Arsenic Trioxide

Arsenic trioxide is used for the treatment of promyelocytic leukemia in patients who have not responded to other medication. It can also be used to treat other kinds of cancer.

Overview

Arsenic trioxide is an antineoplastic medicine, which interferes with the growth of cancer cells, enabling them to be destroyed by the body. Healthy cells will also be affected by the medicine, which means that unwanted side effects will occur.

Arsenic trioxide is used to treat promyelocytic leukemia in patients who have not responded to other medicines.

Promyelocytic leukemia is a blood cancer that affects myeloid cells. This includes red blood cell platelets and some white blood cells. This is a rare sub-type of myeloid leukemia. The biggest effect of this condition is stopping the bone marrow from making enough normal blood cells to keep the body healthy.

Arsenic trioxide can also be used to combat other forms of cancer when a doctor determines that this is the best course of action.

Arsenic trioxide can increase the chances of getting other forms of cancer in the future. Before taking this treatment you should consider the side effects and the risks and weigh them against the benefits of taking Arsenic trioxide. Discuss the positives and negatives with your doctor before making a decision.

This medicine can only be given under the direct supervision of a doctor.

Condition(s) treated

  • Promyelocytic leukemia
  • Other cancers

Type of medicine

  • Antineoplastic
  • Chemotherapy

Side Effects

Arsenic trioxide works by attacking cells and will attack healthy cells as well as cancerous ones. As such there will be side effects. Not all side effects that occur will require medical attention, but some will need to be reported to your doctor right away.

If you experience any of the following symptoms you should tell your doctor right away:

More common

  • Chills
  • Convulsions (seizures)
  • Cough
  • Smaller amounts of urination
  • Dry mouth
  • Soreness of the eyes
  • General feeling of illness
  • Headache
  • Increased thirst
  • Irregular heartbeat
  • Loss of appetite
  • Mood changes
  • Muscle pain or cramps
  • Nausea or vomiting
  • Numbness or tingling in hands, feet, or lips
  • Sore throat
  • Trouble breathing
  • Unusual tiredness or weakness

Less common

  • Abdominal or stomach cramps
  • Black, tarry stools
  • Bluish lips or skin
  • Blurred vision
  • Chest pain
  • Dizziness or lightheadedness
  • Fever
  • Flushed, dry skin
  • Fruit-like breath odor
  • Increased hunger
  • Increased urine output
  • Irregular or pounding heartbeat or pulse
  • Painful or difficult urination
  • Sores, ulcers, or white spots on the lips or in the mouth
  • Stomachache
  • Sweating
  • Swollen glands
  • Unexplained weight loss
  • Unusual bleeding or bruising
  • Unusual weight gain

Rare

  • Anxiety
  • Behavior changes similar to drunkenness
  • Bleeding
  • Blood in the urine or stools
  • Bluish fingernails, palms, or nailbeds
  • Bruising
  • Cloudy urine
  • Cold sweats
  • Cool, pale skin
  • Drowsiness
  • Headache
  • Large hives or rash
  • Persistent bleeding or oozing from puncture sites, mouth, or nose
  • Severe nausea
  • Shakiness
  • Sore mouth or tongue
  • Swelling of the eyelids, lips, or face
  • Vomiting of blood or material that looks like coffee grounds
  • White patches in the mouth or on the tongue

Side effects will occur that do not require any medical attention. These side effects can subside as the treatment goes on and the body gets used to the presence of the medicine. Your healthcare professional should also be able to help you with advice on how to combat the side effects and make yourself more comfortable. If any side effects are ongoing or bothersome, inform your healthcare professional to see if they can help.

You would not usually need to seek medical attention for the following side effects:

More common

  • Diarrhea

Less common

  • Acid or sour stomach
  • Back pain
  • Belching
  • Bloating or swelling of the face, hands, lower legs, or feet
  • Bone pain
  • Constipation
  • Flushing
  • Heartburn
  • Heavy non-menstrual vaginal bleeding
  • Indigestion
  • Injection site pain, redness, or swelling
  • Itching
  • Itchy, red skin
  • Joint or muscle pain
  • Limb pain
  • Loss of appetite
  • Mental depression
  • Neck pain
  • Nosebleeds
  • Pale skin
  • Shivering chills
  • Trouble sleeping or getting to sleep
  • Weight gain

Rare

  • Agitation
  • Blisters inside the mouth
  • Coughing or spitting up blood
  • Earache
  • Eye dryness, redness, or pain
  • Loss of bowel or bladder control
  • Night sweats
  • Rapid, shallow breathing
  • Ringing in the ears
  • Small red or purple spots on skin
  • Swelling of the abdominal or stomach area
  • Swelling or puffiness of the face or eyelids
  • Swollen, painful, or tender lymph glands in the neck, armpit, or groin

Other side effects can also occur. If you experience any other side effects contact your doctor.

Dosage

A doctor or trained healthcare professional will administer this medicine to you or your child in a hospital or in some cases in a cancer clinic. The medicine is given intravenously through a needle placed directly into one of your veins.

The dose will be determined depending on your condition and your body size.

If you experience any symptoms of overdose, seek urgent medical attention. The symptoms of overdose are as follows:

  • Confusion
  • Convulsions or seizures
  • Muscle weakness, severe

The following doses are indications of doses given. Your doctor will determine your dose:

  • Adult: 0.15 mg/kg IV infused over 1-2 hours. Administered once per day until bone marrow remission is seen. Do not exceed 60 doses.
    • Wait 3-6 weeks before second round of dosing then:
    • 0.15 mg/kg IV infused over 1-2 hours. Administer 25 doses over up to 5 weeks.
  • Child over the age of 4 years: 0.15 mg/kg IV infused over 1-2 hours. Administered once per day until bone marrow remission is seen. Do not exceed 60 doses.
    • Wait 3-6 weeks before second round of dosing then:
    • 0.15 mg/kg IV infused over 1-2 hours. Administer 25 doses over up to 5 weeks.
  • Child under the age of 4 years: Safety and efficiency of medicine not established. Consult your doctor.

Interactions

Certain medicines should not be used together. In some cases medicines can stop other drugs from working and in some cases two drugs can interact violently in the body, causing adverse side effects. In cases where more than one medicine is prescribed, your doctor may wish to manage doses and take other necessary precautions.

Before agreeing to receive this treatment it is important to tell your medical professional about what other medications you are also taking and any medical conditions that you might have. The following list of medications has been compiled because of severity and does not necessarily include all of the medicines. Make sure you tell your doctor about all substances that you are taking.

Using this medicine with any of the following medicines is not recommended. Your doctor may make the decision to prescribe both medicines or change some of the medicines you are taking.

  • Amifampridine
  • Amisulpride
  • Bepridil
  • Cisapride
  • Dronedarone
  • Foscarnet
  • Lidoflazine
  • Mesoridazine
  • Pimozide
  • Piperaquine
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

Using this medicine with any of the following medicines is not usually recommended. In some cases it may be necessary and your doctor may wish to amend doses or observe you more closely.

  • Acecainide
  • Acetazolamide
  • Ajmaline
  • Alfuzosin
  • Amiloride
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Amphotericin B
  • Anagrelide
  • Apomorphine
  • Aprindine
  • Aripiprazole
  • Artemether
  • Asenapine
  • Astemizole
  • Atazanavir
  • Azimilide
  • Azithromycin
  • Azosemide
  • Bedaquiline
  • Bemetizide
  • Bendroflumethiazide
  • Benzthiazide
  • Bretylium
  • Bumetanide
  • Buserelin
  • Buthiazide
  • Canrenoate
  • Canrenone
  • Chloral Hydrate
  • Chloroquine
  • Chlorothiazide
  • Chlorpromazine
  • Chlorthalidone
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clopamide
  • Clozapine
  • Crizotinib
  • Cyclobenzaprine
  • Cyclothiazide
  • Dabrafenib
  • Dasatinib
  • Degarelix
  • Delamanid
  • Desipramine
  • Deslorelin
  • Diazoxide
  • Dibenzepin
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Donepezil
  • Doxepin
  • Droperidol
  • Ebastine
  • Efavirenz
  • Encainide
  • Enflurane
  • Eplerenone
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Ethacrynic Acid
  • Etozolin
  • Famotidine
  • Felbamate
  • Fenquizone
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Fosphenytoin
  • Furosemide
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Glycerin
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Halothane
  • Histrelin
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Hydroquinidine
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indapamide
  • Isoflurane
  • Isradipine
  • Itraconazole
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Levofloxacin
  • Levomethadyl
  • Lopinavir
  • Lorcainide
  • Lumefantrine
  • Mannitol
  • Mefloquine
  • Methadone
  • Methyclothiazide
  • Metolazone
  • Metronidazole
  • Mifepristone
  • Mizolastine
  • Moxifloxacin
  • Nafarelin
  • Nelfinavir
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Ondansetron
  • Paliperidone
  • Panobinostat
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perflutren Lipid Microsphere
  • Perphenazine
  • Pimavanserin
  • Pipamperone
  • Piretanide
  • Pirmenol
  • Pitolisant
  • Polythiazide
  • Posaconazole
  • Prajmaline
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinethazone
  • Quinidine
  • Quinine
  • Ranolazine
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Salmeterol
  • Sematilide
  • Sertindole
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Spiramycin
  • Spironolactone
  • Sulfamethoxazole
  • Sulpiride
  • Sultopride
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Tedisamil
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Ticrynafen
  • Tizanidine
  • Tolterodine
  • Toremifene
  • Torsemide
  • Trazodone
  • Triamterene
  • Trichlormethiazide
  • Trifluoperazine
  • Trimethoprim
  • Trimipramine
  • Triptorelin
  • Urea
  • Vandetanib
  • Vardenafil
  • Vasopressin
  • Vemurafenib
  • Venlafaxine
  • Vinflunine
  • Voriconazole
  • Vorinostat
  • Xipamide
  • Zotepine
  • Zuclopenthixol

Medicines can interact with the food and drink that you are consuming. It can also interact with alcohol and tobacco. Discuss your eating, drinking and smoking habits with your healthcare professional for advice on how they will interact.

Other medical conditions can also affect the use of this medicine. If you have any medical conditions then make sure you tell your doctor about them. If you have ever had any allergies to medicines you should also tell your doctor about these.

Be especially clear if you have or have suffered with any of the following conditions:

  • Congestive heart failure
  • Heart block
  • Irregular heartbeat
  • Hypokalemia
  • Hypomagnesemia
  • Kidney disease
  • Liver disease

Effects of this medicine can be increased when used on patients with liver failure. Slower removal of the medicine from the body can lead to greater effects.

Arsenic trioxide often causes vomiting. This is normal and it is important that you continue taking the medicine despite this. Your doctor can help you with advice on how to minimize these feelings.

Warnings

Regular check-ups are vitally important when taking this medicine. Checks need to be made to ensure that the medicine is working properly and blood and urine tests will need to be carried out to check for any unwanted side effects.

Do not take this medicine if you are pregnant. This medicine attacks developing cells and will harm an unborn child. It is also important that you avoid becoming pregnant or impregnating someone else during the use of this medicine and for several months afterwards. You should discuss effective use of contraception with your doctor to prevent this. If you suspect that you are pregnant or have impregnated someone then you should tell your doctor straight away.

If you experience chest pain or discomfort, chills, cough, difficulty breathing, eye pain, fever, general illness, headache, sore throat, tiredness, weakness or weight gain while using this medicine then you should inform your doctor straight away. These symptoms can be a sign of a significant condition known as retinoic-acid-APL.

Use of Arsenic trioxide can increase your chance of developing other cancers. Discuss this risk with your doctor before taking this medicine.

Do not take any other forms of medication during treatment unless they have been approved by your doctor. This includes non-prescribed medications that can be bought over the counter.

Arsenic trioxide can cause heart rhythm irregularities that can be very serious. If you have a heart condition make this known to your doctor right away. Your doctor will monitor your heart for arrhythmias and you should talk to your doctor if you have any concerns relating to this.

Storage

Do not freeze.

Keep in a sealed container away from direct light, moisture and heat. Keep at room temperature.

Once diluted, shelf life is 24 hours.

Summary

Arsenic trioxide is used for the treatment of promyelocytic leukemia and other types of cancer in both adults and children.

Promyelocytic leukemia is a blood cancer that affects myeloid cells. This includes red blood cell platelets and some white blood cells. This is a rare sub-type of myeloid leukemia. The biggest effect of this condition is stopping the bone marrow from making enough normal blood cells to keep the body healthy.

Arsenic trioxide works by attacking cells and will attack both healthy and cancerous cells in the body. As such the patient will experience unwanted side effects from use of the medicine. Nausea and vomiting is common and use of the medicine should not be stopped in this case.

Usually the medicine is administered daily until bone marrow remission is witnessed. Once remission is in place the treatment is stopped for 3-6 weeks before follow up doses are administered.

Arsenic trioxide must be administered by a doctor and is usually given in a hospital or cancer clinic.

Arsenic trioxide has a large number of interactions with other medicines and you should be sure to tell your doctor about any other medication that you are taking. You should also inform your doctor about any medical conditions that you have or have had before taking this medicine.

Arsenic trioxide can increase your chances of getting other types of cancer and this should be considered with your doctor before taking the medication. You should weigh up the positives and negatives of this treatment before beginning it.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
Content Source: