[.
]Action/Kinetics:
Antibiotic produced by Streptomyces plicatus, S. argillaceus and S. tanashiensis. Complexes with DNA in the presence of magnesium (or other divalent cations), resulting in inhibition of cellular and enzymatic RNA synthesis. Decreases blood calcium by blocking the hypercalcemic effect of vitamin D, acting on osteoclasts, and preventing the action of parathyroid hormone. Cleared rapidly from the blood and is concentrated in the Kupffer cells of the liver, renal tubular cells, and along formed bone surfaces. Crosses the blood-brain barrier. Excreted through the urine.
Uses:
Malignant testicular tumors usually associated with metastases and when radiation or surgery is not an alternative. Hypercalcemia and hypercalciuria associated with advanced malignancy and not responsive to other therapy.
Additional Contraindications:
Thrombocytopenia, thrombocytopathy, coagulation disorders, and increased tendency to hemorrhage. Impaired bone marrow function. Pregnancy (category: X). Lactation. Do not use for children under 15 years of age.
Special Concerns:
Use with caution in impaired liver or kidney function.
Additional Side Effects:
Severe thrombocytopenia, hemorrhagic tendencies. Facial flushing. Hepatic and renal toxicity. Extravasation may cause irritation or cellulitis. Electrolyte imbalance including hypocalcemia, hypokalemia, and hypophosphatemia.
Laboratory Test Alterations:
Serum calcium, potassium, and phosphorus. 
Serum BUN, creatinine, AST, ALT, alkaline phosphatase, bilirubin, isocitric dehydrogenase, ornithine carbamyltransferase, LDH. BSP retention.
Overdose Management:
Symptoms: Hematologic toxicity. Treatment: Monitor hematologic status, especially clotting factors. Also, closely monitor serum electrolytes and hepatic and renal functions.
How Supplied:
Powder for injection: 2.5 mg
Dosage
•IV Only
Testicular tumor.
Dose individualized. Usual: 25-30 (maximum) mcg/kg (given over a period of 4-6 hr) daily for 8-10 (maximum) days. Alternatively, 25-50 mcg/kg on alternate days for an average of eight doses.
Hypercalcemia, hypercalciuria.
Dose individualized: 15-25 mcg/kg (given over a period of 4-6 hr) daily for 3-4 days. Additional courses of therapy may be warranted at weekly intervals if initial course is unsuccessful.
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