Home Drug Guide Thiotepa

Drug Guide

Generic Name

Thiotepa

Brand Names Thioplex, Tepadina, Tepylute

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Alkylating agent

FDA Approved Indications

  • Intravesical chemotherapy for bladder cancer
  • Preparation for bone marrow transplant in hematologic malignancies

Mechanism of Action

Thiotepa is an alkylating agent that crosslinks DNA strands, inhibiting DNA replication and leading to cell death, primarily affecting rapidly dividing cells.

Dosage and Administration

Adult: Dose varies based on treatment protocol, generally given intravenously or intravesically as per oncologist instructions.

Pediatric: Used with caution; dose determined by body surface area and treatment protocol.

Geriatric: Adjusted based on renal and hepatic function, with careful monitoring.

Renal Impairment: Dose adjustment may be necessary due to decreased clearance.

Hepatic Impairment: Use with caution; monitor liver function due to potential hepatotoxicity.

Pharmacokinetics

Absorption: Rapid when administered intravenously.

Distribution: Widely distributed in body tissues, crossing the blood-brain barrier.

Metabolism: Extensively metabolized in the liver.

Excretion: Primarily excreted via urine.

Half Life: Approximately 3-4 hours.

Contraindications

  • Hypersensitivity to thiotepa or other alkylating agents.
  • Severe myelosuppression.

Precautions

  • Use cautiously in hepatic or renal impairment.
  • Pregnancy Category D: risk to fetus; effective contraception recommended during treatment and for some time after.

Adverse Reactions - Common

  • Bone marrow suppression (neutropenia, thrombocytopenia, anemia) (Common)
  • Alopecia (Common)
  • Nausea and vomiting (Common)

Adverse Reactions - Serious

  • Hemorrhagic cystitis (Serious)
  • Secondary malignancies (late effect) (Rare)
  • Severe infections due to immunosuppression (Serious)

Drug-Drug Interactions

  • Other myelosuppressive agents, including radiation therapy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts regularly; assess renal and hepatic function.

Diagnoses:

  • Risk for infection
  • Impaired tissue integrity
  • Risk for bleeding

Implementation: Administer as ordered; implement protective precautions against infection; monitor for signs of hemorrhagic cystitis.

Evaluation: Assess blood counts; monitor for adverse effects; evaluate response to treatment.

Patient/Family Teaching

  • Report symptoms of infection, bleeding, or unusual fatigue.
  • Maintain hydration to prevent cystitis.
  • Follow instructions regarding contraception.
  • Avoid contact with sick individuals.

Special Considerations

Black Box Warnings:

  • May cause severe myelosuppression leading to infection, bleeding, and anemia.
  • Potential for secondary malignancies.

Genetic Factors: Not well characterized; genetic variations may affect metabolism and toxicity.

Lab Test Interference: May cause false elevation of serum creatinine.

Overdose Management

Signs/Symptoms: Bone marrow suppression, hemorrhagic cystitis, severe mucositis.

Treatment: Supportive care, discontinuation of drug, and possibly administration of hematopoietic growth factors or transfusions.

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable under recommended storage conditions for the duration of shelf life.

🛡️ 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.