Posted on April 28th, 2009 by
Generic Name: Procarbazine (proh-KAR-be-zeen)
Trade Name: Matulane®
How is this drug used? Procarbazine is FDA approved for the treatment of advanced Hodgkin’s disease, in combination with other chemotherapy agents. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Procarbazine belongs to a group of drugs called alkylating agents. Procarbazine produces its anti-cancer effects by causing a chemical reaction that damages the DNA in a cell and inhibits DNA and protein synthesis. The DNA damage caused by procarbazine results in cell death.
How is procarbazine given (administered)? Procarbazine is administered orally, in the form of capsules, and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.
Patients should not drink alcohol while receiving procarbazine due to an acute reaction. Symptoms may include nausea or vomiting, flushing, headache, sweating, dizziness, difficulty breathing, chest pain or irregular heartbeat. Patients should not eat tyramine containing foods such as wine, chocolate, aged meats, ripe cheeses, yogurt, or bananas due to potential hypertensive crisis, bleeding and headache,
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with procarbazine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
What are the common (occur in 30% or more of patients) side effects of treatment with procarbazine?
• Low white blood cell levels – increases risk of infection
• Low platelet levels – increases risk of bleeding
• Low red blood cell levels – increases risk of anemia
• Nausea and vomiting
• Loss of appetite
What are the less common (occur in 10% to 29% of patients) side effects of treatment with procarbazine?
• Mouth sores
• Fever, chills, aches (flu-like symptoms)
• Loss of hair
• Allergic-type reaction (difficulty breathing, dizziness, rash, itching, hives, closing of the throat)
• Loss of balance, drowsiness, dizziness, headache, confusion (central neurotoxicity)
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are the possible late side effects of treatment with procarbazine?
Patients treated with procarbazine have a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment. Infertility may also be a long-term side effect of procarbazine treatment.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, patients should avoid large crowds or persons who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should not consume the following: wine or alcohol, aged meats, chocolate, yogurt, ripe cheese and bananas.
• Procarbazine has cross-reactions with several types of medications and foods – patients need to discuss these with their physician.
• If an oral dose is missed, do not double up on doses. Patients should contact their doctor in this event.
• Keep capsules out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
• Patients should use caution when driving or completing tasks that require mental alertness until effects of the drug are known
When should patients notify their physician?
• Allergic-type reaction symptoms – difficulty breathing, dizziness, rash, itching, hives, closing of the throat
• Loss of balance, drowsiness, dizziness, headache
• Chest pain or palpitations
• Difficulty breathing, cough
• Changes in vision
• Seizures, convulsions
• Yellowing of skin or eyes
• Swelling of feet or ankles
• Sudden weight gain
• Severe abdominal pain
• Fever, chills, cough, sore throat, flu or cold-like symptoms
• Signs of infection – redness, swelling, pus, tenderness, painful urination
• Persistent or severe fatigue
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Mouth sores
• Severe or prolonged diarrhea
• Confusion, depression, hallucinations, nightmares
• Irritability or nervousness
• Tingling or numbness
• Chest pain or change in heart rhythm
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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