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Altretamine

(all-tret-ah-meen)

Trade/other name(s): Hexalen, Hexamethylmelamine

Why would this drug be used?

Altretamine is used to treat ovarian cancer that is no longer responding to first-line drugs.

How does this drug work?

Altretamine is a chemotherapy drug called an alkylating agent. It can disrupt the growth of cancer cells, which are then destroyed.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever had chemotherapy, or if you have numbness in your hands or feet. This drug can cause or worsen numbness.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could affect the baby.
  • If you think you might want to have children in the future. This drug may cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Do not take this medicine with pyridoxine (vitamin B-6) supplements, because it may reduce the effectiveness of altretamine.

If you are taking any of the drugs known as monoamine oxidase inhibitors (MAO inhibitors, which are an older type of antidepressant), talk with your doctor before taking altretamine. It can cause your blood pressure to go dangerously low.

Cimetidine (Tagamet) may worsen the side effects of altretamine by keeping it in the body longer.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with altretamine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Altretamine is a capsule taken by mouth. The dose depends upon your size. The daily dose is taken 4 times a day, after each meal and at bedtime. Altretamine is taken for 14 or 21 days every 4 weeks (28 days). Your doctor may lower your dose if you have low blood counts or other problems taking the drug.

Keep the medicine in a tightly closed container and out of the reach of children and pets. Take this drug exactly as directed by your doctor. If you do not understand the instructions, your doctor or nurse can explain them to you.

Precautions

This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. These symptoms can sometimes progress to include trouble walking or holding things in your hands. You may become constipated. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

This drug may also cause dizziness, vertigo (feeling that the room is moving or spinning), unsteady walking, confusion, and problems with mood. Let your doctor know right away if you notice any of these problems. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

Do not have any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Altretamine may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits.

This drug can lower your white blood cell count. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Altretamine can cause nausea, vomiting, diarrhea, and stomach cramping. Your doctor or nurse will give you prescriptions for medicines to take at home to prevent these side effects. It is important to have these medicines on hand and to take them as prescribed by your doctor. If the medicines do not help the symptoms, ask your doctor or nurse about other ways to prevent or lessen them.

Avoid pregnancy while taking this drug and for some time afterward. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • low red blood cell count (anemia) with tiredness, weakness, and other symptoms
  • nausea*
  • vomiting*
  • lower sperm production
  • fetal abnormalities if the medicine is taken during pregnancy

Less common

  • sleepiness
  • mood changes
  • tiredness, flu-like symptoms
  • loss of appetite
  • stomach cramps*
  • diarrhea*
  • abnormal blood tests which suggest that the drug is affecting the kidneys (Your doctor will discuss the importance of this finding, if any.)
  • abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)

Rare

  • numbness or sensation of pins and needles in hands and/or feet*
  • clumsiness*
  • dizziness*
  • difficulty walking*
  • skin rash, itching
  • long-term or short-term infertility

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – This drug was first approved in 1990

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 01/12/2010
Last Revised: 01/12/2010