📋 Indications & Clinical Dosage
*Variety of cancers including leukaemias, lymphomas, and some solid tumours (e.g. breast and lung cancer):*
BY IV INF: Adults: 0.4-1.4 mg/m2, may repeat every wk or 0.4-0.5 mg/day continuous INF for 4 days every 4 week or 0.25-0.5 mg/ m2/d continuous INF for 5 days every 4 week. Also refer individual protocols for dosages.
Children: <10 kg or BSA<1 m2: Initial therapy: 0.05 mg/kg once weekly then titrate dose; max single dose: 2 mg. 10 kg or BSA>1 m2: 1-2 mg/m2, may repeat once wkly for 3-6 week; max single dose: 2 mg.
*Neuroblastoma:*
BY IV INF: Adult: continuous INF with doxorubicin: 1 mg/m2/day for 72 hr.
💊 Mode of Administration
Administered as slow (1-2 min) push or short (10-15 min) infusion; 24 hours continuous infusions are occasionally used.Solutions for IV infusion may be mixed in NS or D5W.
⛔ Contraindications
Patients with demyelinating form of Char-cot- Marie- tooth syndrome.
⚠️ Precautions & Warnings
Impaired hepatic function, elderly, pre-existing neuro-muscular disease. Intrathecal administration can cause severe neurotoxicity which may result in death.
🔄 Drug Interactions
Digoxin, CYP3A4 enzyme inhibitors, mitomycin C.
⚠️ Adverse Reactions / Side Effects
Alopecia, autonomic neuropathy, extravasation, eye disorders, hyperuricaemia, loss of deep tendon reflexes, motor weakness, muscle wasting, myelosuppression, neurotoxicity, oral mucositis, ototoxicity, peripheral neuropathy, peripheral paraesthesia, severe bronchospasm, severe local irritation, thromboembolism, tumourlysis syndrome, vomiting. Rare: Inappropriate secretion of antidiuretic hormone, intestinal necrosis, paralytic ileus, seizures, urinary retention
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Positive evidence of risk: Avoid
Lactation / Breastfeeding:
Contraindicated. Discontinue breast-feeding
🧪 Compatibility & Storage Stability
Compatibility: Stable in D5W, LR, NS.
Stability & Storage: Store refrigerated at 2C-8C (36F-46F). Protect from light.
📚 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.