📋 Indications & Clinical Dosage
*Choriocarcinoma, Ovarian teratoma, Wilms tumour, Rhabdomyosarcoma, Testicular teratoma, Ewings sarcoma, Neuroblastoma (adjunct):*
Adults: 2.5 mg/m2 in divided doses, over 1 week, repeated every 2 weeks or 0.75-2 mg/m2 every 1-4 weeks or 400-600 mg/m2/day for 5 days, repeated every 3-6 weeks. Refer to individual protocol.
💊 Mode of Administration
Infuse over 10-15 min. Avoid
extravasation. Extremely damaging to soft tissue and will cause a severe local reaction if extravasation occurs. Administer slow IV push over 10-15 min. An in line cellulose membrane filter should not be used during administration of Dactinomycin soln. Do not give IM or SC. Dilute with 1.1 ml of preservative-free SWFI to yield a final concentration of 500 mcg/ml; do not use preservative diluent as precipitation may occur.
⛔ Contraindications
Patients with concurrent or recent chickenpox or herpes zoster, anaphylactic reaction
⚠️ Precautions & Warnings
Use with caution in patients with blood disorder, gout, dental disease, heart disease, who have received radiation therapy. Avoid use within 2 months of radiation treatment for right-sided Wilms tumor, may increase the risk of hepatotoxicity. Discontinue treatment with severe myelo-suppression, diarrhoea or stomatitis.
Avoid use in infants below 6 months age.
🔄 Drug Interactions
BCG; clozapine; natalizumab;
pimecrolimus; tacrolimus (topical); live vaccines (avoid), leflunomide, roflumilast, trastuzumab.
⚠️ Adverse Reactions / Side Effects
Radiosensitization effects, bone marrow suppression, neutropenic fever, anaphylactic reaction, fatigue, alopecia (reversible), Stevens-Johnson syndrome, growth retardation, hyperuricemia, abdominal pain, anorexia, diarrhoea, GI ulceration, nausea, vomiting, anaemia, increased bilirubin, hepatotoxicity, liver function test abnor-mality , erythema oedema, myaliga.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Positive evidence of risk: Avoid
Lactation / Breastfeeding:
Contraindicated. Discontinue breast feeding
🧪 Compatibility & Storage Stability
Compatibility: Stable in D5W, NS, SWFI.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.