Dangerous Drug: Dactinomycin (Actinomycin D, ACT)(dak ti noe mye’ sin)
Cosmegen
PREGNANCY CATEGORY D
Drug Classes
Antibiotic
Antineoplastic
Therapeutic Actions
Cytotoxic: Inhibits synthesis of messenger RNA, causing cell death; cell cycle nonspecific.
Indications
Wilms tumor, rhabdomyosarcoma, Ewing sarcoma, in combination therapy
Testicular cancer (metastatic nonseminomatous) in combination
Gestational trophoblastic neoplasia, as monotherapy or in combination
Palliative treatment or adjunct to tumor resection via isolation-perfusion technique for solid malignancies
Unlabeled uses: Osteosarcoma, malignant melanoma, Paget disease
Contraindications and Cautions
Contraindicated with allergy to dactinomycin; chickenpox, herpes zoster (severe, generalized disease and death could result); pregnancy; lactation.
Use cautiously with bone marrow suppression, radiation therapy, and patients with reduced renal and hepatic function.
Available Forms
Powder for injection—500 mcg
Dosages
Warning Individualize dosage. Toxic reactions are frequent, limiting the amount of the drug that can be given. Give drug in short courses.Adults
Do not exceed 15 mcg/kg/day or 400–600 mcg/m2 per day for 5 days. Calculate dosage for obese or edematous patients on the basis of surface area as an attempt to relate dosage to lean body mass.
Ewing sarcoma, rhabdomyosarcoma: 15 mcg/kg/day IV for 5 days; repeat in 3 wk for Ewing sarcoma and in 3–6 wk for rhabdomyosarcoma. Maximum dose, 15 mcg/kg/day IV for 5 days per 2-wk cycle.
Nonseminomatous testicular carcinoma: 1,000 mcg/m2 IV on day 1 of a combination regimen.
Gestational trophoblastic neoplasia: 12 mcg/kg/day IV for 5 days when used as monotherapy. When used as part of a combination regimen, can give 500 mcg IV on days 1 and 2.
Isolation-perfusion technique: 50 mcg/kg for lower extremity or pelvis; 35 mcg/kg for upper extremity. Use lower dose for obese patients or when previous chemotherapy or radiation therapy has been used.
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