Dactinomycin (Actinomycin D)

Indications
Intravenous
Ewing's sarcoma
Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days.
Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle.
Intravenous
Wilm's tumour
Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days.
Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle.
Intravenous
Childhood rhabdomyosarcoma
Adult: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day for 5 days.
Child: >6 mth: 15 mcg/kg/day or 400-600 mcg/m2 BSA/day. To be given for 5 days per 2-wk cycle.
Intravenous
Gestational trophoblastic tumours
Adult: 12 mcg/kg/day for 5 days as a single agent or 500 mcg/day on days 1 and 2 of combination regimens.
Intravenous
Metastatic nonseminomatous testicular cancer
Adult: 1 mg/m2 on day 1 of combination regimens.

Special Populations: Adult and children: dose intensity should not exceed 15 mcg/kg/day or 400-600 mcg/m2/day for 5 days /2-week cycle. Lower doses may be used when combined with chemotherapy or radiotherapy.

Reconstitution: Reconstitute with sterile water for inj without preservatives under aseptic conditions because preservatives may cause precipitation.
Incompatibility: Y-site incompatibility: Filgrastim.
Contraindications
Infection with chicken pox or herpes zoster; hypersensitivity; infants <12 mth. Lactation.
Warnings / Precautions
Admin drug with care to avoid extravsasation. GI toxicity and bone marrow suppression has been reported when given with x-ray therapy. Increased risk of hepatomegaly and elevated SGOT levels when administering within 2 mth of irradiation for the treatment of right-sided Wilms' tumor. Discontinue drug if stomatitis, diarrhoea or severe haematopoietic depression results, until patient recovers. Monitor renal, hepatic and bone marrow functions regularly. Pregnancy.
Adverse Reactions
Cheilitis, dysphagia, oesophagitis, ulcerative stomatitis, pharyngitis; anorexia, nausea, vomiting, abdominal pain, diarrhoea, GI tract ulceration; liver toxicity including ascites, hepatomegaly, hepatitis, LFT abnormalities; anaemia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, reticulopenia, alopoecia; skin eruptions, acne, flare-up of erythema or increased pigmentation of previously irradiated skin. If extravasation occurs during IV use, it leads to severe damage of soft tissues. Malaise, fatigue, lethargy, fever, myalgia, proctitis and hypocalcaemia.
Potentially Fatal: Veno-occlusive disease (primarily hepatic) may result in fatality especially in children <48 mth.
Overdose Reactions
Nausea, vomiting, diarrhoea, mucositis, GI ulceration, skin disorders (e.g. exanthema, desquamation and epidermolysis), severe haematopoietic depression, veno-occlusive disease, acute renal failure and death. Treatment of toxicity is mainly symptomatic and supportive. Monitor skin and mucous membrane integrity, renal, hepatic and bone marrow functions frequently.
Lab Interactions
Dactinomycin may interfere with bioassay procedures for the determination of antibacterial drug levels.
Mechanism of Actions
Dactinomycin binds to the guanine portion of DNA forming a complex which interferes with DNA and RNA synthesis as well as protein synthesis. It may also enhance the cytotoxic effects of radiotherapy.
Distribution: Rapidly distributed with high concentrations in bone marrow and nucleated cells.
Metabolism: Minimal metabolism.
Excretion: Slowly excreted in urine and bile. Plasma half-life: about 36 hr.
Storage Conditions
Intravenous: Store at 25°C.
ATC Classification
L01DA01 - dactinomycin ; Belongs to the class of cytotoxic antibiotics, actinomycines. Used in the treatment of cancer.
Storage
Intravenous: Store at 25°C.
Available As
  • Dactinomycin (Actinomycin D) 500 mcg
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