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Dactinomycin

(dak-tin-oh-mye-sin)

Trade/other name(s): actinomycin D, Cosmegen, Act-D

Why would this drug be used?

Dactinomycin is used to treat Wilms and Ewings tumors, testicular cancer, sarcomas (cancers that grow from cartilage, fat, muscle, or bone), and other types of cancer.

How does this drug work?

Dactinomycin is in the group of chemotherapy drugs known as antibiotics. It stops cancer cells from growing, causing them to die.

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, infections, or if you have had kidney stones. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever been treated with radiation or chemotherapy. Your doctor may want to give you lower doses of dactinomycin.
  • 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 harm the baby.
  • If you think you might want to have children in the future. Some drugs can 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

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with dactinomycin. 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?

Dactinomycin is given as an injection in a vein over about 15 minutes. Tell the nurse if you feel pain, burning, or discomfort in the vein when the medicine is given. The dose and how often you get the medicine depends upon your size, your blood counts, and the type of cancer you are being treated for. You will have your blood counts and other lab work checked before each treatment; if the results are outside the safe range, your treatment will be delayed. You may be given other anti-cancer medicines in addition to this one. You should get medicine before the dactinomycin and to take afterward to stop any nausea or vomiting.

Precautions

This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV.

Your doctor will probably 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 altogether. Keep all your appointments for lab tests and doctor visits.

Dactinomycin can lower your white blood cell count, especially in the weeks after the drug is given. 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 in the weeks after it is given, which can increase your risk of bleeding. Talk 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.

Dactinomycin may lower your red blood cell count. If this occurs, it is usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

Do not get any immunizations (vaccinations), either during or after treatment with this drug, without your doctor's OK. Dactinomycin may affect your immune system. This could make vaccinations ineffective, or could 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.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will probably also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. Let your doctor know if these drugs do not stop the vomiting.

Call your doctor if you notice sores in your mouth or throat, or if you get diarrhea that lasts more than a day or two. You may need your dactinomycin dose changed.

Dactinomycin can cause radiation recall. When a person receives this drug, the skin or tissue damage from prior radiation therapy can become red and appear damaged again. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Avoid pregnancy during and for at least a few months after treatment, since exposure to this drug may harm the fetus. Talk with your doctor about this.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor believes that this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

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*
  • nausea*
  • vomiting*
  • loss of appetite
  • low platelet count with increased risk of bleeding*
  • sores in mouth or on lips, esophagus, or rectal area (worse if these areas have been recently treated with radiation)*
  • darkening of skin along vein used for giving the drug
  • diarrhea*
  • rash
  • hair loss, including face and body hair
  • radiation recall (skin changes where you have had radiation before)*

Less common

  • tiredness (fatigue)
  • abdominal pain
  • fever
  • fetal abnormalities if taken while you are pregnant or if you become pregnant while taking this drug*
  • muscle and bone aches
  • depression

Rare

  • liver damage
  • kidney damage
  • damage to skin and other tissues if the drug leaks out of the vein*
  • second type of cancer*
  • severe allergic reaction at the time the drug is given, with dizziness, itching, rash, shortness of breath, or swelling in the face, tongue, or throat.
  • death due to infection, liver failure, or other cause

*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 – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

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: 02/11/2010
Last Revised: 02/11/2010