Names and pronunciation
(hye-drox′ee-yoo-ree-ah) Droxia, Hydrea, Siklos
Source page 661
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Individual generic drug information
Extracted information for hydroxyurea only.
(hye-drox′ee-yoo-ree-ah) Droxia, Hydrea, Siklos
Source page 661
Func. class.: Antineoplastic, antime- tabolite
Source page 661
Chem. class.: Synthetic urea analog
Source page 661
Do not confuse: hydroxyurea/hydrOXYzine Hydrea/Lyrica
Source page 661
ACTION: Acts by inhibiting DNA syn- H thesis without interfering with RNA or protein synthesis; incorporates thymidine into DNA, thereby causing direct damage to DNA strands; specific for S phase of cell cycle
Source page 661
USES: Melanoma, chronic myeloge- nous leukemia, recurrent or metastatic ovarian cancer, squamous cell carcinoma of the head and neck, sickle cell anemia
Source page 661
Unlabeled uses: Acute myeloid leuke- mia, essential thrombocythemia, hypereo- sinophilic syndrome, meningioma, polycy- themia vera
Source page 661
Extracted information for hydroxyurea only.
CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity, leu- kopenia (<2500/mm3), thrombocytope- nia (<100,000/mm3), anemia (severe) Precautions: Renal disease (severe), anemia, bone marrow suppression, den- tal disease, geriatric patients, HIV, hyper- kalemia, hyperphosphatemia, hyperuri- cemia, hypocalcemia, infection, infertility, IM injection, tumor lysis syndrome, vaccinations
Source page 661
Black Box Warning: Secondary malig- nancy, bone marrow suppression Black Box Warning: Bone marrow sup- pression: HB, total leukocyte count, and platelet count at least once a week dur- ing entire course; if the WBC is ≤2500/ mm3 or platelets are ≤100,000/mm3, interrupt Hydrea until values closer to normal; if severe anemia occurs, manage without interrupting Hydrea; for Droxia, monitor blood counts q2wk and interrupt if neutrophils are <2000/mm3, platelets are <80,000/mm3, hemoglobin is <4.5 g/dL, or reticulocytes are <80,000/mm3 when the HB <9 g/dL; after recovery, Droxia may be resumed at lower dosage; Droxia requires an experienced clinician knowledgeable in the use of this medica- tion for the treatment of sickle cell anemia • Renal studies: BUN; serum uric acid; urine CCr; electrolytes before, during therapy • Tumor lysis syndrome; hyperkale- mia, hyperphosphatemia, hyperuricemia, hypocalcemia; uric acid nephropathy, acute renal failure, metabolic acidosis can also occur; alkalinization of urine, al- lopurinol may help prevent this • I&O ratio; report fall in urine output to <30 mL/hr • Monitor temperature; fever may indi- cate beginning infection • Hepatic studies before, during therapy: bilirubin, alk phos, AST, ALT, LDH; prn or monthly; pancreatitis may also occur • Cutaneous vasculitic toxicity and gangrene: more common in those who are receiving interferon • Bleeding: hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr • Buccal cavity for dryness, sores or ul- ceration, white patches, oral pain, bleed- ing, dysphagia • Pulmonary reactions: assess for pul- monary fibrosis, fever, dyspnea, diffuse pulmonary infiltrates • Symptoms indicating severe allergic reaction: rash, urticaria, itching, flushing • Neurotoxicity: headaches, hallucina- tions, seizures, dizziness • Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss Black Box Warning: Secondary ma- lignancy: leukemia may occur after ex- tended use • Pregnancy/breastfeeding: do not use in pregnancy/breastfeeding
Source pages 661, 662, 663
SIDE EFFECTS CNS: Headache, confusion, hallucina- tions, dizziness, seizures CV: Angina, ischemia GI: Nausea, vomiting, anorexia, diarrhea, stomatitis, constipation, hepatotoxicity, pancreatitis GU: Increased BUN, uric acid, creatinine, temporary renal function impairment HEMA: Leukopenia, anemia, thrombocy- topenia, megaloblastic erythropoiesis INTEG: Rash, urticaria, pruritus, dry skin, facial erythema META: Hyperphosphatemia, hyperurice- mia, hypocalcemia MISC: Fever, chills, malaise, secondary cancers, tumor lysis syndrome RESP: Pulmonary fibrosis, diffuse pulmo- nary infiltrates
Source page 662
INTERACTIONS Increase: pancreatitis/hepatotoxicity— didanosine, stavudine Increase: toxicity—radiation or other antineoplastics Increase: bleeding risk—NSAIDs, anti- coagulants, thrombolytics, salicylates, platelet inhibitors Increase: uric acid levels—probenecid, sulfinpyrazone • Do not use with live virus vaccines • Do not use hematopoietic progenitor cells (sargramostim, filgrastim) 24 hr be- fore or after antineoplastic Drug/Lab Test Increase: BUN, creatinine, LFTs, uric acid False increase: urea, uric acid, lactic acid Decrease: HB, WBC, platelets, phos- phate, calcium
Source page 662
Extracted information for hydroxyurea only.
DOSAGE AND ROUTES Ovarian cancer, malignant melanoma • Adult: PO 80 mg/kg as a single dose q3days or 20-30 mg/kg as a single dose daily Ovarian cancer in combination with radiation • Adult: PO 80 mg/kg as a single dose q3days Sickle cell anemia • Adult: PO 15 mg/kg/day, may increase by 5 mg/kg/day q12wk, max 35 mg/kg/day Chronic myelogenous leukemia (CML)/acute myelogenous leukemia (unlabeled) • Adult: PO WBC >100,000/mm3, 50- 75 mg/kg/day; WBC <100,000/mm3, 10- 30 mg/kg/day; adjust for WBCs • Child: PO 10-20 mg/kg/day, adjust to hematologic response Renal disease • Adult: PO CCr <59 mL/min use 50% of dose
Source pages 661, 662
Available forms: Caps 200, 300, 400, 500 mg
Source page 662
Administer: • Gloves should be worn when handling bottles or caps, including by caregivers; wash hands immediately and thoroughly • Do not crush or chew caps; caps can be opened and contents mixed with water • Antiemetic 30-60 min before product and prn
Source page 662
Extracted information for hydroxyurea only.
Assess:
Source page 662
Evaluate: • Therapeutic response: decreased tu- mor size, spread of malignancy
Source page 663
CLINICAL CONSIDERATIONS
Source page 662
Patient and caregiver information: • To report signs of infection: elevated temperature, sore throat, flulike symp- toms • To report signs of anemia: fatigue, headache, faintness, SOB, irritability • To report bleeding; to avoid use of razors, commercial mouthwash • To avoid use of aspirin products, ibu- profen (thrombocytopenia) • To avoid foods with citric acid, hot or rough texture if stomatitis is present • To report stomatitis: any bleeding, white spots, ulcerations in the mouth; to examine mouth daily, report symptoms • To inform provider if planning to re- ceive vaccinations • To wear gloves, wash hands before and after handling capsules • To notify prescriber if pregnancy is planned or suspected H • To notify prescriber of fever, chills, sore throat, nausea, vomiting, anorexia, diar- rhea, bleeding, bruising; may indicate blood dyscrasias; mental status changes, pancreatitis, hepatotoxicity
Source page 663
Extracted information for hydroxyurea only.
PHARMACOKINETICS Readily absorbed; peak 1-4 hr; degraded in liver; excreted in urine; almost totally eliminated within 24 hr; crosses blood- brain barrier; eliminated as CO2; half-life 3.5-4.5 hr
Source page 662
Filter the extracted dose blocks for this individual drug.
Ovarian cancer, malignant melanoma
• Child: PO 10-20 mg/kg/day, adjust to hematologic response Renal disease
Candidate age grouping · source pages 661, 662