Parenteral Manual

DACTINomycin

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): 
ACTINOMYCIN D, COSMEGEN
Classification: 
Antineoplastic, antibiotic (alkylator) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
March 2019
Indications: 
  • Wilms' tumour
  • Rhabdomyosarcoma
  • Other sarcomas

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: 
  • Reconstitute 0.5 mg vial of powder with 1.1 mL sterile water (preservative free) for a final concentration of 0.5 mg/mL. Shake well
  • Protect from light
  • Reconstituted vial stable for 6 hours* room temperature
  • Stable in syringe for 12 hours* room temperature
  • Do not filter
  •     * For NAPRA sterility compliance
Compatibility: 

- Solutions Compatible: D5W, NS

- Incompatible: G-CSF

Administration: 

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

SC NO
IM NO
IV Direct

Yes, preferred. specially trained RNs may administer IV direct

Infusion Time: 1- 5 minutes

IV Intermittent Infusion

YES

Usual dilution: undiluted

Infusion time: 10-15 minutes

IV Continuous Infusion NO

 

Dosage: 

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

- Children >12 months:  

  • 1.25 mg/m2 or 0.045 mg/kg Q 3 weeks
  • Maximum: 2.5 mg/dose

- Infants <12 months:  

  • Half of above doses

- Radiation to the field of the liver within 3 weeks of dactinomycin:

  • Half of above doses

** Dosage may differ according to protocol

Potential hazards of parenteral administration: 

Immediate (within minutes to hours):

  • Nausea and vomiting (moderately high emetogenic potential)
  • Vein irritation
  • Allergic reaction - fever, chills, flushing (rarely anaphylaxis)
  • VESICANT:  extravasation may lead to severe tissue damage; refer to Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines. 

Delayed (within days to weeks):

  • Mucositis, diarrhea
  • Myelosuppression; nadir 14-21 days
  • "Radiation recall" - erythema, desquamation of previously irradiated areas
  • Immune thrombocytopenia
  • Alopecia
  • Skin rash, hyperpigmentation, photosensitivity
  • Veno occlusive disease, liver problems (increased liver function tests, ascites, liver enlargement)

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

Notes: 
  • Monitor hematologic parameters, liver function
  • Hydrate 30 minutes pre;  1 hour post at 125 mL/m2/h (saline/dextrose combinations)

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