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Pentostatin
(2'-deoxycoformycin; DCF)
Pentostatin (Nipent)
2'-deoxycoformycin (Nipent)
DCF (Nipent)
Pentostatin
(PEN-toh-stah-tin)
Pregnancy Category: D Nipent (Rx)

Classification: Antineoplastic antibiotic

See Also: See also Antineoplastic Agents.

Action/Kinetics: Isolated from Streptomyces antibioticus; inhibits the enzyme ADA. Inhibition of ADA, especially in the presence of adenosine or deoxyadenosine, results in cellular toxicity (T cells, B cells) due to elevated intracellular levels of dATP; this blocks the synthesis of DNA through inhibition of ribonucleotide reductase. Also inhibits RNA synthesis and causes increased DNA damage. t1/2, distribution: 11 min; terminal: 5.7 hr. Approximately 90% is excreted in the urine as unchanged pentostatin or metabolites.

Uses: Hairy cell leukemia in adults who are refractory to alpha-interferon; such individuals have progressive disease after a minimum of 3 months of alpha-interferon therapy or no response after a minimum of 6 months of alpha-interferon therapy.

Contraindications: In combination with fludarabine phosphate. Lactation.

Special Concerns: Treat clients with infection only if the potential benefit outweighs the risk; infection should be treated before pentostatin therapy is initiated or resumed. Safety and effectiveness have not been determined in children.

Side Effects: Hematologic: Leukopenia, anemia, thrombocytopenia, ecchymosis, lymphadenopathy, petechia, abnormal erythrocytes, leukocytosis, pancytopenia, purpura, splenomegaly, eosinophilia, hematologic disorder, hemolysis, lymphoma-like reaction. GI: N&V;, anorexia, abdominal pain, diarrhea, constipation, flatulence, stomatitis, colitis, dysphagia, dyspepsia, eructation, gastritis, GI hemorrhage gum hemorrhage, intestinal obstruction, leukoplakia, melena, periodontal abscess, proctitis, abnormal stools, esophagitis, gingivitis, mouth disorder. Hepatic: Hepatitis, hepatomegaly, hepatic failure. CNS: Headache, anxiety, abnormal thinking, confusion, depression, dizziness, insomnia, nervousness, paresthesia, somnolence, agitation, amnesia, ataxia, abnormal dreams, depersonalization, emotional lability, hyperesthesia, hypesthesia, hypertonia, incoordination, decreased libido, neuropathy, stupor, tremor, vertigo, coma, seizures. CV: Arrhythmia, abnormal ECG, hemorrhage thrombophlebitis, aortic stenosis, arterial anomaly, cardiomegaly, CHF, cardiac arrest flushing, hypertension, MI palpitation, varicose vein, shock. Dermatologic: Rash, skin disorder, eczema, dry skin, herpes simplex, herpes zoster, maculopapular rash, pruritus, seborrhea, skin discoloration, sweating, vesiculobullous rash, acne, alopecia, exfoliative dermatitis, contact dermatitis, fungal dermatitis, benign skin neoplasm, psoriasis, SC nodule, skin hypertrophy, urticaria. GU: GU disorder, dysuria, hematuria, fibrocystic breasts, gynecomastia, hydronephrosis, oliguria, polyuria, pyuria, toxic nephropathy, urinary frequency, urinary retention, urinary urgency, UTI, impaired urination, urolithiasis, vaginitis. Musculoskeletal: Myalgia, arthralgia, asthenia, facial paralysis, abnormal gait, arthritis, bone pain, osteomyelitis, neck rigidity, pathologic fracture. Respiratory: Cough, URI, lung disorder, bronchitis, dyspnea, epistaxis, lung edema, pneumonia, pharyngitis, rhinitis, sinusitis, asthma, atelectasis, hemoptysis, hyperventilation, hypoventilation, increased sputum, laryngitis, larynx edema, lung fibrosis, pleural effusion, pneumothorax, pulmonary embolus. Body as a whole: Fever, infection, fatigue, weight loss or gain, peripheral edema, pain, allergic reaction, chills, sepsis, chest pain, back pain, flu syndrome, malaise, neoplasm, abscess, enlarged abdomen, ascites, acidosis, dehydration, diabetes mellitus, gout, abnormal healing, cellulitis, facial edema, cyst, fibrosis, granuloma, hernia, hemorrhage or inflammation of the injection site, moniliasis, pelvic pain, photosensitivity, anaphylaxis mucous membrane disorder, immune system disorder, neck pain. Ophthalmic: Abnormal vision, conjunctivitis, eye pain, blepharitis, cataract, diplopia, exophthalmos, lacrimation disorder, optic neuritis, retinal detachment. Miscellaneous: Ear pain, deafness, otitis media, parosmia, taste perversion, tinnitus.

Laboratory Test Alterations: LFT, BUN, creatinine, LDH, CPK, gamma globulins. Albuminuria, glycosuria, hyponatremia, hypocholesterolemia.

Overdose Management: Symptoms: Severe renal, hepatic, pulmonary, and CNS toxicity; death can result. Treatment: General supportive measures.

Drug Interactions: Fludarabine / Risk of fatal pulmonary toxicity Vidarabine / Effect of vidarabine, including side effects

How Supplied: Powder for Injection: 10 mg

Dosage
•IV Bolus, IV Infusion Alpha-interferon-refractory hairy cell leukemia.
4 mg/m² every other week.