15B Cytoprotective and supportive care agents
ONCOLOGY
;DENOSUMAB
XGEVA Amgen
Osteoclast inhibitor (RANKL inhibitor). Denosumab
120mg/vial (70mg/mL); soln for SC inj; preservative-free.
Indications: Prevention of skeletal-related events
(SRE) in patients with bone metastases from
solid tumors. Not for preventing SRE with multiple
myeloma.
Adults: Give by SC inj into upper arm, upper thigh,
or abdomen. 120mg once every 4 weeks.
Children: Not recommended (interferes with bone
growth and dentition).
Warnings/Precautions: Correct hypocalcemia
before starting; ensure adequate daily calcium,
magnesium, and Vit.D intake, esp. in renal
impairment (CrCl;30mL/min). Monitor calcium,
phosphorus, magnesium levels in susceptible
patients (eg, severe renal impairment, receiving
dialysis). Monitor for osteonecrosis of the jaw. Do
baseline oral exam and preventive dentistry before
and regularly during therapy. Maintain good oral
hygiene. Avoid invasive dental procedures during
treatment. Pregnancy (Cat.C). Nursing mothers:
avoid (may impair mammary gland development/
lactation).
Interactions: Concomitant drugs that can lower
calcium levels; monitor.
Adverse reactions: Fatigue, asthenia,
hypophosphatemia, GI upset, dyspnea, osteonecrosis
of jaw, severe hypocalcemia.
How supplied: Single-use vial ( 1.7mL)– 1
;DEXRAZOXANE
TOTECT TopoTarget
Detoxifying agent. Dexrazoxane 500mg; per vial;
pwd for IV infusion after reconstitution and dilution;
preservative-free.
Indications: To treat extravasation resulting from IV
anthracycline chemotherapy.
Adults: Give once daily for 3 consecutive days by IV
infusion over 1–2 hours. Initiate 1st dose as soon as
possible and within 1st 6 hours after extravasation.
Days 1 and 2: 1000mg/m2; max 2000mg. Day 3:
500mg/m2; max 1000mg. Renal impairment (CrCl
;40mL/min): reduce dose by 50%.
Children: Not recommended.
Warnings/Precautions: Renal or hepatic
impairment (monitor liver enzymes). Monitor for
myelosuppression; obtain blood counts periodically.
Elderly. Labor & delivery. Pregnancy (Cat.D); avoid
use. Nursing mothers: not recommended.
Interactions: Avoid dimethylsulfoxide (DMSO).
Caution with concurrent cytotoxic chemotherapy
(additive cytotoxicity).
Adverse reactions: Inj site reactions, GI
upset, stomatitis, leukopenia, neutropenia,
thrombocytopenia, elevated liver enzymes, pyrexia,
infections.
How supplied: Kit– 10 single-use vials (w. diluent)
;DEXRAZOXANE
ZINECARD Pfizer
Chelating agent. Dexrazoxane 250mg, 500mg; per
vial; pwd for IV infusion after reconstitution and
dilution.
Indications: To reduce the incidence and severity
of cardiomyopathy associated with doxorubicin
administration in women with metastatic breast
cancer who have received a cumulative doxorubicin
dose of 300mg/m2 and will continue to receive
doxorubicin therapy to maintain tumor control.
Adults: Give by slow IV push or rapid drip IV
infusion. Doxorubicin should be administered
within 30 minutes after starting Zinecard infusion.
Administer in 10: 1 ratio (eg, 500mg/m2 Zinecard:
50mg/m2 doxorubicin). Renal impairment (CrCl
;40mL/min): reduce ratio to 5: 1 (eg, 250mg/m2
Zinecard: 50mg/m2 doxorubicin). Hepatic impairment:
may need to reduce doxorubicin dose, therefore
Zinecard dose must be reduced (maintaining 10: 1
ratio).
Children: Not recommended.
Contraindications: Chemotherapy regimens that
do not contain an anthracycline.
Warnings/Precautions: Not recommended for
use with initiation of doxorubicin. Renal or hepatic
impairment. Monitor cardiac function and for
myelosuppression; obtain CBCs frequently. Pregnancy
(Cat.C). Nursing mothers: not recommended.
Adverse reactions: Inj site pain,
myelosuppression, possible secondary malignancies
(see literature).
How supplied: Single-use vial– 1 (w. diluent)
;DIAZOXIDE
PROGLYCEM SUSPENSION Teva
Nondiuretic benzothiadiazine derivative. Diazoxide
50mg/mL; chocolate-mint flavor; contains alcohol
7.25%.
Indications: Management of hypoglycemia due to
hyperinsulinism associated with: inoperable islet
cell adenoma or carcinoma, or extrapancreatic
malignancy in adults; leucine sensitivity, islet cell
hyperplasia, nesidioblastosis, extrapancreatic
malignancy, islet cell adenoma, or adenomatosis in
infants and children.
Adults and Children: Individualize. Infants and
newborns: Initially 10mg/kg/day divided into 3 equal
doses every 8hrs. Usual range: 8–15mg/kg divided
into 2–3 equal doses every 8–12hrs. Adults and
children: Initially 3mg/kg/day divided into 3 equal
doses every 8hrs. Usual range: 3–8mg/kg divided
into 2–3 equal doses every 8–12hrs. Refractory
hypoglycemia: may require higher dosages.
Discontinue if not effective after 2–3 weeks.
Contraindications: Functional hypoglycemia.
Thiazide hypersensitivity.
Warnings/Precautions: Compromised cardiac
reserve: may precipitate CHF. Hyperuricemia.
History of gout. Renal impairment: consider reducing
