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Drug:   Dacarbazine

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

NS,   D5W

Dilution Data

DILUTION SUMMARY

[Amount of drug] [Infusion volume] [Infusion rate]

[Prescribed dose ]  [250-500 ml]  [ 30 - 120 minutes]

 (Infused through main IV line or central venous access device, with an additional 500 mL or more of NS run at the same time by IVPB, to reduce vein irritation).

Reconstitution:
Dacarbazine for injection 200 mg/vial is reconstituted with 19.7 mL of sterile water for injection, USP. Dacarbazine for injection 500 mg/vial is reconstituted with 49.25 mL of sterile water for injection, USP. The resulting solution contains 10 mg/mL of dacarbazine having a pH of 3.0 to 4.0. The calculated dose of the resulting solution is drawn into a syringe and administered only intravenously.1

The reconstituted solution may be further diluted with 5% dextrose injection or sodium chloride injection and administered as an intravenous infusion.

After reconstitution and prior to use, the solution in the vial may be stored at 4°C for up to 72 hours or at normal room conditions (temperature and light) for up to 8 hours. If the reconstituted solution is further diluted in 5% dextrose injection or sodium chloride injection, the resulting solution may be stored at 4°C for up to 24 hours or at normal room conditions for up to 8 hours. 1


IV Administration:
[Prescribed dose ]  [250 - 500 ml]  [ 30 to 120 minutes] 2


Stability / Miscellaneous

WARNINGS INDICATIONS CONTRAINDICATIONS
DOSAGE AND ADMINISTRATION PREPARATION / DILUTION HOW SUPPLIED
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WARNINGS
It is recommended that dacarbazine for injection be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.
  1. Hemopoietic depression is the most common toxicity with dacarbazine for injection. (See WARNINGS.)
  2. Hepatic necrosis has been reported. (See WARNINGS.)
  3. Studies have demonstrated this agent to have a carcinogenic and teratogenic effect when used in animals.
  4. In treatment of each patient, the physician must weigh carefully the possibility of achieving therapeutic benefit against the risk of toxicity.


DESCRIPTION
Dacarbazine for injection, USP is a colorless to an ivory colored solid which is light sensitive. Each 20 mL vial contains 200 mg of dacarbazine (active ingredient). Each vial also contains anhydrous citric acid and mannitol. Dacarbazine for injection is reconstituted and administered intravenously (pH 3–4). Dacarbazine for injection is an anticancer agent.

CLINICAL PHARMACOLOGY
After intravenous administration of dacarbazine for injection, the volume of distribution exceeds total body water content suggesting localization in some body tissue, probably the liver. Its disappearance from the plasma is biphasic with initial half-life of 19 minutes and a terminal half-life of 5 hours.1 In a patient with renal and hepatic dysfunctions, the half-lives were lengthened to 55 minutes and 7.2 hours.1 The average cumulative excretion of unchanged dacarbazine in the urine is 40% of the injected dose in 6 hours.1 Dacarbazine is subject to renal tubular secretion rather than glomerular filtration.

At therapeutic concentrations dacarbazine is not appreciably bound to human plasma protein.

In man, dacarbazine is extensively degraded. Besides unchanged dacarbazine, 5-aminoimidazole -4 carboxamide (AIC) is a major metabolite of dacarbazine excreted in the urine. AIC is not derived endogenously but from the injected dacarbazine, because the administration of radioactive dacarbazine labeled with 14C in the imidazole portion of the molecule (dacarbazine-2-14C) gives rise to AIC-2-14C.1

Although the exact mechanism of action of dacarbazine for injection is not known, three hypotheses have been offered:
1] Inhibition of DNA synthesis by acting as a purine analog
2] Action as an alkylating agent
3] Interaction with SH groups


INDICATIONS AND USAGE
Dacarbazine for injection is indicated in the treatment of metastatic malignant melanoma. In addition, dacarbazine for injection is also indicated for Hodgkin's disease as a secondary-line therapy when used in combination with other effective agents.


CONTRAINDICATIONS
Dacarbazine for injection is contraindicated in patients who have demonstrated a hypersensitivity to it in the past.

WARNINGS
Hemopoietic depression is the most common toxicity with dacarbazine for injection and involves primarily the leukocytes and platelets, although anemia may sometimes occur. Leukopenia and thrombocytopenia may be severe enough to cause death. The possible bone marrow depression requires careful monitoring of white blood cells, red blood cells, and platelet levels. Hemopoietic toxicity may warrant temporary suspension or cessation of therapy with dacarbazine for injection.

Hepatic toxicity accompanied by hepatic vein thrombosis and hepatocellular necrosis resulting in death, has been reported. The incidence of such reactions has been low; approximately 0.01% of patients treated. This toxicity has been observed mostly when dacarbazine for injection has been administered concomitantly with other anti-neoplastic drugs; however, it has also been reported in some patients treated with dacarbazine for injection alone.

Anaphylaxis can occur following the administration of dacarbazine for injection.


DOSAGE AND ADMINISTRATION

Malignant Melanoma
The recommended dosage is 2 to 4.5 mg/kg/day for 10 days. Treatment may be repeated at 4 week intervals.

An alternate recommended dosage is 250 mg/square meter body surface/day IV for 5 days. Treatment may be repeated every 3 weeks.


Hodgkin's Disease
The recommended dosage of dacarbazine for injection in the treatment of Hodgkin's Disease is 150 mg/square meter body surface/day for 5 days, in combination with other effective drugs. Treatment may be repeated every 4 weeks. An alternative recommended dosage is 375 mg/square meter body surface on day 1, in combination with other effective drugs, to be repeated every 15 days.


Dacarbazine for injection 200 mg/vial is reconstituted with 19.7 mL of sterile water for injection, USP. Dacarbazine for injection 500 mg/vial is reconstituted with 49.25 mL of sterile water for injection, USP. The resulting solution contains 10 mg/mL of dacarbazine having a pH of 3.0 to 4.0. The calculated dose of the resulting solution is drawn into a syringe and administered only intravenously.

The reconstituted solution may be further diluted with 5% dextrose injection or sodium chloride injection and administered as an intravenous infusion.

After reconstitution and prior to use, the solution in the vial may be stored at 4°C for up to 72 hours or at normal room conditions (temperature and light) for up to 8 hours. If the reconstituted solution is further diluted in 5% dextrose injection or sodium chloride injection, the resulting solution may be stored at 4°C for up to 24 hours or at normal room conditions for up to 8 hours.

Procedures for proper handling and disposal of anticancer drugs should be considered. Several guidelines on this subject have been published. There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate.


HOW SUPPLIED
Sterile Dacarbazine for Injection is available as follows:

NDC Number Concentration Package Size
0703-5075-01 200 mg 20 mL vial,
packaged individually
0703-5075-03 200 mg 20 mL vials,
10 per package

Store in a refrigerator 2°C to 8°C (36°F to 46°F). Use within 8 hours of reconstitution. Protect from light.

Parenteral drug products should be inspected visually for particulate matter or discoloration prior to administration whenever solution and container permit.


Dacarbazine for Injection USP is supplied as follows (lyophilized powder):
NDC 55390-339-10   200 mg/vial of sterile dacarbazine in boxes of 10.
Store in a refrigerator 2° to 8°C (36° to 46°F).

Reference(s)

1)  [PACKAGE INSERT DATA] : DACARBAZINE injection. Teva Parenteral Medicines, Inc.  Irvine, CA 92618. Revision Date 10/2009.


2) Solimando, Dominic A. Drug Information Handbook for Oncology: A Complete Guide to Combination Chemotherapy Regimens, 8th ed. Hudson, OH: Lexi-Comp, Inc.; 2010.


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The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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