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Streptozocin

(strep-toe-zoe-sin)

Trade/other name(s): Zanosar, streptozotocin

Why would this drug be used?

Streptozocin is used to treat carcinoid tumors and pancreatic cancer. It is also sometimes used to treat other types of cancer.

How does this drug work?

Streptozocin is an antibiotic type drug that is only used to treat cancer. It belongs to a group of alkylating agents called nitrosoureas. It blocks the making of DNA, which keeps cancer cells from growing and causes 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, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have taken chemotherapy before, including this drug. This may affect how much streptozocin you can take.
  • If you have diabetes. This drug may affect blood sugar (glucose) levels. You and your doctor will need to watch your glucose levels closely.
  • 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. The drug may pass into breast milk and 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

Doxorubicin can worsen the effects on blood cells if taken with streptozocin.

There are also other drugs that are processed by the kidney that may worsen your risk of kidney damage if they are taken during the same time as streptozocin. For example, medicines for pain, inflammation, and fever (such as aspirin, ibuprofen, naproxen, fenoprofen, diclofenac, indomethacin, suprofen, tolmetin, meclofenamate, and others) may increase the chance that streptozocin will damage your kidneys.

Phenytoin (Dilantin, an anti-seizure medicine) may reduce the action of streptozocin.

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

Streptozocin is injected in a vein over 1 to 2 hours. You will be given anti-nausea medicine before the streptozocin. Tell the nurse right away if you feel discomfort in the vein during the treatment. Your dose will depend on your height and weight, and the type of cancer being treated.

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 doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.

You may feel confused and lethargic, especially if you take the drug each day for 5 days. Do not drive or do anything requiring that you be focused and alert until you know how the drug affects you. Talk to your doctor if you notice this.

Streptozocin can affect blood sugar levels. Call your doctor about symptoms of low blood sugar such as muscle weakness, sweating, flushing, restlessness, headache, confusion, trembling, or loss of consciousness (fainting). Tell your nurse or doctor if you notice signs of high blood sugar, such as increased thirst, increased urination, and increased hunger.

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

Your doctor will likely test your blood and urine 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.

Streptozocin 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.

Streptozocin 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.

Streptozocin can damage the kidneys. Your doctor may advise that you drink extra fluids while you are taking this drug, and will likely check labs so that if any kidney abnormalities occur, they can be found early. If you notice swelling in your feet or legs, or a decrease in your urine output, call your doctor right away.

Because of the way streptozocin 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 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.

Avoid pregnancy during and for some time after treatment with this drug. It may harm the fetus. Check 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

  • kidney damage (usually improves when the drug is stopped)
  • nausea
  • vomiting
  • liver damage with yellowing of the skin or eyes (jaundice)
  • pain or burning in the vein where drug is given

Less common

  • high or low blood sugar*

Rare

  • diarrhea
  • abdominal cramping
  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • death due to kidney damage, bone marrow shutdown, liver failure, or other causes

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

There are other side effects that are 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: 01/12/2010
Last Revised: 05/09/2012