Tinowel Injection
Dactinomycin
Getwell Pharmaceuticals
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Indications
Tinowel Injection is used for:
Wilms Tumor, Rhabdomyosarcoma, Ewing Sarcoma, Gestational Trophoblastic Neoplasms, Testicular Cancer,
Adult Dose
Intravenous
Childhood rhabdomyosarcoma, Ewing's sarcoma, Wilm's tumour
Adult: 15 mcg/kg daily for 5 days, in combination regimens. Max: 15 mcg/kg or 400-600 mcg/m2 daily for 5 days per 2-wk cycle.
Metastatic nonseminomatous testicular cancer
Adult: 1 mg/m2 on day 1 of combination regimens. Max: 15 mcg/kg or 400-600 mcg/m2 daily for 5 days per 2-wk cycle.
Gestational trophoblastic tumours
Adult: 12 mcg/kg daily for 5 days as a single agent or 500 mcg daily on days 1 and 2 of combination regimens. Max: 15 mcg/kg or 400-600 mcg/m2 daily for 5 days per 2-wk cycle.
Child Dose
Intravenous
Childhood rhabdomyosarcoma, Ewing's sarcoma, Wilm's tumour
Child: >6 mth Same as adult dose.
Renal Dose
Administration
IV Preparation
Follow cytotoxic handling and disposal guidelines
Reconstitute with 1.1 mL of preservative-free sterile water for injection to yield a final concentration of 500 mcg/mL
Resulting solution should appear clear, gold-colored
Further dilute reconstituted product with D5W or 0.9% NaCl to yield concentration >10 mcg/mL
Contains no preservative, discard any unused portions
IV Administration
Vesicant
Administer diluted reconstituted product IV over 10-15 minutes
Do not use in-line cellulose ester membrane filter
Do not give IM or SC
Contra Indications
Hypersensitivity. Patient w/ varicella or herpes zoster infection.
Precautions
Patient w/ impaired bone marrow. Renal and hepatic impairment. Pregnancy and lactation.
Pregnancy-Lactation
Interactions
Combination w/ radiation therapy may result in increased toxicity esp when w/in 2 mth of radiation treatment for right-sided Wilm's tumour. May diminish the therapeutic effect of live vaccines.
Adverse Effects
Side effects of Dactinomycin :
Nausea, vomiting, cheilitis, oesophagitis, GI ulceration, proctitis, fever, malaise, hypocalcaemia, myalgia, alopecia, pneumonitis, kidney and liver abnormalities, eruptions, acne, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, severe tissue damage, oedema, neutropenia and febrile neutropenia.
Potentially Fatal: Hepatic failure, hepatic veno-occlusive disease, particularly in childn <4 yr, myelosuppression, sepsis, including neutropenic sepsis.
Mechanism of Action
Dactinomycin binds to the guanine portion of DNA forming a complex which interferes w/ DNA and RNA synthesis as well as protein synthesis. It is also immunosuppressive and possesses some hypocalcaemic activity.
Note
Tinowel Injection manufactured by Getwell Pharmaceuticals. Its generic name is Dactinomycin. Tinowel is availble in Nepal.
Farmaco Nepal drug index information on Tinowel Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.