Home Drug Guide Bexarotene

Drug Guide

Generic Name

Bexarotene

Brand Names Targretin

Classification

Therapeutic: Antineoplastic agent, Retinoid

Pharmacological: Retinoid X receptor (RXR) agonist

FDA Approved Indications

  • Cutaneous T-cell lymphoma (CTCL) refractory to at least one prior systemic therapy

Mechanism of Action

Bexarotene selectively activates retinoid X receptors, leading to modulation of gene expression involved in cell differentiation and apoptosis, which helps control malignant T-cell proliferation in CTCL.

Dosage and Administration

Adult: Starting dose typically 300 mg/m²/day orally, adjusted based on response and tolerance.

Pediatric: Not approved for pediatric use; safety and efficacy not established.

Geriatric: Use with caution, considering potential increased sensitivity and comorbidities.

Renal Impairment: No specific dosage adjustment recommended; monitor closely.

Hepatic Impairment: Use with caution; hepatic function should be monitored, dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally, with peak plasma concentrations within 2 hours.

Distribution: Highly plasma protein bound (~99%).

Metabolism: Primarily metabolized by the liver via CYP3A4 enzymes.

Excretion: Metabolites excreted mainly in the feces, minor renal excretion.

Half Life: Approximately 7 hours, but can be longer due to tissue binding.

Contraindications

  • Hypersensitivity to bexarotene or other retinoids.

Precautions

  • Risk of hyperlipidemia, hypothyroidism, pancreatitis, hepatotoxicity; requires regular monitoring.
  • Use with caution in pregnancy; teratogenic risk.

Adverse Reactions - Common

  • Hyperlipidemia (Very common)
  • Hypothyroidism (Common)
  • CNS effects (headache, fatigue) (Common)

Adverse Reactions - Serious

  • Pancreatitis (Rare)
  • Hepatotoxicity (Rare)
  • Teratogenicity (category X) (N/A, contraindicated in pregnancy)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase bexarotene levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor lipid profile, liver function tests, thyroid function, and complete blood counts regularly.

Diagnoses:

  • Risk for altered nutrition: less than body requirements due to gastrointestinal side effects.
  • Impaired skin integrity.

Implementation: Administer with fatty meals to enhance absorption. Educate patient on avoiding pregnancy.

Evaluation: Assess for reduction in skin lesions, monitor for adverse effects.

Patient/Family Teaching

  • Take medication with a meal containing fat to improve absorption.
  • Report symptoms of hyperlipidemia, hypothyroidism, or pancreatitis.
  • Use effective contraception during therapy and for at least 1 month after discontinuation.

Special Considerations

Black Box Warnings:

  • Pregnancy Category X: contraindicated in pregnant women due to high teratogenic risk.

Genetic Factors: None specifically identified.

Lab Test Interference: May cause hyperlipidemia and hypothyroidism, requiring routine labs.

Overdose Management

Signs/Symptoms: Severe hyperlipidemia, hepatotoxicity, hypothyroidism.

Treatment: Discontinue drug; provide supportive care; manage symptoms accordingly.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 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.