CV: edema (IV only).
Derm: pruritus (Jelmyto only), alopecia (IV only), desquamation (IV only).
F and E: hyperkalemia (Jelmyto only), hypocalcemia (Jelmyto only).
GI: abdominal pain (Jelmyto only), hypoalbuminemia (Jelmyto only), nausea, vomiting, anorexia, stomatitis (IV only).
GU: dysuria (Jelmyto only), flank pain (Jelmyto only), hematuria (Jelmyto only), pollakiuria (Jelmyto only), renal impairment, ureteric obstruction (Jelmyto only), urinary tract infection (Jelmyto only), infertility (IV only), UROSEPSIS (JELMYTO ONLY).
Hemat: anemia, leukopenia, lymphopenia (Jelmyto only), thrombocytopenia, HEMOLYTIC UREMIC SYNDROME (IV ONLY), NEUTROPENIA.
Local: phlebitis at IV site.
Metab: hyperuricemia (Jelmyto only).
Resp: PULMONARY TOXICITY (IV ONLY).
Misc: chills (Jelmyto only), fatigue, fever.
Interactions noted are for IV therapy only.
Drug-Drug:
- Additive bone marrow depression with other antineoplastics or radiation therapy.
- May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
- Concurrent or sequential use with vinca alkaloids may result in respiratory toxicity.
IV and pyelocalceal (ureteral) formulations are not interchangeable.
- IV (Adults): 20 mg/m2 every 6–8 wk.
- Pyelocalyceal (ureteral) (Adults): Instill 4 mg per mL via ureteral catheter or a nephrostomy tube, with total instillation volume based on volumetric measurements using pyelography (not to exceed 15 mL [60 mg]). Instill once weekly for a total of 6 wk. If complete response demonstrated 3 mo after initiation of therapy, continue instillations once monthly for a maximum of 11 additional instillations.
Therapeutic Classification: antineoplastics
Pharmacologic Classification: antitumor antibiotics
Absorption: IV administration results in complete bioavailability. Bioavailability following pyelocalyceal administration unknown.
Distribution: Widely distributed, concentrates in tumor tissue. Does not enter CSF.
Metabolism/Excretion: Mostly metabolized by the liver. Small amounts (<10%) excreted unchanged by the kidneys and in bile.
Half-life: IV: 50 min.
(effects on blood counts)
6 hr postinstillation. Advise patients to void sitting on a toilet; flush the toilet several times after use; and to wash hands, perineum, or glans with soap and water after each instillation procedure. Advise patients to wash clothing soiled with urine promptly and separately from other clothing.