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Thiotepa

(thigh-oh-TEP-uh)

Trade/other name(s): Thioplex, Triethylenethiophosphoramide

Why would this drug be used?

Thiotepa is used to treat lymphoma and cancers of the breast, ovary, bladder, and other cancer types. It may also be used to control the fluid that can build up in body spaces (such as the abdomen) where cancer has spread.

How does this drug work?

Thiotepa belongs to a group of chemotherapy drugs called alkylating agents. It slows or 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 ever had any medical conditions such as kidney disease, liver disease (including hepatitis), bone marrow damage, heart disease, congestive heart failure, diabetes, gout, or if you have an infection. 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 reported to cause temporary or permanent 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

Thiotepa may increase the effects of some types of surgical anesthesia. If you're going to be put to sleep for surgery, be sure your doctor and/or anesthesiologist know you are taking this drug.

The anti-seizure drugs carbamazepine and phenytoin have both been reported to increase the effects of thiotepa. There may be other drugs that cause this problem as well.

Drugs or treatments that lower the blood counts (many types of chemotherapy, radiation therapy) should not be used along with thiotepa. If such a drug is used before or after thiotepa, the second drug should be started only after blood counts have come back up.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with thiotepa. 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 is in the medicines you take.

Research on drug interactions is lacking at this time. 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?

Thiotepa is injected into a vein. It can also be given directly into the bladder using a urinary catheter. It is sometimes injected into certain spaces of the body, such as the abdominal (peritoneal) cavity or the space around the spine. The dose depends on how much you weigh, the type of cancer you are being treated for, and how it is being used.

Precautions

Thiotepa can cause allergic reactions in some people. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), hives, itching, wheezing, shortness of breath, tightness in the throat, wheezing, or swelling of the face, tongue, or eyes. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug or shortly afterward.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Thiotepa 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 before, during, and after 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 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.

Thiotepa 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.

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 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.

If you plan to have surgery or any type of procedure, be sure the doctor or dentist knows you are taking this drug.

Use effective birth control to avoid conceiving a child while taking this drug. It can cause birth defects or otherwise harm the fetus.

Even if you are getting thiotepa in your bladder or another body space, a great deal of it can be absorbed into the bloodstream. You may have the same kinds of side effects as when it is given in a vein.

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
  • temporary or permanent sterility (inability to have children)

Less common

  • tiredness (fatigue)
  • anemia (low red blood cell count)
  • dizziness
  • headache
  • fever
  • pain where the drug was injected
  • hair loss, thinning or brittle hair (including hair on the face or body)

Rare

  • blurred vision
  • confusion
  • allergic reaction with itching, hives (welts), swelling in throat, wheezing, dizziness, or shortness of breath*
  • second type of cancer*
  • death from infection, bleeding, or other cause

*See the "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: 01/12/2010
Last Revised: 01/12/2010