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Procarbazine

(pro-kar-buh-zeen)

Trade/other name(s): Matulane

Why would this drug be used?

Procarbazine is used to treat Hodgkin disease and brain tumors. It may also be usd to treat other conditions.

How does this drug work?

Procarbazine acts as an alkylating agent which helps to stop cancer cells from growing.

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 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. This drug has been linked to sterility in some people. 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

The anti-seizure drugs phenytoin, phenobarbital, and carbamazepine may increase the risk of allergic reaction if taken with procarbazine.

Because procarbazine is a mild MAO inhibitor (MAOI), it can cause flushing (red face or skin), fast heart rate, high blood pressure and other problems if taken with certain drugs and supplements such as antihistamines, St. John's wort, tryptophan, some pain medicines, antidepressants, decongestants, nose sprays, drugs that affect the brain (stimulants, amphetamines, and many illicit drugs), and more. Talk with your doctor about which drugs to avoid, and tell your doctor about any new drug before you start taking it.

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

Procarbazine may make you drowsy. This can add to the effects of other medicines or substances that make you sleepy or less alert, such as:

  • antihistamines
  • anti-anxiety drugs (tranquilizers or sedatives)
  • sleeping pills
  • muscle relaxers
  • barbiturates
  • anti-seizure medicines
  • opioid pain medicines
  • anesthetics
  • antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), doxepin (Sinequan), and others
  • anti-psychotic drugs
  • certain anti-nausea medicines

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

Interactions with foods

Procarbazine can cause very high blood pressure and rapid heart rate if you have wine or beer (even non-alcoholic ones); yogurt; aged cheese; aged meats (salami, sausage, bologna, dried meat, or meat extracts); protein supplements; fermented bean curd; aged, pickled, or fermented fish; fava beans; banana peel; liver; brewer's yeast; and other foods with high tyramine content. This effect can last for a few weeks after treatment is done, and can be dangerous. Talk with your doctor or cancer team to get a list of food restrictions during and after treatment with procarbazine.

Alcoholic drinks can cause serious symptoms if taken with this drug.

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

How is this drug taken or given?

Procarbazine is a pill taken by mouth usually daily for a certain number of days. Make sure you take your anti-nausea pill an hour before taking the medicine. Some people like to take the dose at bedtime. The dose depends on your weight and the type of cancer being treated.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

This drug may make you feel drowsy when you first start taking it or after the dose is increased. Do not drive or operate heavy machinery until you know how the drug affects you. Talk to your doctor or nurse if you feel too drowsy or it does not go away.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Procarbazine may affect your immune system. This could make vaccinations ineffective, or even lead to serious infections if you get a live virus vaccine during treatment or soon afterward. 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, 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. 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.

Do not drink alcohol while taking procarbazine (see also "Interactions with foods", above). It can cause symptoms like headache, difficulty breathing, nausea, vomiting, sweating, chest pain, low blood pressure, and changes in how you think and feel.

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 likely 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.

Call your doctor right away if you notice numbness or tingling in your hands or feet, confusion, or diarrhea.

This drug may cause sores in the mouth or on the lips. Let the doctor know right away if you notice any sign of a sore. Your medicine may need to be stopped.

Because of the way this drug and the others that are given with it act on cells in the body, you may have a higher long-term risk of getting a second type of cancer, such as leukemia or lung cancer. (The risk of lung cancer is much higher among smokers.) 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 feels 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*
  • low platelet count with increased risk of bleeding*
  • nausea*
  • vomiting*
  • loss of appetite
  • feeling sleepy or drowsy
  • depression
  • difficulty sleeping
  • nightmares
  • nervousness
  • flu-like symptoms (tiredness, headache, muscle aches, fever, stuffy nose)

Less common

  • trouble swallowing
  • dry mouth
  • headache
  • short-term or long-term infertility (inability to have children) in men and women

Rare

  • diarrhea*
  • tremors, confusion, coma, convulsions*
  • numbness and tingling in hands and feet progressing to difficulty walking*
  • hair loss or thinning, including face and body hair (usually grows back after treatment)
  • rash
  • darkening of skin
  • itching
  • blood clots in arms, legs, lungs (with serious trouble breathing), or brain (stroke)
  • allergic reaction, with symptoms like hives, itching, swelling in the mouth or throat, trouble breathing or swallowing
  • second type of cancer, usually years later*

*See the "Precautions" section for more detailed information.

There are other side effects not listed above 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: 01/12/2010
Last Revised: 01/12/2010