Parenteral Manual

Dacarbazine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
DTIC, DIC, IMIDAZOLE CARBOXAMIDE
Classification: 
Antineoplastic, alkylator - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Hodgkin's disease (relapse and high risk)

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available in 600 mg vial.  Reconstitute with 59.1 mL Sterile Water for Injection for a 10 mg/mL solution
  • Protect from light
  • Solutions should be clear to pale yellow in colour
  • Change in colour from pale yellow to darker yellow is a sign of decomposition; do not use solutions that are pink or orange-red
  • Refrigerate; reconstituted solution stable 72 hours in fridge or 8 hours at room temperature
  • Stable for 24 hours in D5W or 0.9% Sodium Chloride at room temperature or in fridge
Compatibility: 

- Solutions Compatible: D5W, saline solutions

- Additives/Above Cassette Compatible: no information on compatibility KCl

- Y-site Compatible: doxorubicin, ondansetron

Incompatible: allopurinol, heparin, hydrocortisone sodium succinate, piperacillin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittant Infusion YES
Usual dilution: further dilute in  D5W to concentration of 0.19mg/mL to 3 mg/mL
Infusion time: 15 minutes - 2 hours
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Hodgkin's:

  • 375 mg/m2 day 1 and 15 of each 28 day cycle

- dosage may differ according to protocol

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Burning sensation at injection stie, pain, chemical phlebitis- application of cool compresses may help
  • Nausea and vomiting (highly emetogenic) (1-12 hours after dose)
  • Influenza-like syndrome- myalgia, malaise, fever (<10% of patients)
  • Facial flushing, paresthesias
  • Metallic taste
  • VESICANT: extravasation may result in tissue damage, necrosis, severe pain- ensure patency of vein, central line is preferred, slow infusion rate if patient cannot tolerate.  Refer to extravasation protocol (Section H, Infusion Therapy Manual). If extravasation occurs, click HERE for treatment guidelines. 

Delayed (within a few days to weeks):

  • Myelosuppression; nadir 14-28 days
  • Alopecia (rare)
  • Transient abnormalities of liver enzymes
  • Veno occlusive disease (VOD), allergic vasculitis (rare)
  • Hepatocellular necrosis

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor hematological status, liver and kidney function
  • Metabolic inducers (i.e: phenytoin, phenobarbitol) may increase metabolism of dacarbazine

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