Home Drug Guide Plicamycin

Drug Guide

Generic Name

Plicamycin

Brand Names Mithracin

Classification

Therapeutic: Antineoplastic agent, Antibiotic

Pharmacological: DNA synthesis inhibitor

FDA Approved Indications

  • Treatment of testicular cancer, especially metastatic disease

Mechanism of Action

Plicamycin binds to DNA, inhibiting RNA synthesis and interfering with cell replication, leading to cytotoxicity especially in rapidly dividing cells.

Dosage and Administration

Adult: Dose varies; typically 20-30 micrograms/kg IV weekly, adjusted based on response and toxicity.

Pediatric: Limited data; use is generally not recommended in children.

Geriatric: Use with caution; monitor closely for toxicity due to decreased organ function.

Renal Impairment: Adjust dose and monitor renal function.

Hepatic Impairment: Use cautiously; hepatic function should be evaluated before and during therapy.

Pharmacokinetics

Absorption: Not applicable (administered IV)

Distribution: Widely distributed; crosses placental barrier

Metabolism: Primarily hepatic

Excretion: Renal and biliary routes

Half Life: Approximately 70 hours, but variable depending on patient condition.

Contraindications

  • Hypersensitivity to plicamycin or other anthracyclines.
  • Severe hepatic or renal impairment.

Precautions

  • Monitor liver and renal functions during therapy.
  • Avoid use in pregnant women due to potential fetal harm.
  • Use with caution in patients with bleeding disorders, as thrombocytopenia may occur.

Adverse Reactions - Common

  • Thrombocytopenia (Common)
  • Neurological effects (e.g., peripheral neuropathy) (Uncommon)
  • Liver toxicity (elevated liver enzymes) (Uncommon)

Adverse Reactions - Serious

  • Myocarditis or cardiomyopathy (Rare)
  • Severe myelosuppression leading to bleeding or infection (Uncommon)
  • Severe allergic reactions (Rare)

Drug-Drug Interactions

  • Other cardiotoxic agents (e.g., anthracyclines) increase risk of cardiotoxicity.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor CBC, liver and renal function tests before and during treatment. Assess neurological status.

Diagnoses:

  • Risk for bleeding due to thrombocytopenia.
  • Risk for cardiotoxicity.
  • Risk for infection due to myelosuppression.

Implementation: Administer IV slowly as prescribed. Monitor for signs of toxicity, bleeding, and allergic reactions.

Evaluation: Assess for tumor response and monitoring adverse effects regularly.

Patient/Family Teaching

  • Report signs of bleeding, infection, or allergic reactions immediately.
  • Avoid pregnancy during treatment and for some time after due to teratogenicity.
  • Follow scheduled blood tests and clinic visits.

Special Considerations

Black Box Warnings:

  • Potentially serious and sometimes fatal cardiotoxicity.
  • Severe myelosuppression.

Genetic Factors: None specified.

Lab Test Interference: May cause transient elevations in liver enzymes and changes in blood counts.

Overdose Management

Signs/Symptoms: Severe myelosuppression, cardiotoxicity, and hypersensitivity reactions.

Treatment: Supportive care includes blood product transfusions, management of cardiac symptoms, and symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

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.