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dactinomycin (actinomycin-D, Cosmegen)
Tradename: Cosmegen.
Indications:
1) Wilm's tumor
2) rhabdomyosarcoma
3) Ewing's sarcoma
4) melanoma
5) neuroblastoma
6) retinoblastoma
7) trophoblastic neoplasms
8) testicular carcinoma
9) other malignancies
Contraindications:
1) patients with chicken pox or Herpes zoster
2) infants < 6 months of age
Dosage:
1) 1-2 mg/m2 every 3-4 weeks
2) 0.25-0.6 mg/m2 daily for 5 days every 3-4 weeks
Powder for injection: 0.5 mg/3mL.
Do NOT use inline cellulose filter for IV administration.
Pharmacokinetics:
1) well distributed to tissues
2) poor CSF penetration
3) metabolized by liver
4) eliminated in the bile & urine
5) 1/2life 30-40 hours
Adverse effects: (worse with consecutive doses)
1) common (> 10%)
- alopecia (reversible)
- hyperpigmentation of the skin
- fatigue
- esophagitis
- nausea/vomiting (moderate to severe)
2) less common (1-10%)
- diarrhea, mucositis
3) uncommon (< 1%)
- anaphylactoid reaction, hepatitis, hyperuricemia, skin eruptions, acne, fever, hypocalcemia
4) other
- extravasation may lead to tissue necrosis
- myelosuppression
- dose-limiting toxicity
- onset 7 days; nadir 14-21 days; recovery 21-18 days
- leukopenia (moderate)
- thrombocytopenia (moderate)
- pancytopenia, agranulocytosis, aplastic anemia
- mucositis
- radiation recall
Drug interactions:
- may interfere with drug level determination of vancomycin & gentamicin
Mechanism of action:
1) anti-tumor antibiotic
2) DNA intercalating agent
a) inhibits DNA replication
b) inhibits RNA synthesis
3) topoisomerase inhibitor [3]
3) non cell-specific
Interactions
drug interactions
General
actinomycin
antibiotic antineoplastic agent
Properties
MISC-INFO: elimination route LIVER
KIDNEY
1/2life 30-40 HOURS
Database Correlations
PUBCHEM correlations
References
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 529