Home Drug Guide Arsenic Trioxide

Drug Guide

Generic Name

Arsenic Trioxide

Brand Names Trisenox

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Differentiating agent

FDA Approved Indications

  • Acute Promyelocytic Leukemia (APL), specifically in cases with relapsed or refractory disease

Mechanism of Action

Induces apoptosis and promotes differentiation of leukemic cells by targeting the PML-RARα fusion protein, disrupting abnormal cell proliferation.

Dosage and Administration

Adult: 0.15 mg/kg/day IV over 2 hours for 5 days, repeated every 4 weeks until remission or intolerable toxicity.

Pediatric: Dose based on body weight, typically 0.15 mg/kg/day IV over 2 hours, with adjustments based on response and toxicity.

Geriatric: Use cautiously; monitor for toxicity due to decreased organ function.

Renal Impairment: Adjust dose based on renal function; closely monitor renal parameters.

Hepatic Impairment: No specific adjustment available; monitor liver function tests.

Pharmacokinetics

Absorption: Poor oral absorption; administered intravenously.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized partially in the liver.

Excretion: Primarily via urine, with some fecal excretion.

Half Life: Approximately 1 to 3 days, variable depending on individual patient factors.

Contraindications

  • Known hypersensitivity to arsenic compounds

Precautions

  • Monitor for QT prolongation and arrhythmias, hepatic and renal impairment, electrolyte imbalances, secondary infections, and signs of differentiation syndrome. Use with caution in pregnancy and lactation, as safety is not fully established.

Adverse Reactions - Common

  • Nausea, vomiting, diarrhea (Common)
  • Electrolyte imbalances (hypokalemia, hypomagnesemia) (Common)
  • QT prolongation, arrhythmias (Uncommon)

Adverse Reactions - Serious

  • QTc prolongation leading to torsades de pointes (Rare)
  • Differentiation syndrome (fever, weight gain, respiratory distress, effusions) (Potentially serious but rare)
  • Hepatotoxicity, hepatocellular injury (Rare)
  • Myelosuppression (Common)

Drug-Drug Interactions

  • QT prolonging agents (e.g., certain antiarrhythmics, antidepressants)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor cardiac status (ECGs), electrolytes, liver and kidney function, and signs of differentiation syndrome.

Diagnoses:

  • Risk for cardiac arrhythmias
  • Risk for infection due to myelosuppression
  • Altered nutrition related to gastrointestinal symptoms

Implementation: Administer IV as prescribed, monitor vital signs and labs closely, correct electrolyte imbalances, and provide supportive care.

Evaluation: Assess for remission of leukemia, resolution of symptoms, and monitor for adverse effects.

Patient/Family Teaching

  • Inform about the importance of regular blood tests and cardiac monitoring.
  • Report any signs of arrhythmias, abnormal bleeding, or infection immediately.
  • Avoid concomitant use of other QT-prolonging medications unless supervised by healthcare provider.

Special Considerations

Black Box Warnings:

  • QT prolongation and serious arrhythmias, including torsades de pointes.
  • Differentiation syndrome, which can be life-threatening.
  • Pregnancy category D: risk to fetus; use only if benefits outweigh risks.

Genetic Factors: None specific beyond general pharmacogenomic considerations.

Lab Test Interference: May cause transient increases in liver enzymes; monitor labs regularly.

Overdose Management

Signs/Symptoms: Severe nausea, vomiting, diarrhea, hypotension, arrhythmias, CNS effects including ataxia and encephalopathy.

Treatment: Discontinue arsenic; manage supportive care including electrolyte correction, cardiac monitoring, and symptomatic treatment. Consider chelation therapy with dimercaprol in severe cases.

Storage and Handling

Storage: Store in a secure, well-ventilated area at controlled room temperature. Keep out of reach of children.

Stability: Stable when stored properly; do not use beyond expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.