dacarbazine

ROUTE		ONSET		PEAK		DURATION
IV (WBCs)		16–20 days		21–25 days		3–5 days
IV (platelets)		unknown		16 days		3–5 days

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

Interactions ⬆ ⬇

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.

Route/Dosage ⬆ ⬇

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 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.

Availability ⬆ ⬇

(Generic available)

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

Assessment ⬆ ⬇

Monitor vital signs prior to and frequently during therapy.
Monitor for bone marrow suppression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis), and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Monitor intake and output, appetite, and nutritional intake. Assess for nausea and vomiting, which may be severe and last 1–12 hr. Administering an antiemetic prior to and periodically during therapy, restricting oral intake for 4–6 hr before administration, and adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status. Nausea usually ↓ on subsequent doses.

Lab Test Considerations:

Monitor CBC with differential prior to and periodically throughout therapy. The nadir of thrombocytopenia occurs in 16 days. The nadir of leukopenia occurs in 3–4 wk. Recovery begins in 5 days. Withhold dose and notify physician if platelet count <100,000/mm³ or WBC count <4000/mm³.
- Monitor for ↑ AST, ALT, BUN, and serum creatinine. May cause hepatic necrosis.

Implementation ⬆ ⬇

High Alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, calculations, and infusion pump settings.
High Alert: Administer under supervision of a physician experienced in use of cancer chemotherapeutic agents.

IV Administration:

Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers.
Dacarbazine is an irritant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient’s extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days.
Intermittent Infusion: Reconstitution: Reconstitute each 100 mg and 200 mg vial with 9.9 mL and 19.7 mL, respectively, of sterile water for injection. Solution is colorless or clear yellow. Do not use solution that has turned pink. Solution is stable for 8 hr at room temperature and for 72 hr if refrigerated. Concentration: 10 mg/mL. Diluent: Further dilute reconstituted solution with 250 mL of D5W or 0.9% NaCl. Stable for 24 hr if refrigerated or 8 hr at room temperature.
Rate: Administer over 15–60 min.
Y-Site Compatibility:
- alemtuzumab
- aminocaproic acid
- aminophylline
- amiodarone
- anidulafungin
- argatroban
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefotetan
- cefoxitin
- ceftazidime
- cefuroxime
- chlorpromazine
- cisatracurium
- cisplatin
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- daunorubicin
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- docetaxel
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- gemcitabine
- gemtuzumab ozogamicin
- glycopyrrolate
- granisetron
- haloperidol
- hydralazine
- hydromorphone
- idarubicin
- ifosfamide
- insulin, regular
- irinotecan
- isoproterenol
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- methadone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitoxantrone
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- topotecan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- allopurinol
- amikacin
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- cefazolin
- ceftriaxone
- cefepime
- cefotaxime
- chloramphenicol
- dantrolene
- dexamethasone
- diazepam
- dobutamine
- dopamine
- epinephrine
- ganciclovir
- gentamicin
- imipenem/cilastatin
- ketorolac
- meropenem
- mesna
- methohexital
- methotrexate
- methylprednisolone
- minocycline
- mitomycin
- nafcillin
- norepinephrine
- pantoprazole
- pemetrexed
- phenytoin
- piperacillin/tazobactam
- tobramycin
- trimethoprim/sulfamethoxazole

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Instruct patient to notify health care provider 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 provider 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.
Instruct patient not to receive any vaccinations without advice of health care provider.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Advise patient of the need for a nonhormonal method of contraception.

Evaluation/Desired Outcomes ⬆ ⬇

Death of rapidly growing tissue cells, especially malignant ones.

Code ⬆

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9245- Dacarbazine
  - 0143-9245-10- 10 VIAL in 1 CARTON (0143-9245-10) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (0143-9245-01)

42973- Apicore Pharmaceuticals Private Limited
- 42973-149-
  - 42973-149-00- 50 kg in 1 DRUM (42973-149-00)

54875- Heraeus Precious Metals GmbH & Co. KG
- 54875-0003-
  - 54875-0003-1- 1 BOTTLE, PLASTIC in 1 BAG (54875-0003-1) / 2000 g in 1 BOTTLE, PLASTIC

63323- Fresenius Kabi USA, LLC
- 63323-127- Dacarbazine
  - 63323-127-10- 10 VIAL, SINGLE-DOSE in 1 TRAY (63323-127-10) / 10 mL in 1 VIAL, SINGLE-DOSE (63323-127-00)

63323- Fresenius Kabi USA, LLC
- 63323-128- Dacarbazine
  - 63323-128-20- 10 VIAL, SINGLE-DOSE in 1 TRAY (63323-128-20) / 20 mL in 1 VIAL, SINGLE-DOSE (63323-128-00)

71288- Meitheal Pharmaceuticals Inc.
- 71288-174- Dacarbazine
  - 71288-174-21- 10 VIAL, SINGLE-USE in 1 CARTON (71288-174-21) / 20 mL in 1 VIAL, SINGLE-USE (71288-174-20)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇