Procarbazine (Oral)

Often used in conjunction with other medicines or treatments, procarbazine is a cancer treatment which works to inhibit the growth of cancer cells in order to destroy them.

Overview

Procarbazine is a cancer treatment most commonly used to treat Hodgkin's lymphoma. This type of cancer begins in the white blood cells, which are responsible for fighting off infection. Procarbazine is an alkylating agent and it works by interfering with the growth of cancer cells in order that they are destroyed. Sometimes, the drug is also used to treat certain types of brain tumor.

Like other similar cancer treatments, procarbazine can affect the growth of other cells in the body in the same way that it affects the growth of cancer cells. For this reason, it can cause a wide variety of side effects, some of which are very serious. Patients tend to be very closely observed throughout treatment with procarbazine for this reason and can expect to undergo many laboratory tests during treatment. The drug is only available with a prescription and treatment has to be supervised by a doctor who is experienced in chemotherapy medications.

In the US, procarbazine is known under the brand name Matulane. It is administered orally in capsule form.

Conditions Treated?

  • Hodgkin's lymphoma
  • Brain tumor

Type Of Medicine?

  • Alkylating agent

Side Effects

There are very many potential side effects which patients may experience while undergoing treatment with procarbazine. Some of them are very serious and warrant urgent medical attention, while others are minor and don't necessarily need to be referred to a doctor. You may not experience all the side effects, but you should be prepared for them so that you can recognize when to seek medical care.

If you notice any of the following side effects, consult your doctor or visit the ER right away:

  • Shortness of breath
  • Rapid heartbeat
  • Severe dizziness or fainting
  • Swelling
  • Burning, numb or tingling sensations
  • Shakiness
  • Seizures
  • Problems with balance
  • Tiredness or weakness
  • Diarrhea
  • More frequent urination
  • Confusion
  • Difficulty concentrating
  • Mood changes
  • Hallucinations
  • Bad dreams or nightmares
  • Changes in vision
  • Inability to control eye movements
  • Eye pain or severe eye irritation
  • Hearing loss
  • Mouth sores or other irritation
  • Swallowing problems
  • Slurred speech
  • Increased sweating
  • Enlarged breasts (in male children only)
  • Signs of allergy, such as:
    • Rash
    • Hives
    • Itching
    • Swollen skin
    • Peeling skin
    • Blisters
    • Wheezing
    • Tight chest
    • Tight through
    • Difficulty breathing
    • Difficulty talking
    • Hoarseness
    • Swollen face, mouth, lips, tongue or throat
  • Signs of infection, such as:
    • Chills
    • Fever
    • Very sore throat
    • Cough
    • Increased sputum or changes to color of sputum
    • Ear pain
    • Sinus pain
    • Mouth sores
    • Wounds that won't heal
    • Painful urination
  • Signs of abnormal bleeding, such as:
    • Vomiting blood
    • Vomiting substance that looks like coffee grounds
    • Coughing blood
    • Blood in urine
    • Black, tarry stools
    • Red stools
    • Bleeding gums
    • Unusual vaginal bleeding
    • Bruising that appear without reason
    • Bruises that suddenly become bigger
    • Bleeding that doesn't stop
  • Signs of liver problems, such as:
    • Yellow eyes or skin
    • Dark urine
    • Light-colored stools
    • Vomiting
    • Upset stomach
    • Stomach pain
    • Loss of appetite

The following side effects are minor and don't require medical attention unless they become very severe or prolonged. You may want to discuss them with your doctor at your routine appointments, but it may not be necessary to report them to your doctor as soon as they occur. If they become particularly bothersome, your doctor may be able to recommend lifestyle changes you could make to reduce the severity of the side effects or make them easier to cope with.

  • Sleepiness
  • Dizziness
  • Weakness
  • Muscle or joint pain
  • Headache
  • Reduced appetite
  • Upset stomach or vomiting
  • Constipation
  • Stomach pain or discomfort
  • Hair loss
  • Dry mouth
  • Difficulty sleeping
  • Flushing
  • Changes to skin color

This is not necessarily an exhaustive list of all side effects associated with procarbazine. If you experience any other unwanted effects while taking this drug, consult your doctor as soon as possible. You could also report side effects to the FDA.

Dosage

The amount of procarbazine a patient takes will depend greatly upon their medical history and the nature of their illness. For example, patients with decreased kidney or liver function may be prescribed lower doses than those with normal kidney or liver function, as the drug may be removed at a slower rate from the body which can make it more potent. Doctors will determine appropriate doses on a case by case basis.

Usually, procarbazine is taken in combination with other medicines and doses, therefore, vary depending on the other treatments being administered at the same time. You may be instructed to take procarbazine on certain days within a month-long cycle. Furthermore, your doctor may adjust your dose throughout treatment, depending on how you respond to it and the side effects that you experience. Always follow your doctor's dosage instructions closely.

You can expect to undergo frequent tests during your treatment with procarbazine so that your doctor can continually assess your progress. Not only will they be looking to see how successful the drug is for you, but they'll also check for harmful side effects to ensure the drug isn't causing serious health complications. You will have frequent appointments with your doctor and these are good opportunities to discuss your side effects with them and ask for advice on how to manage minor side effects which are causing inconvenience.

How to take procarbazine

Procarbazine should be taken only on the days instructed by your doctor. It is usually best to take it around the same time each day on those days. Take care to follow your doctor's instructions in regard to taking it with other medicines; you may need to take it at the same time as other drugs, or at different times to avoid mixing them. Your healthcare provider will help you to work out a schedule for all the medicines you need to take.

Procarbazine is provided in capsule form. The capsules should be swallowed whole, either with or without food. Do not crush, chew, break or open the capsules. You may swallow them with water if necessary.

A common side effect of procarbazine is nausea and vomiting. If you vomit soon after taking a dose of procarbazine, consult your doctor. It may be necessary for you to take another dose, or it may be okay for you to wait until the next dose. Do not stop taking procarbazine without your doctor's approval, even if it makes you feel sick. Your doctor may be able to advise you on ways to reduce nausea.

Missed doses

If you miss a dose of procarbazine, take it as soon as you remember. However, if it is almost time for you next dose when you realize you have missed one, simply skip the missed dose and take the next one at your usual schedule. If you have been instructed to avoid mixing procarbazine with other prescribed medicines, consult your doctor to check that you will not cause a harmful interaction by taking a missed dose at a later time than usual.

Overdose

If you accidentally take too much procarbazine, call your doctor immediately or call your local poison control center. If the patient is unconsciousness or has stopped breathing, call 911. Overdosing on this medicine could cause very serious side effects and it is, therefore, important to seek immediate medical care.

Interactions

Procarbazine can interact with a wide variety of medicines. It is vital that your doctor knows about all the medicines you take, including those prescribed to you and those purchased over the counter. You should also mention any herbal supplements or vitamins you take. It may be helpful to keep a list of all these medicines which you can then present to all doctors and other healthcare professionals you have meetings with so that they can avoid prescribing contraindicated drugs.

It is particularly important to tell your doctor about the following medicines before you start taking procarbazine:

  • Allergy and hay fever medications
  • Amitriptyline (Elavil)
  • Asthma medications
  • Barbiturates, such as phenobarbital
  • Blood pressure medications
  • Imipramine (Tofranil)
  • Medications containing alcohol, such as cough and cold products like Nyquil, and other liquid products)
  • Medications for mental illness
  • Nasal decongestants, including nose drops and sprays
  • Nausea medications
  • Opioid (narcotic) pain medicines
  • Sedatives
  • Sleeping pills
  • Tranquilizers

If you do take a medicine which is known to interact with procarbazine, your doctor may avoid prescribing it to you or they may change the medicines you are currently taking. If both medicines are deemed absolutely necessary, your doctor may make dosage adjustments or tell you to take the medicines at certain times of day to prevent interactions. Always follow your doctor's instructions closely.

Warnings

Recent radiation therapy or chemotherapy

Procarbazine may not be safe for you if you have had radiation therapy, chemotherapy or other cancer treatments within the last 30 days. Make sure your doctor knows your entire treatment history.

Kidney or liver disease

In people with kidney disease or liver disease, procarbazine may be removed from the body at a slower rate than usual. This could make the medicine more potent and increase the risk of serious side effects. For this reason, you may not be able to take procarbazine if you have very severe kidney or liver disease. If you have mild or moderate liver or kidney disease, you may still be able to take procarbazine at smaller dosages than usual.

Hair loss

Many people who take procarbazine experience hair loss or hair thinning. This effect is temporary and normal hair growth should return once treatment with procarbazine has ended.

Avoid tyramine in food

Tyramine, which is found in a range of different foods, can increase blood pressure to dangerous levels when consumed at the same time as procarbazine treatment. Severely high blood pressure can be life-threatening. You may need to make changes to your diet to avoid foods which contain particularly high levels of tyramine, such as:

  • Anchovies
  • Avocados
  • Bananas
  • Bean curd
  • Beef or chicken liver
  • Beer
  • Bologna
  • Caffeine (including tea, coffee and cola)
  • Caviar
  • Champagne
  • Cheese (particularly aged or processed cheeses such as American, blue, brie, cheddar, mozzarella, Parmesan, Romano and Swiss)
  • Chocolate
  • Distilled spirits
  • Fava beans
  • Figs
  • Game meat
  • Ginseng
  • Herring
  • Meat extracts
  • Miso soup
  • Papaya
  • Pepperoni
  • Pickled, dried or smoked fish
  • Raisins
  • Sauerkraut
  • Sherry
  • Shrimp paste
  • Sour cream
  • Soy sauce
  • Summer Sausage
  • Vermouth
  • Wine (particularly red)
  • Yeast extracts
  • Yogurt

Your doctor may be able to refer you to a dietitian to help you formulate a safe, balanced and healthy diet plan which you should follow throughout your treatment. You could also refer to a doctor or dietitian if you find that you feel unwell after eating certain foods while taking procarbazine.

Live vaccines

Procarbazine can make live vaccines less effective, which may mean you are not fully protected from the disease you are hoping to be inoculated against. You should, therefore, avoid live vaccines while undergoing treatment with procarbazine. This includes:

Risk of contamination to caregivers

Procarbazine can pass into urine, feces and vomit and risks contaminating caregivers. Since the drug can be extremely harmful to those it is not prescribed to, caregivers should take care to protect themselves against potential contamination. They should wear rubber gloves when cleaning bodily fluids or handling contaminated laundry or other items. Hands should also be washed before and after removing the gloves. All soiled linens and clothes should be washed separately to other laundry to prevent contamination.

Higher risk of infection

Since procarbazine affects cell growth, it can cause the immune system to become weaker and patients taking the drug are therefore more susceptible to infection. You should avoid being near people with infection, even it is just a common cold, as your body will have a harder time fighting it than usual. Tell your doctor if you notice any signs of infection, such as:

  • High temperature
  • Skin which feels hot to touch
  • Fever with chills
  • Aching muscles
  • Pain or stinging sensation when passing urine
  • Confusion or dizziness
  • Unusual tiredness or weakness

Pregnancy and breastfeeding

Procarbazine is a pregnancy category D drug, which means that it is not suitable for use during pregnancy unless it is a life-threatening situation and alternative treatments aren't available. Studies have demonstrated that procarbazine poses a serious risk of congenital malformations of the fetus. You should use birth control throughout treatment with procarbazine to prevent pregnancy. If you do become pregnant while taking procarbazine, consult your doctor immediately but do not stop taking the medicine until your doctor instructs you to do so.

It is not known whether procarbazine is excreted in human breast milk, but it is believed that the drug could cause serious harm to nursing infants if it is. For this reason, women should avoid breastfeeding during treatment with procarbazine.

Male fertility

Procarbazine can lower sperm count in men, which could affect their ability to have children. Patients who plan to have children in the future should consult their doctor about the risk of infertility in order that they can decide whether procarbazine is the right treatment for them.

Avoid alcohol and tobacco

You may experience unpleasant side effects if you drink alcohol while taking procarbazine, such as vomiting, stomach cramps, headaches, sweating and flushing of the face. You should therefore not drink any alcohol during treatment with this drug. If you feel that this is something you may struggle with, ask your doctor for advice on quitting alcohol. You may not be able to take procarbazine if you are addicted to alcohol.

Smoking can increase the risk of lung cancer during treatment with procarbazine. Ask your doctor for advice on quitting smoking before you start procarbazine therapy.

Interactions With Medical Problems

Certain medical problems may affect the use of procarbazine, so it is very important that your doctor knows your entire medical history before you begin taking it. Be sure to mention all conditions you have had in the past, as well as those you currently suffer from.

Procarbazine should not be taken by patients who have bone marrow suppression.

Procarbazine can lower blood pressure which may cause complications for patients with the following conditions:

Patients with the following viruses risk the disease affecting other parts of the body while taking procarbazine:

  • Chickenpox (including recent exposure)
  • Herpes zoster (shingles)

The following conditions may be worsened by procarbazine:

In patients with type 2 diabetes, procarbazine can increase blood sugar levels and this may affect the amount of diabetes medicine they have to take.

Patients with epilepsy may find that the nature of their seizures changes during treatment with procarbazine.

In patients who regularly experience severe or frequent headaches, it may be difficult to tell when a headache is caused by a dangerous reaction to procarbazine. Ask your doctor for advice on recognizing harmful reactions to the drug.

You should also make sure your doctor knows if you suffer from:

  • Anemia (low red blood cell counts)
  • Low white blood cell counts
  • Low blood platelet levels
  • Fluid retention

Storage

Store procarbazine at room temperature and away from direct light, heat or moisture. Avoid storing it in the bathroom. You should keep the capsules in the containers they are provided in, with the caps tightly closed at all times so that they cannot be accessed by children. Store the container up and away from the ground so it isn't within easy reach of children or pets.

Do not keep expired or unused procarbazine capsules. Ask your healthcare provider how to dispose of them safely. There may be a local medicine take-back program you could use. These are typically run by pharmacies, healthcare providers, or garbage or recycling departments.

Summary

Procarbazine is an alkylating agent which is used, usually in combination with other medicines, to treat cancer. It is most commonly prescribed to patients with Hodgkin's lymphoma, but sometimes it is also used to treat certain types of brain tumors. It works by interfering with the growth of cancer cells in order to destroy them. It also works on normal cells, which is why it can cause a wide variety of unwanted effects as well as its needed effects.

Many people who take procarbazine experience hair loss or hair thinning. This effect is temporary, and hair will begin to regrow once treatment has ended. It is also common for patients to experience nausea, dizziness, sleepiness, weakness and headache.

Some side effects of procarbazine are serious and should be reported to a doctor immediately. Examples of this are abnormal bleeding, signs of liver problems, shortness of breath, problems with balance and muscle control, changes to vision, and mood changes.

Procarbazine is provided in capsule form and should be taken orally. The amount a patient takes will depend on many factors, including the type of cancer they have and the severity of their condition, their medical history, and the other medicines being used to treat the cancer. Doctors may give specific instructions in regard to taking the capsule at the same time or at different times to other medicines. Furthermore, doctors may adjust the dose of procarbazine as treatment continues depending on the progress the patient makes. Patients should carefully follow their doctor's instruction to ensure the drug is as successful as possible while causing minimal harmful side effects.

Patients should not take procarbazine if they have had radiation therapy, chemotherapy or any other type of cancer treatment within the last 30 days. The drug may also be unsuitable for people with kidney or liver disease, or with bone marrow suppression. Pregnant women should not take procarbazine due to the serious risk to the fetus.

When patients take procarbazine, their immune system will become weakened and they will be more susceptible to infection. They should, therefore, avoid close contact with anyone who has an infection.

Procarbazine can pass into urine, feces and vomit and caregivers should, therefore, take care to avoid contamination when coming into contact with these bodily fluids. They should wear gloves when cleaning urine, vomit or feces and wash hands both before and after using the gloves.

Patients should avoid alcohol while taking procarbazine due to a risk of very unpleasant side effects such as stomach cramps and vomiting. They should also avoid tobacco, because smoking could increase the risk of lung cancer while taking this medicine. It's also important to avoid foods which contain large amounts of tyramine, such as avocado, caffeine and aged or fermented foods such as cheeses, processed meat products and yeast. Tyramine can cause dangerously high blood pressure when consumed at the same time as procarbazine. A dietitian may be able to recommend an appropriate diet.