Names and pronunciation
(proe-kar′ba-zeen) Matulane
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Drug reference
(proe-kar′ba-zeen) Matulane
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Func. class.: Antineoplastic, alkylating agent
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Chem. class.: Hydrazine derivative
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Do not confuse: Matulane/Materna
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ACTION: Inhibits DNA, RNA, protein synthesis; has multiple sites of action; nonvesicant
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USES: Lymphoma, Hodgkin’s disease, cancers resistant to other therapy
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CONTRAINDICATIONS: Preg nancy, breastfeeding, hypersensitivity, thrombocytopenia, bone marrow depression Precautions: Cardiac/renal/hepatic dis- ease, radiation therapy, seizure disorder, anemia, bipolar disorder, Parkinson’s disease
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Black Box Warning: Requires a special- ized care setting and an experienced clinician Black Box Warning: To be used only in a specialized care setting with emergency equipment Black Box Warning: To be given only by an experienced clinician knowledgeable in cytotoxic products • CNS changes: confusion, paresthesias, neuropathies; product should be discon- tinued • Tyramine foods in diet; hypertensive crisis can occur • Toxicity: facial flushing, epistaxis, in- creased PT, thrombocytopenia; product should be discontinued • Bleeding: hematuria, guaiac stools, bruis- ing or petechiae, mucosa or orifices q8hr • Effects of alopecia on body image; discuss feelings about body changes • Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdomi- nal pain, fever, diarrhea • Buccal cavity for dryness, sores or ul- ceration, white patches, oral pain, bleed- ing, dysphagia • GI symptoms: frequency of stools, cramping • Acidosis, signs of dehydration: rapid res- pirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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SIDE EFFECTS CNS: Headache, dizziness, insomnia, hallucinations, confusion, coma, pain, chills, fever, sweating, paresthesias, sei- zures, peripheral neuropathy EENT: Retinal hemorrhage, nystagmus, photophobia, diplopia, dry eyes GI: Nausea, vomiting, anorexia, diar- rhea, constipation, dry mouth, stomatitis, elevated hepatic enzymes GU: Azoospermia, cessation of menses HEMA: Thrombocytopenia, anemia, leu- kopenia, myelosuppression, bleeding ten- dencies, purpura, petechiae, epistaxis, hemolysis INTEG: Rash, pruritus, dermatitis, alope- cia, herpes, hyperpigmentation MS: Arthralgias, myalgias RESP: Cough, pneumonitis, hemoptysis SYST: Secondary malignancy
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INTERACTIONS Increase: hypotension—meperidine; do not use together Increase: neuroleptic malignant syn- drome, seizures, hyperpyrexia—alcohol, MAOIs, tricyclics, sympathomimetic prod- ucts, SSRIs, SNRIs Increase: hypertension—guanethidine, levodopa, methyldopa, reserpine, caffeine Life-threatening hypertension: sympa thomimetics Increase: bleeding risk—NSAIDs, anti- coagulants, platelet inhibitors, thrombolytics Increase: CNS depression—barbiturates, antihistamines, opioids, hypotensive agents, phenothiazines Drug/Food P • Hypertensive crisis: tyramine foods
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DOSAGE AND ROUTES • Adult: PO 2-4 mg/kg/day for 1st wk; maintain dosage of 4-6 mg/kg/day until platelets, WBC fall; after recovery, 1-2 mg/kg/day, may use as single agent or in combination • Child: PO 50 mg/m2/day for 7 days, then 100 mg/m2 until desired response, leukopenia, or thrombocytopenia oc- curs; 50 mg/m2/day maintenance after bone marrow recovery
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Available forms: Caps 50 mg
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Administer: • In divided doses and at bedtime to minimize nausea and vomiting • Nonphenothiazine antiemetic 30-60 min before product and 4-10 hr after treatment to prevent vomiting
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Assess: • Bone marrow suppression: CBC, dif- ferential, platelet count weekly; withhold product if WBC is <4000/mm3 or platelet count is <100,000/mm3; notify prescriber • Hepatic/renal disease: can cause ac- cumulation of drug, increased toxicity; renal studies: BUN; serum uric acid; urine CCr; electrolytes before, during therapy; I&O ratio, report fall in urine output to <30 mL/hr; hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos, LDH prn or monthly • Monitor temperature; fever may indi- cate beginning infection
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Evaluate: • Therapeutic response: decreasing ma- lignancy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any complaints, side ef- fects to nurse or prescriber: CNS changes, diarrhea, cough, SOB, fever, chills, sore throat, bleeding, bruising, vomiting blood; black, tarry stools • That hair may be lost during treatment and wig or hairpiece may make patient feel better; that new hair may be different in color, texture • To avoid sunlight or UV exposure; to wear sunscreen or protective clothing • To avoid foods with citric acid, hot temperature, or rough texture • To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily • To avoid driving, activities requiring alertness because dizziness may occur • Pregnancy/breastfeeding: to use ef- fective contraception; to avoid breast- feeding; that product may cause infertil- ity • To avoid the ingestion of alcohol, caf- feine, tyramine-containing foods; that cold, hay fever, and weight-reducing products may cause serious product in- teractions; to avoid smoking • To avoid crowds, persons with infec- tions if granulocytes are low • To avoid vaccines
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PHARMACOKINETICS Half-life 1 hr; concentrates in liver, kid- ney, skin; metabolized in liver, excreted in urine
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• Adult: PO 2-4 mg/kg/day for 1st wk; maintain dosage of 4-6 mg/kg/day until platelets, WBC fall; after recovery, 1-2 mg/kg/day, may use as single agent or in combination
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• Child: PO 50 mg/m2/day for 7 days, then 100 mg/m2 until desired response, leukopenia, or thrombocytopenia oc- curs; 50 mg/m2/day maintenance after bone marrow recovery
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