Dacarbazine (injection, intravenous route)

Dacarbazine is a potent chemotherapy drug primarily used to treat lymphatic and skin cancers.

Overview:

Dacarbazine is a chemotherapy drug used to combat different forms of cancer, including Hodgkin’s Disease and skin cancer. Dacarbazine works by interfering with the growth and proliferation of cancer cells, impeding the cancer’s spread and potentially rolling it back. This mechanism is not necessarily confined to cancer cells, though, and patients may experience impeded cell growth in other areas, most prominently in the hair.

Dacarbazine was first developed by Bayer Healthcare and was approved by the FDA in 1975. Multiple other pharmaceutical companies have since begun producing dacarbazine, including Teva Pharmaceuticals and Fresenius Kabi.

Dacarbazine is included on the World Health Organization’s list of essential medicines.

Conditions Treated:

  • Cancer, primarily skin cancer & cancer in the lymph nodes

Type of Medicine:

  • Alkylating agent

Side Effects:

Along with its’ primary effects, dacarbazine can have a wide variety of other, sometimes adverse effects on the patient. Some of these effects can be very serious and require medical attention. Other side effects can simply be symptoms of the patient’s body adapting to the sudden influx of a new drug, and only be as serious as the discomfort it causes for the patient. The following is a list of serious side effects. Patients who begin to experience any of the following side effects after beginning to take dacarbazine should contact their doctor immediately.

  • Pain, swelling, or redness at the site of the injection
  • Blackened or otherwise discolored stool
  • Tarry stools
  • Bloody stools
  • Bloody urine
  • Painful or otherwise uncomfortable urination, when accompanied by chills
  • Coughing, hoarseness when accompanied by chills
  • Fever
  • Chills
  • Pain in the patient’s back or sides, when accompanied by chills
  • Pinpoint red marks on the skin
  • Shortness of breath
  • Stomach pain
  • Swelling of the face
  • Yellow discoloration of the eyes or skin
  • Sores on the mouth or lips
  • Unusual bleeding
  • Unusual bruising

Patients may experience a burning sensation, pain, or swelling at the injection site while dacarbazine is being injected. Patients should notify their doctor immediately if they experience these effects, as this may be a sign of an improper injection. Dacarbazine which escapes the vein during injection can cause scarring and other problems.

Potentially dangerous side effects can persist even after the patient stops taking dacarbazine. Patients who begin (or continue) to experience any of the following side effects after ceasing dacarbazine treatment should contact their doctor immediately. The following side effects may require medical attention.

  • Blackened stool
  • Tarry stool
  • Bloody stool
  • Bloody urine
  • Painful or otherwise uncomfortable stools, especially when accompanied by chills
  • Coughing, hoarseness especially when accompanied by chills
  • Pain in the lower back or side, especially when accompanied by chills
  • Chills
  • Fever
  • Pinpoint red marks on the skin
  • Rogue or unusual bleeding
  • Rogue or unusual bruising

Not all side effects necessarily require medical attention. Patients who experience any of the following side effects should contact their doctor to determine how to mitigate or lessen the following side effects:

  • Appetite loss
  • Nausea (typically subsides after a few days)
  • Vomiting (typically subsides after a few days)
  • Generalized feelings of unease
  • Flushing of the face
  • Muscle pain
  • Numbness in the face

Patients who experience particularly severe nausea or vomiting should avoid eating for as long as six hours prior to receiving a dacarbazine injection. This can stop the patients from experiencing the worst of the nausea and vomiting.

Patients should be aware that dacarbazine can cause temporary hair loss in some patients. Normal hair growth typically resumes shortly after the patient stops taking dacarbazine.

This is not necessarily a complete list of side effects. Patients who begin to experience new or worsening symptoms after taking dacarbazine should contact their doctor immediately. Patients can report new side effects to the FDA at 1 800 FDA 1088 or on the web at www.fda.gov/medwatch.

Dosage:

Dacarbazine is delivered intravenously, through use of an IV.

The dosage of dacarbazine used can vary widely, depending on the condition being treated and the severity of that condition. Dosage may also need to be adjusted based on a patient’s weight and body composition.

For treatment of malignant melanomas:

Two different dosing schedules are usually used to treat malignant melanomas in patients. The first features ten days of daily treatment repeated once every four weeks. Over the course of the ten days of treatment, patients will usually be given a daily dose of 2.5 to 4 milligrams of dacarbazine per kilogram of body weight.

The other features five consecutive days of dacarbazine treatment every three weeks. Over the course of the five days of treatment, patients will usually be delivered a dose of 250 mg/m2. That treatment will usually be repeated every 3 weeks for the duration of the treatment.

For treatment of Hodgkin’s Disease (Lymphatic Cancer):

Patients using dacarbazine to treat Hodgkin’s Disease will usually undergo five days of consecutive treatment, repeated every four weeks or one treatment delivered every fifteen days.

For patients receiving treatment every four weeks, patients will usually receive a daily dose of 150 mg/m² for each of the five days of treatment.

For patients receiving treatment once every fifteen days, patients will usually receive a dose of 375 mg/m² all at once, repeated every fifteen days.

Patients who miss a dose should contact their doctor for advice on what to do. Patients taking dacarbazine should do everything in their power to avoid missing a dose.

The dosage information detailed above describes average or standard doses. These doses may not be ideal for every patient. Patients should rely on their doctor to determine the optimal dose for them.

Interactions:

Dacarbazine can interact with a wide variety of different drugs, including a number of different vaccines. Dacarbazine can have a depressing effect on the immune system, which will both lessen the effectiveness of a vaccine and put the patient at a significantly increased risk of infection from the vaccine. Additionally, dacarbazine can interact negatively with drugs which are immunosuppressive and can depress white blood cell count, as dacarbazine can also have that effect.

The following drugs can interact negatively with dacarbazine. It is not recommended that patients take any of the following drugs while receiving dacarbazine injections. Patients who must take any of the following drugs concurrently with dacarbazine should consult with their doctor to determine alternative treatment options. Patients should disclose a complete list of all the drugs, medications, and supplements to their doctor prior to deciding to receive dacarbazine injections.

  • Adalimumab
  • Aldesleukin
  • Bcg
  • Certolizumab
  • Clozapine
  • Deferiprone
  • Etanercept
  • Fingolimod
  • Golimumab
  • Infliximab
  • Influenza vaccine (live)
  • Influenza (H1N1) vaccine (live)
  • Leflunomide
  • Lomitapide
  • Measles virus vaccine
  • Mipomersen
  • Mumps virus vaccine
  • Nalidixic acid
  • Natalizumab
  • Poliovirus vaccine (live)
  • Rotavirus vaccine
  • Rubella virus vaccine
  • Samarium sm 153 lexidronam
  • Smallpox vaccine
  • Talimogene laherparepvec
  • Teriflunomide
  • Thalidomide
  • Tofacitinib
  • Typhoid vaccine (live)
  • Varicella vaccine (live)
  • Yellow fever vaccine
  • Zoster vaccine (live)

The following drugs can interact with dacarbazine, but not necessarily as strongly or with as much frequency as those listed above. Patients should still avoid taking any of the following drugs while receiving dacarbazine injections. Patients who must take any of the following drugs while receiving dacarbazine injections should consult with their doctor to determine viable alternative treatments. Patients should disclose a complete list of all the drugs, medications, and supplements they are taking before they decide to receive dacarbazine injections.

  • Adenovirus vaccine
  • Alefacept
  • Alemtuzumab
  • Anakinra
  • Anthrax vaccine (adsorbed)
  • Azathioprine
  • Bedaquiline
  • Bendamustine
  • Black cohosh
  • Bleomycin
  • Brentuximab
  • Busulfan
  • Canakinumab
  • Candida albicans extract
  • Capecitabine
  • Carboplatin
  • Carmustine
  • Cholera vaccine
  • Cholera vaccine (live)
  • Cisplatin
  • Cladribine
  • Clofarabine
  • Coccidioidin skin test
  • Cyclophosphamide
  • Dactinomycin
  • Daunorubicin
  • Decitabine
  • Denosumab
  • Docetaxel
  • Doxorubicin
  • Efalizumab
  • Efavirenz
  • Epirubicin
  • Etoposide
  • Filgrastim
  • Floxuridine
  • Fludarabine
  • Fluorouracil
  • Ganciclovir
  • Gemcitabine
  • Hepatitis A vaccine
  • Hepatitis B vaccine
  • Histoplasmin
  • Human papillomavirus vaccine
  • Hydroxyurea
  • Idarubicin
  • Idelalisib
  • Ifosfamide
  • Imatinib
  • Influenza virus vaccine (h5n1)
  • Influenza virus vaccine, inactivated
  • Interferon alfa-2a
  • Interferon alfa-2b
  • Interferon alfa-2b / ribavirin
  • Interferon beta-1a
  • Interferon beta-1b
  • Japanese enceph vacc sa14-14-2, inactivated
  • Japanese encephalitis virus vaccine nakayama
  • Lomustine
  • Lyme disease vaccine
  • Mechlorethamine
  • Melphalan
  • Meningococcal conjugate vaccine
  • Meningococcal group B vaccine
  • Meningococcal polysaccharide vaccine
  • Mercaptopurine
  • Methotrexate
  • Mitomycin
  • Mitoxantrone
  • Mixed respiratory vaccine
  • Mumps skin test antigen
  • Naltrexone
  • Nelarabine
  • Niraparib
  • Ocrelizumab
  • Olaparib
  • Omacetaxine
  • Oxaliplatin
  • Palifermin
  • Pegfilgrastim
  • Peginterferon beta-1a
  • Pemetrexed
  • Pentostatin
  • Plague vaccine
  • Pneumococcal vaccine
  • Rabies vaccine
  • Radium 223 dichloride
  • Rilonacept
  • Roflumilast
  • Ruxolitinib
  • Sargramostim
  • Sipuleucel-T
  • Skin test antigens
  • Sodium phosphate p32
  • Staphage lysate (spl)
  • Streptozocin
  • Strontium-89 chloride
  • Tbo-filgrastim
  • Temozolomide
  • Tetanus toxoid
  • Thioguanine
  • Thiotepa
  • Topotecan
  • Trabectedin
  • Trichophyton skin test
  • Tuberculin purified protein derivative
  • Ustekinumab
  • Valganciclovir
  • Vinorelbine
  • Vitamin E
  • Cinoxacin

Additionally, a number of different fluoroquinolone antibiotics may interact negatively with dacarbazine in the patient’s body. Patients who must take a fluoroquinolone antibiotic while they are receiving dacarbazine treatment should consult with their doctor to determine whether or not it is safe to do so or determine alternative treatment methods. Patients should supply their doctor with a complete list of all the drugs, medications, and supplements they are taking prior to deciding to receive dacarbazine injections.

  • Ciprofloxacin
  • Delafloxacin
  • Enoxacin
  • Gatifloxacin
  • Gemifloxacin
  • Grepafloxacin
  • Levofloxacin
  • Lomefloxacin
  • Moxifloxacin
  • Norfloxacin
  • Ofloxacin
  • Sparfloxacin
  • Trovafloxacin

Different drugs can interact with each other in a variety of potentially unforeseen ways. This is not necessarily a complete list of potential interactions. Patients should rely on their doctor to identify any potential interactions between dacarbazine and any other drugs they are taking. Patients should ensure their doctor is fully apprised of all the drugs, medications, and supplements they are taking prior to deciding to receive treatment with dacarbazine.

Warnings:

Dacarbazine can deplete the body’s ability to fight infections. Patients with infectious diseases or who are at an elevated risk of contracting an infectious disease should exercise extreme caution when deciding whether or not to receive dacarbazine injections. Patients should consult with their doctor to determine whether or not dacarbazine is right for them.

Patients should be on high alert for signs of a possible infectious disease, which can include a sore throat and fever. Patients taking dacarbazine should be closely monitored for possible viral or bacterial infections.

Patients receiving dacarbazine therapy are at an increased risk of becoming sick and will have a much more severe experience with any illness they do contract. Because of this, patients receiving dacarbazine therapy (or any other form of chemotherapy) should avoid exposure to any sick person as a preventative measure.

Dacarbazine can impede the body’s ability to create blood clots. This can potentially lead to uncontrolled bleeding and other blood-related problems. Patients should be especially careful not to break skin while receiving dacarbazine treatments.

Patients should avoid contact sports and other activities which may lead to bruises or cuts. Dacarbazine can cause the body to bruise and bleed easily. Patients should do their best to mitigate this effect by limiting their participation in high-risk contact activities.

Additionally, patients should be cautious when brushing and flossing. Because of the effect of dacarbazine on blood clotting, bleeding in the patient’s gums may persist for hours. The gums will also bruise more easily while the patient is taking dacarbazine. Patients should consult with their doctor or dentist to determine the lowest impact way of cleaning their teeth. Patients may also need to put off any dental work they need doing until after they finish their dacarbazine treatments.

Dacarbazine can pass into the bodily fluids (including feces, blood, vomit, urine) of patients being treated with dacarbazine for as long as 48 hours after treatment. For that reason, patients being treated with dacarbazine should ensure their bodily fluids do not come into contact with their hands or any other surface. Persons who need to clean up after a person receiving dacarbazine injections should wear gloves and be careful not to touch any of the bodily fluids.

Contaminated clothes and other cloth items should be washed separately from clean, uncontaminated clothes.

Patients have been known to suffer severe allergic reactions to dacarbazine. Patients who have had allergic reactions to dacarbazine in the past should not take dacarbazine. Patients who are undergoing dacarbazine therapy should remain vigilant for signs of an allergic reaction, which can include:

  • Hives
  • Rash
  • Swelling of the neck or throat
  • Anaphylaxis

Dacarbazine is considered a class C drug in terms of pregnancy. This means that risk of damage to human fetuses cannot be ruled out, due to inconclusive studies or general lack of data. Regardless, patients should avoid becoming pregnant while taking dacarbazine. The confluence of cancer, dacarbazine therapy, and then pregnancy will put more stress on the patient’s body than most patients can handle. Patients are usually advised to abstain from sex while receiving cancer treatment, or if that is impossible, use multiple forms of contraceptives. Additionally, patients are cautioned against breastfeeding while receiving dacarbazine treatment. Dacarbazine can pass into breast milk, and dacarbazine can have a very serious, negative effect on a breastfeeding child.

Storage:

Dacarbazine should be stored by your doctor at a medical clinic. Patients should not have to store their dacarbazine themselves.

Summary:

Dacarbazine is a standard chemotherapy treatment which is especially useful in treating skin and lymphatic cancers. Like any chemotherapy drug, the risk of indiscriminate cell damage exists and the side effects can be particularly severe. However, in most cases, these effects pale in comparison to the effects of letting cancer go untreated, which is usually lethal. Patients should be prepared for a long, painful, and uncertain process when they begin to treat their cancer with dacarbazine.

Dacarbazine is not necessarily the most punishing chemotherapy drug on the market, and in fact, it has replaced a former chemotherapy drug in a number of treatments after it was found to have a similar efficacy but without some major side effects.