Drug Guide

Generic Name

Denileukin Diftitox

Brand Names Ontak

Classification

Therapeutic: Antineoplastic, Immunotoxin

Pharmacological: Cytotoxic agent

FDA Approved Indications

  • Treatment of persistent or recurrent cutaneous T-cell lymphoma (CTCL) in patients with CD25-positive disease

Mechanism of Action

Denileukin Diftitox is a recombinant fusion protein that combines interleukin-2 (IL-2) with diphtheria toxin. It binds to IL-2 receptors (particularly CD25) on target cells, is internalized, and delivers the diphtheria toxin intracellularly, inhibiting protein synthesis and leading to cell death.

Dosage and Administration

Adult: 7.5 μg/kg via intravenous infusion over 15 minutes daily for 5 consecutive days, repeated every 3 weeks as needed.

Pediatric: Not typically recommended; consult specific pediatric protocols.

Geriatric: No specific dosage adjustment, but caution with renal and hepatic function.

Renal Impairment: No specific adjustment; monitor renal function.

Hepatic Impairment: No specific adjustment reported.

Pharmacokinetics

Absorption: Not applicable; administered intravenously.

Distribution: Widely distributed in body tissues.

Metabolism: Enzymatic degradation in tissues and plasma.

Excretion: Primarily via proteolytic degradation; not explicitly excreted unchanged.

Half Life: Approximately 24 hours.

Contraindications

  • Hypersensitivity to Denileukin Diftitox or diphtheria toxin.
  • Active infection.

Precautions

  • Monitor for infusion-related reactions, hypersensitivity, cardiac events, and capillary leak syndrome. Use cautiously in patients with impaired cardiac or vascular function.

Adverse Reactions - Common

  • Fatigue (Common)
  • Nausea (Common)
  • Vomiting (Common)
  • Fever (Common)

Adverse Reactions - Serious

  • Capillary leak syndrome (Rare but serious)
  • Cardiac arrhythmias (Rare)
  • Severe hypersensitivity reactions including anaphylaxis (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines, other cytotoxic agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infusion reactions, hypersensitivity, and capillary leak syndrome. Assess cardiac status and fluid balance.

Diagnoses:

  • Risk for fluid volume overload
  • Risk for hypersensitivity reactions

Implementation: Administer via slow IV infusion under close monitoring. Ensure emergency management measures are available.

Evaluation: Monitor for reduction in CTCL symptoms, adverse effects, and infusion site reactions.

Patient/Family Teaching

  • Report signs of allergic reactions immediately.
  • Inform about possible infusion reactions and symptoms of capillary leak syndrome.
  • Advise against live vaccines during treatment.
  • Follow instructions on infusion schedule and medication handling.

Special Considerations

Black Box Warnings:

  • Capillary leak syndrome may be life-threatening and requires immediate management.

Genetic Factors: No specific genetic markers identified for response.

Lab Test Interference: May alter immune cell counts; monitor labs accordingly.

Overdose Management

Signs/Symptoms: Severe hypotension, shock, edema, or signs of capillary leak syndrome.

Treatment: Supportive care, manage fluid status, and provide intensive care support as needed.

Storage and Handling

Storage: Store vials refrigerated at 2-8°C. Protect from light.

Stability: Stable until the expiration date 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.