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dactinomycin
generic
Adult Dosing .
Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; dose obese or edematous pts based on BSA
Wilms tumor
- [45 mcg/kg/dose IV q3-6wk for up to 26wk]
- Info: part of multi-drug chemo regimen
rhabdomyosarcoma
- [15 mcg/kg/dose IV qd x5 days q3-9wk for up to 112wk]
- Info: part of multi-drug chemo regimen
Ewing sarcoma
- [1250 mcg/m^2/dose IV x1 on day 1 of 21-day cycle x17 cycles]
- Info: part of multi-drug chemo regimen
gestational trophoblastic neoplasia
- [low-risk and non-metastatic dz, monotherapy]
- Dose: 12 mcg/kg/dose IV qd x5 days
- [high-risk metastatic dz, combo tx]
- Dose: 500 mcg IV x1 on days 1-2 of 14-day cycle for up to 4 cycles
solid malignancy, locally recurrent or locoregional
- [lower extremity or pelvis]
- Dose: 50 mcg/kg/dose via regional perfusion x1; Info: for adjunctive or palliative tx; use w/ melphalan
- [upper extremity]
- Dose: 35 mcg/kg/dose via regional perfusion x1; Info: for adjunctive or palliative tx; use w/ melphalan
nonseminomatous testicular CA, metastatic
- [1000 mcg/m^2/dose IV x1 on day 1 of 21-day cycle x4 cycles]
- Info: part of multi-drug chemo regimen
osteosarcoma (off-label)
- [600 mcg/m^2/dose IV x1 on days 1-3 of tx wk 15, 31, 34, 39, and 42]
- Info: part of multi-drug chemo regimen
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments; dose obese or edematous pts based on BSA
Wilms tumor
- [45 mcg/kg/dose IV q3-6wk for up to 26wk]
- Info: part of multi-drug chemo regimen
rhabdomyosarcoma
- [15 mcg/kg/dose IV qd x5 days q3-9wk for up to 112wk]
- Info: part of multi-drug chemo regimen
Ewing sarcoma
- [1250 mcg/m^2/dose IV x1 on day 1 of 21-day cycle x17 cycles]
- Info: part of multi-drug chemo regimen
gestational trophoblastic neoplasia
- [low-risk and non-metastatic dz, monotherapy, postmenarchal pts]
- Dose: 12 mcg/kg/dose IV qd x5 days
- [high-risk metastatic dz, combo tx, postmenarchal pts]
- Dose: 500 mcg IV x1 on days 1-2 of 14-day cycle for up to 4 cycles
nonseminomatous testicular CA, metastatic
- [1000 mcg/m^2/dose IV x1 on day 1 of 21-day cycle x4 cycles]
- Info: part of multi-drug chemo regimen
osteosarcoma (off-label)
- [600 mcg/m^2/dose IV x1 on days 1-3 of tx wk 15, 31, 34, 39, and 42]
- Info: part of multi-drug chemo regimen
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to mannitol
- pregnancy 1st trimester
- avoid: breastfeeding during tx and x14 days after D/C
- caution: XRT, concurrent
- caution: XRT, recent
- caution: myelosuppressive agent use, concurrent
- caution: pts <4 yo
- caution: pregnancy 2nd trimester
- caution: pregnancy 3rd trimester
- caution: female pts of reproductive potential
- caution: male pts of reproductive potential
Drug Interactions .
Overview
dactinomycin
cyclic peptide antibiotic
- immunosuppressive oncologic agent
- myelosuppressive oncologic agent
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- chloramphenicol
- cladribine oral
- deferiprone
- dexrazoxane
- etrasimod
- fexinidazole
- ganciclovir
- palifermin
- penicillamine
- pimecrolimus topical
- primaquine
- rabies vaccine
- radium Ra 223 dichloride
- ropeginterferon alfa-2b
- valganciclovir
Monitor/Modify Tx
- albendazole
- alemtuzumab
- allopurinol
- anthrax vaccine
- anti-thymocyte globulin
- aripiprazole bimonthly injection
- asenapine
- atidarsagene autotemcel
- auranofin
- azathioprine
- balsalazide
- baricitinib
- benznidazole
- betibeglogene autotemcel
- cidofovir
- clozapine
- colchicine
- COVID-19 vaccine
- dapsone
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- eflapegrastim (G-CSF)
- everolimus
- filgrastim (G-CSF)
- flucytosine
- foscarnet
- fostamatinib
- hepatitis A vaccine
- human papillomavirus vaccine
- hydroxychloroquine
- hydroxyurea
- influenza H5N1 vaccine
- interferon beta 1a
- interferon gamma 1b
- Japanese encephalitis vaccine
- leflunomide
- lonafarnib
- lovotibeglogene autotemcel
- lumateperone
- lymphocyte immune globulin, anti-thymocyte globulin
- meningococcal vaccine
- mercaptopurine
- mesalamine rectal
- methotrexate
- mycophenolic acid
- olsalazine
- pegfilgrastim (G-CSF)
- peginterferon alfa 2a
- poliovirus vaccine
- respiratory syncytial virus vaccine
- ribavirin
- ruxolitinib topical
- sarilumab
- satralizumab
- sipuleucel-T
- smallpox/mpox vaccine, live
- succimer
- sulfasalazine
- teplizumab
- thalidomide
- tocilizumab
- trimethoprim
- typhoid vaccine
- upadacitinib
- valproic acid
Caution Advised
- abatacept
- abrocitinib
- adalimumab
- anakinra
- anifrolumab
- avacopan
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- betamethasone
- bimekizumab
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- canakinumab
- certolizumab pegol
- corticotropin
- cortisone
- cyclosporine
- danicopan
- deflazacort
- deucravacitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- diroximel fumarate
- dupilumab
- eculizumab
- efgartigimod alfa
- emapalumab
- fingolimod
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- golimumab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- inebilizumab
- infliximab
- iptacopan
- ixekizumab
- loteprednol ophthalmic
- methylprednisolone
- mirikizumab
- mitoxantrone
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- nadofaragene firadenovec intravesical
- natalizumab
- ocrelizumab
- ofatumumab
- ozanimod
- pegcetacoplan
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- ravulizumab
- rilonacept
- risankizumab
- ritlecitinib
- rozanolixizumab
- secukinumab
- siltuximab
- siponimod
- sirolimus
- spesolimab
- sutimlimab
- tacrolimus
- tezepelumab
- tildrakizumab
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vamorolone
- vedolizumab
- vilobelimab
- voclosporin
- zilucoplan
Adverse Reactions .
Serious Reactions
- secondary malignancy
- hepatic veno-occlusive dz
- hepatotoxicity
- myelosuppression
- tissue damage, extravasation-related
- hypersensitivity rxn
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- radiation recall rxn
- renal failure
- sepsis
Common Reactions
- infection
- alopecia
- rash
- dysphagia
- fatigue
- pyrexia
- nausea
- vomiting
- anemia
- neutropenia
- thrombocytopenia
- mucositis
- hepatotoxicity
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; CBC w/ diff at baseline, then before each cycle; Cr, electrolytes, LFTs, weight at baseline, then frequently
Look/Sound-Alike Drug Names
DACTINomycin confused with: DAPTOmycin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use in 1st trimester, weigh risk/benefit in 2nd and 3rd trimesters; inadequate human data available; risk of teratogenicity based on animal data at 0.5-2x recommended human dose and drug's mechanism of action
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and for at least 6mo after D/C in female pts and during tx and x3mo after D/C in male pts
Lactation
Clinical Summary
avoid breastfeeding during tx and x14 days after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver minimally; CYP450: unknown
Excretion: bile/feces (50% unchanged), urine (10% unchanged); Half-life: 36h
Subclass: Antibiotic Oncologics
Mechanism of Action
binds to DNA, inhibiting RNA synthesis and resulting in cytotoxicity
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: generic
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/dactinomycin
intravenous powder for injection:
- 0.5 mg (1 vial, 1 mL): $540.00
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