. hypotension
  61. ileus
  62. impotence (erectile dysfunction)
  63. infection
  64. insomnia
  65. lacrimation
  66. laryngeal edema
  67. leukopenia
  68. libido decrease
  69. maculopapular rash
  70. muscle paralysis
  71. myalgia
  72. nausea
  73. nephrolithiasis
  74. nephrotoxicity
  75. neuritis
  76. neurotoxicity
  77. new primary malignancy
  78. otalgia
  79. paresthesias
  80. pericardial effusion
  81. peripheral edema
  82. petechiae
  83. pharyngitis
  84. phlebitis
  85. photophobia
  86. photosensitivity
  87. pruritus
  88. pulmonary edema
  89. pulmonary embolism
  90. pulmonary toxicity
  91. rash
  92. renal failure (unspecified)
  93. retinopathy
  94. rhinitis
  95. seizures
  96. sinusitis
  97. stomatitis
  98. syncope
  99. thrombocytopenia
  100. thrombotic thrombocytopenic purpura (TTP)
  101. tinnitus
  102. urticaria
  103. vasculitis
  104. vertigo
  105. visual impairment
  106. vomiting
  107. xerophthalmia
  108. xerosis

Monitoring Parameters

  • CBC with differential
  • serum creatinine/BUN

Contraindications

  • anemia
  • bone marrow suppression
  • breast-feeding
  • hepatotoxicity
  • infection
  • infertility
  • nephrotoxicity
  • neurotoxicity
  • neutropenia
  • pregnancy
  • pulmonary toxicity
  • renal impairment
  • requires an experienced clinician
  • serious rash
  • thrombocytopenia
  • use with fludarabine

Interactions

  • Alpha interferons
  • Amlodipine; Celecoxib
  • Antithymocyte Globulin
  • Azelastine; Fluticasone
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Basiliximab
  • Beclomethasone
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Carbamazepine
  • Celecoxib
  • Ciclesonide
  • Clozapine
  • Corticosteroids
  • Cortisone
  • Cyclophosphamide
  • Cyclosporine
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Echinacea
  • Efalizumab
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Filgrastim, G-CSF
  • Fludarabine
  • 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
  • Methotrexate
  • Methylprednisolone
  • Mometasone
  • Muromonab-CD3
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Palifermin
  • Pegfilgrastim
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Piroxicam
  • Platelet Inhibitors
  • Prednisolone
  • Prednisone
  • Rofecoxib
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • Sulindac
  • Tbo-Filgrastim
  • Tolmetin
  • Triamcinolone
  • Tuberculin Purified Protein Derivative, PPD
  • Typhoid Vaccine
  • Valdecoxib
  • Varicella-Zoster Virus Vaccine, Live
  • Vigabatrin
  • Yellow Fever Vaccine, Live

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