• Metastatic malignant melanoma.
• Hodgkin’s disease as second-line therapy (in combination with other agents).

Contraindicated in:

• Hypersensitivity
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Active infection
• Bone marrow depression
• Renal impairment
• Hepatic impairment
• Pedi: Safety and effectiveness not established in children.

Derm: alopecia, facial flushing, photosensitivity, rash.

Endo: gonadal suppression.

GI: anorexia, nausea, vomiting, diarrhea, HEPATIC NECROSIS, hepatic vein thrombosis.

Hemat: anemia, leukopenia, thrombocytopenia.

Local: pain at IV site, phlebitis at IV site, tissue necrosis.

MS: myalgia.

Neuro: facial paresthesia, malaise.
Misc: ANAPHYLAXIS, fever, flu-like syndrome.

Drug-Drug:

• Additive bone marrow depression with other antineoplastics.
• Carbamazepine, phenobarbital, and rifampin may ↓ levels and effectiveness.
• Amiodarone, ciprofloxacin, fluvoxamine, ketoconazole, ofloxacin, isoniazid, or miconazole may ↑ levels and risk of toxicity.
• May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

• Powder for injection: 100 mg/vial; 200 mg/vial;

Malignant Melanoma

• IV (Adults): 2–4.5 mg/kg/day for 10 days administered every 4 wk or 250 mg/m²/day for 5 days administered every 3 wk.

Hodgkin's Disease

• IV (Adults): 150 mg/m²/day for 5 days (in combination with other agents) administered every 4 wk or 375 mg/m² (in combination with other agents) administered every 15 days.

• Disrupts DNA and RNA synthesis (cell-cycle phase–nonspecific).

• Death of rapidly growing tissue cells, especially malignant ones.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues; probably concentrates in liver; some CNS penetration.

Metabolism/Excretion: 50% metabolized by the liver, 50% excreted unchanged by the kidneys.

Half-life: 5 hr (↑ in renal and hepatic impairment).

(effects on blood counts)

• Instruct patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; abdominal pain; yellowing of eyes; or blood in urine, stool, or emesis occur. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patients should be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs; may increase GI irritation.
• May cause photosensitivity. Instruct patient to avoid sunlight or wear protective clothing and use sunscreen for 2 days after therapy.
• Instruct patient to inform health care professional if flu-like syndrome occurs. Symptoms include fever, myalgia, and general malaise. May occur after several courses of therapy. Usually occurs 1 wk after administration. May persist for 1–3 wk. Acetaminophen may be used for relief of symptoms.
• Discuss with patient the possibility of hair loss. Explore coping strategies.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise patient of the need for a nonhormonal method of contraception.
• Instruct patient not to receive any vaccinations without advice of health care professional.

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