Procarbazine

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Generic Name: Procarbazine Brand Name(s): Generics only. No brands available.

Uses

What is Procarbazine used for?

Procarbazine is used along with other chemotherapy drugs to treat Hodgkin’s disease (also known as Hodgkin’s lymphoma). Procarbazine belongs to a class of drugs known as alkylating agents. It works by slowing or stopping the growth of cancer cells.

How should I take Procarbazine?

Take this medication as directed by your doctor, usually once or twice daily. It is usually taken for a 2-week period, then stopped for a time and repeated. This is called a treatment cycle. Do not chew or crush the capsules before swallowing. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

The dosage is based on your medical condition, response to treatment, age, body size, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician to limit your intake of tyramine while you are taking this medicine. Avoid foods and beverages that are high in tyramine, including aged cheeses, dried/aged meats and sausages (such as salami, liverwurst), preserved fish (such as pickled herring), products that contain large amounts of yeast (such as bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (such as sauerkraut, kim chee), most soybean products (such as soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, and vermouth. Consult your doctor or dietician for more details and a complete list of other foods that contain tyramine which you should limit or avoid.

Do not stop taking this medication, even if you have nausea. If you vomit soon after taking a dose, contact your doctor right away for instructions.

How do I store Procarbazine?

Procarbazine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Procarbazine in the bathroom or the freezer. There may be different brands of Procarbazine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Procarbazine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Procarbazine?

Before taking procarbazine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding/blood problems, current/recent/returning infection, kidney disease, liver disease, radiation treatment.

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana.

Avoid alcoholic drinks and products while taking this medication because severe stomach upset/cramps, nausea, vomiting, headache, and flushing may occur.

Avoid smoking while using this medication. Smoking increases the risk of developing lung cancer while using this drug. Talk to your doctor or pharmacist for more details.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

Procarbazine can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.

Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Children may be more sensitive to the side effects of this drug, especially shaking (tremors), loss of consciousness, or seizures.

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using procarbazine. Procarbazine may harm an unborn baby. Ask about reliable forms of birth control while using this medication. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Procarbazine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Procarbazine. Procarbazine is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Procarbazine?

Nausea, vomiting, loss of appetite, constipation, dry mouth, difficulty swallowing, drowsiness, dizziness, headache, trouble sleeping, muscle/joint pain, or darkening of the skin may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Temporary hair loss may occur. Normal hair growth should return after treatment has ended.

People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk ofside effects. Careful monitoring by your doctor may decrease your risk.

Tell your doctor right away if you have any serious side effects, including: unusual bleeding/bruising, diarrhea, tingling/numbness of hands/feet, mental/mood changes (such as confusion, depression), mouth/lip sores.

This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as sore throat that doesn’t go away, fever, chills).

Get medical help right away if you have any very serious side effects, such as: seizure.

This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (see How to Use and Drug Interactions sections). Stop taking procarbazine and get medical help right away if any of these serious side effects occur: severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (such as double/blurred vision), sudden sensitivity to light (photophobia).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take. Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

Very rarely, people with cancer who are treated with this type of medication have developed other cancers (such as leukemia). Your risk is greater if you have had certain types of chemotherapy or radiation treatment. Talk with your doctor for more details.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, such as: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Procarbazine?

Some products that may interact with this drug are: diet pills/appetite suppressants (such as diethylpropion), drugs for attention deficit hyperactivity-ADHD (such as atomoxetine, methylphenidate), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, deutetrabenazine, dextromethorphan, methyldopa, tetrabenazine, valbenazine, certain narcotic medications (such as meperidine, methadone, tapentadol), certain supplements (such as tryptophan, tyramine), certain “triptans” used to treat migraine headaches (such as rizatriptan, sumatriptan), certain drugs for Parkinson’s disease (entacapone, levodopa, tolcapone).

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/ “ecstasy,” St. John’s wort, certain antidepressants (including maprotiline, mirtazapine, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine, tricyclics such as amitriptyline/doxepin), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Some products can interact with procarbazine if you take them together, or even if you take them weeks before or after taking procarbazine. Tell your doctor or pharmacist if you take anything in the list of products that may interact with this drug, or any of the products that increase serotonin, within 2 weeks before or after taking procarbazine. Also tell them if you have taken fluoxetine within 5 weeks before starting procarbazine. Ask your doctor how much time to wait between starting or stopping any of these drugs and starting procarbazine.

Taking other MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

Before using procarbazine, report the use of drugs that may increase the risk of extremely high blood pressure (hypertensive crisis) when combined with procarbazine, including herbal products (such as ephedra/ma huang), allergy and cough-and-cold products (including dextromethorphan, decongestants such as phenylephrine/pseudoephedrine), and stimulants (such as amphetamines, ephedrine, epinephrine, phenylalanine). Procarbazine should not be used with any of these medications. Talk to your doctor or pharmacist for more details.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and narcotic pain relievers (such as codeine, hydrocodone).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness.

Procarbazine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Procarbazine?

Procarbazine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Procarbazine?

Procarbazine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Procarbazine.

What is the dose of Procarbazine for an adult?

Usual Adult Dose for Hodgkin’s Disease

For administration as a single agent: To minimize the nausea and vomiting experienced by a high percentage of patients beginning procarbazine therapy, single or divided doses of 2 to 4 mg/kg/day for the first week are recommended. Daily dosage should then be maintained at 4 to 6 mg/kg/day until maximum response is obtained or until the white blood count falls below 4000 or the platelets fall below 100,000. When maximum response is obtained, the dose may be maintained at 1 to 2 mg/kg/day. Upon evidence of hematologic or other toxicity, the drug should be discontinued until there has been satisfactory recovery. After toxic side effects have subsided, therapy may then be resumed at the discretion of the physician, based on clinical evaluation and appropriate laboratory studies, at a dosage of 1 to 2 mg/kg/day.

When used in combination with other anticancer drugs, the procarbazine dose should be appropriately reduced, e.g., in the MOPP regimen, the procarbazine dose is 100 mg/m2/day for 14 days.

Usual Adult Dose for Anaplastic Astrocytoma

60 mg/m2 orally once a day on days 8 through 21, when administered as a part of the regimen which also includes lomustine (CeeNU) and vincristine. The PCV regimen may be continued for 29 days.

Usual Adult Dose for Glioblastoma Multiforme

60 mg/m2 orally once a day on days 8 through 21, when administered as a part of the regimen which also includes lomustine (CeeNU) and vincristine. The PCV regimen may be continued for 29 days.

Renal Dose Adjustments

Some clinicians have recommended the use of decreased dosages in patients with renal dysfunction. However, no specific guidelines have been established.

Liver Dose Adjustments

Some clinicians have recommended the use of decreased dosages in patients with hepatic dysfunction. However, no specific guidelines have been established.

Dose Adjustments

When used as single agent therapy, the initial dosage recommended above is used in order to minimize the nausea and vomiting experienced by a high percentage of patients beginning therapy. The daily dosage may then be maintained at 4 to 6 mg/kg/day administered in single or divided doses, until a maximum response is obtained or until the event(s) listed in the paragraph below occur(s).

Prompt cessation of therapy is recommended if any one of the following occurs:

  • Central nervous system signs or symptoms such as paresthesias, neuropathies, or confusion
  • Leukopenia (wbc under 4,000)
  • Thrombocytopenia (platelets under 100,000)
  • Hypersensitivity reaction
  • Stomatitis (the first small ulceration or persistent spot soreness around the oral cavity is a signal for cessation of therapy)
  • Diarrhea (frequent or watery stools)
  • Hemorrhage or bleeding tendencies

Bone marrow depression often occurs from 2 to 8 weeks after the start of treatment. If leukopenia occurs, hospitalization of the patient may be needed to prevent systemic infection.

After toxic side effects have subsided (based on clinical evaluation and appropriate laboratory studies), and at the discretion of the physician, therapy may be resumed at a dosage of approximately 1 to 2 mg/kg/day.

Other Comments

All dosages are based on the patient’s actual weight. However, the estimated lean body mass (dry weight) is used if the patient is obese or if there has been a spurious weight gain due to edema, ascites or other forms of abnormal fluid retention.

Baseline laboratory data should be obtained prior to the initiation of therapy. The hematologic status as indicated by hemoglobin, hematocrit, white blood cell count, differential, reticulocytes and platelets should be monitored no less frequently than every 3 or 4 days.

Hepatic and renal evaluation including urinalysis, transaminase, alkaline phosphatase, and blood urea nitrogen tests, should be repeated at least weekly.

If radiation or a chemotherapeutic agent known to have marrow depressant activity has been used, an interval of one month or longer without such therapy is recommended before starting treatment with procarbazine. The length of this interval may also be determined by evidence of bone marrow recovery based on successive bone marrow studies.

What is the dose of Procarbazine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Procarbazine available?

Procarbazine is available in the following dosage forms and strengths:

  • Oral capsule.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Procarbazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 21, 2018 | Last Modified: April 21, 2018

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