Pentostatin (Intravenous)

As an anticancer chemotherapeutic medicine, pentostatin works by slowing and consequently stopping hairy cell leukemia cells from growing.

Overview

Pentostatin helps cancer patients to treat their condition by alleviating the symptoms and offering relief. This is a drug that must be administered by a qualified physician. It's supplied in powder form with a single-dose containing pentostatin (10 mg) and mannitol (50 mg). Hydrochloric acid or sodium hydroxide is added to the final product to maintain its pH; it should range from 7.0 to 8.5. Combining pentostatin with fludarabine phosphate is prohibited because it can cause severe pulmonary toxicity that can be fatal.

The dosage prescribed depends on the stage of cancer and other factors, particularly the patient's medical history. During treatment, the dosage will be altered according to responsiveness, body size and medical condition of the patient. To achieve the best results, a single doctor monitors the entire process from start to finish to ensure that the drug is used correctly. The injection is given after two weeks. Pentostatin can have a negative impact on the lungs and kidneys, which is why doctors give IV fluids to neutralize these effects. Smoking and alcohol should be avoided before and after the treatment because the interaction can cause unpleasant effects.

Pentostatin should not be used by patients planning to be parents because it can harm the fetus. Also, couples need to use a condom when having sex for a few days after the treatment is given. This is so that you can take protect your partner if there are traces of the drug in the vaginal fluid or semen.

Conditions Treated

Type Of Medicine

  • Anticancer

Side Effects

Although pentostatin is a life-saving drug, it may cause some undesired effects, especially since it has to be used for a period of up to 12 months. Patients who experience the side effects described should seek medical attention immediately. Not all symptoms are visible; others may require tests to ascertain their presence and severity.

Studies show that other side effects may not occur until several months after the patient completes the full treatment. These effects may be cancerous so patients should discuss with their doctors all possible outcomes.

Common side effects that are severe include the following:

  • Constant coughs of huskiness
  • Fatigue, unusual weakness
  • Sudden itching of skin
  • Uneven heart rate
  • Anxiety
  • Difficulty when urinating
  • Fever
  • Joint pain

Less common side effects that are also severe include:

  • Confusion
  • Blurry vision
  • Bloodstained stools or urine
  • Muscle spasms in lower leg
  • Mental despair
  • Difficulty in breathing
  • Feeling sleepy
  • Nose bleeding
  • Numbness in hands or feet
  • Sore eyes
  • Abdominal pain
  • Swollen feet
  • Excessive bleeding
  • Chest pain
  • Sore lips

The above side effects should be reported to a doctor immediately. However, due to the way that pentostatin reacts in the body, some less severe side effects have been reported. These are usually brought about as a result of the components of the drug reacting to the cancer cells in the patient's body. Health professionals check for these symptoms regularly to reduce or prevent their occurrence.

Despite being mild effects, patients should seek medical attention if the following side effects do not disappear after a few weeks.

Here are some common side effects that are less severe include:

  • Mild rashes on the skin
  • Diarrhea
  • Migraine
  • Appetite loss
  • Vomiting
  • Nausea
  • Muscle spasms

Less common side effects that are less severe include:-

Dosage

The pentostatin dosage used to treat hairy cell leukemia is determined by several factors such as the patient's height, weight, response to the drug, tolerance, and other medical conditions. The medicine is supplied in powder form and has to be mixed with other liquid drugs for it to be injected into the veins.

It takes no more than 30 minutes for a single dose to be administered. The dosage should not be adjusted unless the healthcare provider deems it necessary.

Even though each patient's case is different, the manufacturer of the drug recommends the dosage for treating hairy cell leukemia to be 4 mg per m2 injected after two weeks. Patients who are also suffering from kidney disease should be treated with lesser amounts. However, doctors can alter the dose depending on the patient's requirements, especially after monitoring progress.

The treatment takes 6 to 12 months and is stopped when there are no detectable cancer cells, and the blood cell count has been restored to normal. Doctors are required to stop treatment for patients who have not responded positively after 12 months. Also, patients who experience severe side effects should stop treatment immediately and talk to their healthcare providers for suitable alternatives.

Before treatment starts, doctors conduct several blood tests to ensure that there are no other conditions that would prevent the patient from receiving the drug as required. Several medical tests will be performed frequently during the entire treatment procedure to ensure the drug will not cause dangerous effects.

Pentostatin should only be given by a licensed healthcare professional in a setting such as a clinic or a hospital. The drug is for adults and is prohibited for children.

Major drug interactions

Pentostatin remains in your blood for more than 48 hours, and it can pass into vomit, urine, and feces. Patients should avoid coming into contact with their bodily fluids during this period. Healthcare providers must wear gloves while handling the patient's fluids, laundry, diapers or trash. They should also wash their hands before wearing the gloves and after removing them.

You should not receive 'live' vaccines when undergoing pentostatin treatment. Live vaccines include mumps, typhoid, shingles, chickenpox, flu, rubella, and measles. Before the procedure commences, patients should tell their doctors all the medicine they use. Apart from over-the-counter medications, pentostatin also interacts with supplements and herbal products.

A clinical study reveals that pentostatin reacts with allopurinol to increase severe skin rashes on the body. According to data collected from the 25 patients observed, both drugs can also cause hypersensitivity vasculitis, a condition that can be fatal.

Biochemical studies, on the other hand, reveal that pentostatin can interact with vidarabine to multiply the side effects of each drug.

The combination of pentostatin and fludarabine is not recommended as it can lead to fatal pulmonary toxicity.

Hypotension and pulmonary edema (both fatal conditions) have been reported by patients who used pentostatin with a combination of etoposide, cyclophosphamide, and carmustine (bone marrow transplant treatment).

Patients should keep a list of other drugs that they use for doctor's approval since many other drugs may interact with pentostatin. The following is a list of the most common over-the-counter drugs:

  • Campath
  • Alemtuzumab
  • Cladribine
  • Fortaz
  • Cotrim
  • Lyrica
  • Percocet
  • Xanax
  • Inderal
  • Zoloft
  • Zinacef
  • Vibramycin
  • Rituximab

Pentostatin also interacts with alcohol, tobacco and certain types of food. Drinking alcohol or smoking immediately before or after getting the injection may cause severe side effects. Talk to your doctor for a list of all possible foods that should be avoided before and after treatment.

Warnings

Pentostatin may cause some severe problems to the nervous system such as numbness, seizures, and great sleepiness. In addition to this, a few patients may experience liver problems. Before you start using this drug, ensure that you inform your doctor if you have an allergic reaction to pentostatin or its other elements. Patients allergic to other foods, drugs, and substances should also alert their healthcare providers when some symptoms start to show. These include itchiness, hives, coughs, wheezing, and swelling of the throat, lips, face, or tongue.

Pregnant and breastfeeding mothers should not use pentostatin because the medicine can negatively affect the health of the unborn baby or infant. Patients must discuss with their doctors if they're planning to get pregnant (or if it happens without their planning) while still being treated with this drug.

Important things you should know when you're taking pentostatin:-

  • Inform all your doctors, dentists, pharmacists, and nurses that you are being treated with pentostatin. This will enable the healthcare providers to make an informed choice regarding the best treatment alternative in case you start exhibiting symptoms of another disease.
  • You're at a higher chance of contracting the flu when receiving the anticancer drug. Ensure that you steer clear of people with the flu. Be on the lookout for colds and other infections as well.
  • Exercise caution when going about your daily activities or participating in sports because you are susceptible to bleeding. Opt for an electric razor when shaving and a soft toothbrush to prevent self-injury.
  • Make sure that you do not have any infection before you start receiving this medication. Reports reveal that some of these infections can worsen and even lead to death.
  • When combined with certain drugs such as etoposide and carmustine, this drug can cause low blood pressure and deadly lung complications that can lead to death. Have your blood checked for any toxicity to prevent this occurrence.
  • Discuss with a healthcare provider before getting vaccines. Apart from causing infections when used together with pentostatin, other vaccines may also not be able to deliver to the body the effect required.
  • If you get pregnant when taking this medication, alert your doctor immediately so that a way forward can be discussed. It's advisable to use a birth control method to prevent pregnancy when undergoing pentostatin treatment. Pregnant staff should not handle the drug to avoid risking the life of the fetus.
  • If an overdose case is suspected, call the poison control center or take the patient to a hospital immediately. Be ready to explain what was injected, the quantity and the time the incident occurred.
  • Discuss with your doctor before taking any other type of medication including over-the-counter, natural products, and vitamins.
  • After the treatment, the blood and platelets that patients receive must be treated through a complicated process of radiation. This is vital in eliminating the risk of donated blood interacting with the patient's blood and causing adverse effects.
  • Pentostatin may increase the risk of blood clots, which are distinguished by symptoms such as chest pain, difficulty in breathing, and redness. Seek medical treatment straight away when you identify these symptoms because a blood clot is very serious.

This information is not precise medical advice, so only a doctor has the essential training and knowledge pertaining to a patient's particular case. There is vast information on possible uses, precautions, side effects, interactions, and warnings so discuss with your doctor for detailed information regarding the benefits and risks.

Storage

Pentostatin is supplied as a powder and should be stored under refrigeration in a temperature range of 2° to 8°C (36° to 46°F). Avoid storing it at room temperature or removing it from refrigeration before it is needed. In addition to this, the drug should be kept away from moisture and direct light. It must be used before the expiration date set by the manufacturer.

After pentostatin has been diluted with hydrochloric acid or sodium hydroxide, it can be stored at room temperature and in low light. On the other hand, the drug should be used within 8 hours since it does not contain preservatives. Any medication that is left after the treatment session should be discarded according to the law. There are strict guidelines set by the government for handling toxic agents and the correct disposal methods of anticancer drugs.

When handling the drugs to take into storage, wear protective gloves. When disposing of items such as needles and syringes, the preventative measures in place have to be observed.

Summary

Pentostatin is an active cancer treatment drug that helps patients suffering from hairy cell and chronic lymphocytic leukemia to manage the conditions. However, the drug interacts with other types of over-the-counter medication and health supplements, which is why patients should discuss with their doctors before starting treatment. Numerous drugs react with pentostatin, so each patient's case is treated independently. Pregnant women and breastfeeding mothers should not use this drug because it can cause detrimental effects on the unborn babies and infants.

Statistics reveal that pentostatin is effective in alleviating symptoms caused by cancer. In most cases, the drug starts to work after three months and the patients fully recover by 12 months. However, some patients do not react to the drug as anticipated, so treatment has to be stopped, especially if the symptoms worsen. Pentostatin should only be administered by a healthcare professional so consult your doctor for all health benefits, risks, and adverse effects so that you can make an informed decision.