Generic Name

Thiotepa

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Classification

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

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.