Home Drug Guide Dacarbazine

Drug Guide

Generic Name

Dacarbazine

Brand Names DTIC-Dome

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Alkylating agent (imidazole derivative)

FDA Approved Indications

  • Malignant melanoma
  • Hodgkin’s lymphoma
  • Soft tissue sarcomas

Mechanism of Action

Dacarbazine is a prodrug that requires metabolic activation to produce its active metabolites, which methylate DNA, leading to cross-linking and strand breakage, resulting in cell death, particularly in rapidly dividing cells.

Dosage and Administration

Adult: The typical dose is 250-850 mg/m² IV every 3-4 weeks, depending on the indication and patient tolerance.

Pediatric: Dosing varies based on body surface area and condition; consult specific protocols.

Geriatric: Use with caution; adjust dose based on renal and hepatic function.

Renal Impairment: Adjust dosage based on renal function; no specific guidelines—monitor closely.

Hepatic Impairment: Adjust dose in hepatic impairment; no definitive guidelines, caution advised.

Pharmacokinetics

Absorption: Administered IV; not absorbed orally.

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

Metabolism: Hepatically metabolized to active metabolites.

Excretion: Primarily via the urine.

Half Life: Approximately 5-7 hours.

Contraindications

  • Hypersensitivity to dacarbazine or other alkylating agents.
  • Bone marrow suppression.
  • Pregnancy (see pregnancy/lactation guidance).

Precautions

  • Use with caution in hepatic or renal impairment, during active infections, or in patients with myelosuppression.

Adverse Reactions - Common

  • Nausea and vomiting (Very common)
  • Bone marrow suppression (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Severe myelosuppression leading to infection or bleeding (Serious)
  • Liver toxicity, including hepatitis and hepatic failure (Serious)
  • Secondary malignancies, such as leukemia (Long-term risk)

Drug-Drug Interactions

  • CNS depressants, other myelosuppressive agents, phenytoin

Drug-Food Interactions

  • None well established

Drug-Herb Interactions

  • Limited data; caution advised.

Nursing Implications

Assessment: Monitor complete blood counts, liver function tests, and renal function regularly.

Diagnoses:

  • Risk for infection due to immunosuppression
  • Risk for bleeding due to thrombocytopenia

Implementation: Administer IV as prescribed; pre-medicate with antiemetics; monitor blood counts closely.

Evaluation: Assess for effectiveness of therapy and adverse effects; adjust treatment accordingly.

Patient/Family Teaching

  • Report fever, sore throat, unusual bleeding, or unexplained bruising.
  • Use effective antiemetics and eat small, frequent meals if nausea occurs.
  • Avoid pregnancy and use effective contraception.

Special Considerations

Black Box Warnings:

  • Myelosuppression leading to serious or fatal infections, bleeding, or anemia.
  • Secondary malignancies, particularly leukemia and other cancers.

Genetic Factors: Unavailable.

Lab Test Interference: Potentially causes transient elevations in liver enzymes; monitor liver function.

Overdose Management

Signs/Symptoms: Severe myelosuppression, nausea, vomiting, hypotension, seizures, coma.

Treatment: Supportive care, including IV fluids, hematopoietic growth factors, blood transfusions, and symptomatic treatment; no specific antidote.

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable for 24 months when stored properly.

🛡️ 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.