NAME OF DRUG
dacarbazine

CLASSIFICATION

Cytotoxic agent- non-vesicant
Alkylating agent

ALTERNATE NAMES

DTIC

INDICATIONS

• treatment of metastatic malignant melanoma
• in combination with other antineoplastics for treatment of Hodgkin's disease and soft tissue sarcomas

• plasma concentrations of dacarbazine decline in a biphasic manner:  individuals with normal renal function have an initial half-life of 19 minutes and a terminal half-life of 5 hours
• in renal and hepatic dysfunction the initial phase half-life of 55 minutes and the terminal phase half-life of 7.2 hours have been reported
• dacarbazine is extensively metabolized in the liver and is excreted in the urine by tubular secretion:  30-46% of a dose is excreted in the urine within 6 hours:  50% as metabolite and 50% as unchanged drug

• ALL cytotoxic agents are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date.  All cytotoxic waste including bags, sets, tubing, gloves, etc. must be properly disposed of in the cytotoxic waste containers on the nursing unit.

• compatible with D5W and NS
• incompatible with other drugs

• IV direct - at a rate of 100 mg/minute into IV tubing of a running infusion of NS or D5W
• IV intermittent - in 50-250 mL of NS or D5W, administered over 30 minutes

NOTE:  IV intermittent is usually less painful than IV direct.

A Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO # 45) must be used for prescribing if this cytotoxic agent
is not already on an existing PPO.

G - Cytotoxic Agents - See Drug Table G for specific administration guidelines.
H - The IV infusion rate MUST be controlled by an automated infusion control device.

DOSAGE

Dose and schedule depend on protocol and patient response.

• doses from 2-4.5 mg/kg/day for 10 days up to 850 mg/m² as a single dose may be given at intervals of 3-4 weeks
• lower doses may be required for those patients with hepatic and renal dysfunction

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• extravasation (see Appendix VII for extravasation protocol for non-vesicants)
• local pain, burning sensation and irritation at the injection site may be relieved by local application of hot packs

IMPORTANT IMPLICATIONS

• bone marrow depression is usually mild and occurs 2-4 weeks after the last dose; the patient's hematologic status must be carefully monitored
• severe nausea and vomiting occur in more than 90% of patients generally within l hour of the dose
• tolerance to the GI effects usually develops after 1-2 days of treatment
• "flu-like" syndrome may occur either during or after treatment (fever, myalgia and malaise)
• transitory facial flushing and paresthesia may occur

VGH Site only:
Notify security-84 immediately upon accidental spillage.
DO NOT ATTEMPT CLEAN-UP

• See also Appendix VI

Rev. May 2006