Chemotherapy Drugs (Mi - V)
*not all inclusive
Mitoxantrone (Novantrone): approved for administration as an infusion into a freely running intravenous line of a period of not less than 3 minutes. This drug has also been administered as a continuous infusion. Novantrone is generally believed to not be a vesicant (such as Daunorubicin and Doxorubicin). However, every precaution should be made to prevent extravasation of the solution. Extravasation usually results in a blue discoloration of the skin, which slowly fades.
The limiting toxicity for this drug is bone marrow suppression. Other side effects include nausea and vomiting (occurring in up to 50 percent of patients) and stomatitis. Abdominal pain, constipation, diarrhea and hair loss are infrequent.
Cardiac toxicity may also occur. In order to prevent this from happening the cumulative dose should not exceed 160 mg/m2. In patients with prior therapy with Novantrone, adriamycin or Daunorubicin and in individuals with prior radiotherapy the total dose should not exceed 120 mg/m2. Diagnostic indications for stopping Novantrone therapy are a decrease in ejection fraction (a measure of the ability of the heart to pump blood) by at least 10-20 percent.
Oxaliplatin: administered intravenously as either a short infusion or as a prolonged (120 hour) continuous infusion. Peripheral neuropathy (tingling and numbness of the hands and feet and sometimes the lips) is the dose limiting toxicity of this medication. Mild decreases in the white count and platelet count are also seen. However, in contrast to Cis-platin renal and liver effects have not been reported. Additionally, the neurotoxic effects of Oxaliplatin are relatively, rapidly reversible, in contrast to the effects of other platinum containing compounds. Cardiac toxicity has not been observed, nor has hair loss or hearing toxicity.
Paclitaxel (Taxol): administered as an intravenous infusion. Anaphylactic-like (hypersensitivity) reactions have been seen with administration of the drug. The reactions are characterized by wheezing, shortness of breath, facial flushing, facial swelling and decreased blood pressure. The reaction is thought to occur because of histamine release caused by the fluid (Chemophor) Taxol is dissolved in. Premedication with steroid, Benadryl and Cimetidine will help minimize this adverse effect.
The dose limiting side effect of Taxol is bone marrow suppression. Decreases in the white count are more predominant than platelet or red blood cell effects. Neuropathy, characterized by numbness, tingling and pain has also been seen. The neuropathy is typically reversible when the agent is discontinued. Symptom resolution usually occurs over several months. Heart side effects have been seen. Slowing of the heart rate (bradycardia) occurs but is usually short lived. However, rarely, the slowing is progressive leading to complete heart block.
Other effects include nausea and vomiting, diarrhea, mouth sores, hair loss and flu-like symptoms consisting of joint and muscle aches (arthralgia and myalgia), fever, rash, headache and fatigue.
Procarbazine (Matulane): administered orally or by slow intravenous infusion over 10-15 minutes. Procarbazine may interact with certain foods and medications and these should be discontinued during therapy with this medication to decrease the risk of adverse reaction. Below is a list of potential reactive drugs and foods.
Food or medication possible interaction–Ethanol (alcohol): severe gastrointestinal toxicity with nausea, vomiting. Possible visual problems; headache.
Sympathomimetics–Ephedrine, epinephrine, etc.: severe gastrointestinal toxicity with nausea, vomiting. Possible visual problems; headache.
Antidepressants–Tricyclics (i.e. Amitriptyline), Monoamine oxidase inhibitors: extremely high blood pressure, tremor, excitation. Additionally heart problems such as chest pain and abnormal heart rate.
Tyramine rich foods–Dark beer, cheese, wine, bananas, etc.: extremely high blood pressure, tremor, excitation. Additionally, heart problems such as chest pain and abnormal heart rate.
Central nervous system depressants–Narcotics (morphine, etc.), Barbiturates, Antihistamines (Benadryl, etc.), Phenothiazines, High blood pressure medications (Clonidine, etc.): potential respiratory depression secondary to additive effects.
Bone marrow suppression is the main toxic effect of this drug; platelets are selectively affected leading to an increased risk of bleeding. Other effects include nausea and vomiting, diarrhea and flu-like symptoms consisting of fever, chills, sweating, tiredness and joint and muscle aches. Skin reactions are rare but include hair loss, itchiness and rash. Nervous system toxicity includes dizziness, problems with walking, headache and numbness or tingling of the hands and feet. Additionally, double vision, eye sensitivity to light and swelling of the retina have been observed. Hormonally, loss of periods and absence of sperm production occur while on Procarbazine.
Rituxin (Rituximap): administered intravenously; however intravenous bolus or push administration is not recommended. Adverse reactions include an infusion related symptom complex of fever and chills. Other reactions include nausea and vomiting, fatigue, itchiness, wheezing, shortness of breath, low blood pressure and sensation of tongue or throat swelling (angioedema). Flushing and pain at disease sites may also occur. Because of the risk of low blood pressure it is recommended that anti-hypertensive medications be held for 12 hours prior to administration of Rituxin.
Immunologically, B-cell lymphocytes are depleted in the majority of patients but risk of infection does not appear to be increased. Bone marrow suppression with lowered platelet counts, white blood counts and anemia occurs in 1-2 percent of patients. Cardiotoxicity as manifested by irregular and/or fast heart rates have been noted. Reactions occurring between 1-5 percent of the time include joint aches, diarrhea, high blood pressure, chest pain, loss of appetite, anxiety, tiredness, nervousness and taste perversion.
Semustine (Methyl-CCNU): administered orally. The drug may be taken on an empty stomach to help lessen the severity of nausea and vomiting. The major side effect is of bone marrow suppression, which may be prolonged (thus leading to increased risk of infection and bleeding). Other effects include nausea and vomiting (commonly occurring 4-6 hours after ingestion), and loss of appetite.
Tomudex (Raltitrexed): administered as an intravenous infusion over 15 minutes. The major toxicities thus far reported include fatigue, diarrhea, liver function abnormalities and bone marrow suppression.
Topotecan (Hycamtin): administered intravenously. The major side effect is the development of neutropenia (leading to increased risk of infection). Lowered platelets and anemia have also been noted. Thirty percent of patients experience nausea and vomiting. One third (33 percent) of patients experience fever greater than 101 degrees. Microscopic blood in the urine has occurred in 10-12 percent of patients.
Vinblastine (Velban): administered as an intravenous push with the total dose of medication delivered over approximately 1 minute. This drug is very irritating and should not be given underneath the skin (subcutaneously) or into the muscle (intramuscularly). Extravasation (leakage into the tissues around the vein) must be avoided. If it should occur, local injection of hyaluronidase into the area should be performed. An alternative method of treating extravasation is with injection of a steroid, along with saline, into the area followed by application of cold compresses.
Bone marrow suppression is the major side effect. This leads to lowered white blood cell, red blood cell and platelet counts. These decreases lead to increased risk of infection; increased risk of bleeding and decreased exercise tolerance with increased shortness of breath. Rarely, nausea and vomiting occur. However, constipation and abdominal pain have been seen. Neurotoxicity as manifested by depression, headache, malaise, jaw pain, urinary retention, and convulsions have been noted. Other side effects include hair loss (mild), rash, mouth sores and increased sensitivity of the skin to the sun.
Vincristine (Oncovin): administered by intravenous push technique with the entire dose delivered over 1 minute. Alternatively, the drug may be delivered as an infusion over 15 minutes. Vincristine is highly neurotoxic and must not be administered intrathecally (into the brain). It should be noted that inadvertent intrathecal injection of Vincristine is uniformly fatal and must be avoided at all costs.
Extravasation must be avoided. If it should occur, local injection of hyaluronidase and saline (sodium chloride) into the area should be performed. Followed by application of mild heat to the area to disperse the drug.
Neurotoxicity constitutes the common dose limiting toxicity with Vincristine. Symptoms include jaw pain, seizures, constipation, and bladder dysfunction.
Vinorelbine (Navelbine): typically administered as a brief intravenous infusion over 20-30 minutes. Oral capsules are available. The major side effect is the development of bone marrow suppression. This includes decreased white blood counts and anemia (seen in 2 percent of patients). Neurotoxicity has been reported to occur in up to 30 percent of patients with symptoms of constipation and tingling and numbness of the extremities. Hair loss occurs in about one quarter of individuals.