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.