Thiotepa
Thiotepa
Thiotepa
(thigh-oh- TEP-ah)
Pregnancy Category: D (Abbreviation: Thio) Thioplex (Rx)

Classification: Antineoplastic, alkylating agent

See Also: See also Antineoplastic Agents and Alkylating Agents .

Action/Kinetics: Cell-cycle nonspecific; thought to act by causing the release of ethylenimmonium ions that bind or alkylate various intracellular substances such as nucleic acids. Is cytotoxic by virtue of cross-linking of DNA and RNA strands as well as by inhibition of protein synthesis. Rapidly cleared from the plasma following IV use. t 1/2 elimination: About 2.3 hr. May be significantly absorbed through the bladder mucosa. Approximately 85% excreted through the urine, mainly as metabolites.

Uses: Adenocarcinoma of the breast or ovary. To control intracavitary effusions secondary to diffuse or localized neoplastic disease of various serosal cavities. Superficial papillary carcinoma of the urinary bladder. Lymphosarcoma and Hodgkin's disease, although other treatments are used more often.

Contraindications: Lactation. Pregnancy. Renal, hepatic, or bone marrow damage. Acute leukemia. Use with other alkylating agents due to increased toxicity.

Special Concerns: Is both carcinogenic and mutagenic. Use with caution in renal and hepatic dysfunction. Safety and efficacy have not been determined in children.

Side Effects: GI: N&V;, abdominal pain, anorexia. CNS: Dizziness, headache, blurred vision, fatigue, weakness, febrile reaction. Dermatologic: Contact dermatitis, alopecia, pain at injection site, dermatitis, skin depigmentation following topical use. GU: Dysuria, urinary retention, chemical or hemorrhagic cystitis following intravesical use, amenorrhea, interference with spermatogenesis. Hypersensitivity: Rash, urticaria, wheezing, laryngeal edema, asthma, anaphylactic shock. Miscellaneous: Conjunctivitis, discharge from a SC lesion due to tumor tissue breakdown. Significant toxicity to the hematopoietic system.

Overdose Management: Symptoms: Hematopoietic toxicity. Treatment: Transfusions of whole blood, platelets, or leukocytes have been used.

Drug Interactions: Alkylating agents / Combination with other alkylating agents toxicity Pancuronium / Prolonged muscle paralysis and respiratory depression Succinylcholine / Risk of apnea

How Supplied: Powder for injection: 15 mg

Dosage
?IV (may be rapid)
0.3-0.4 mg/kg at 1- to 4-week intervals by rapid administration or 0.2 mg/kg for 4-5 days q 2-4 weeks.
?Intratumor or Intracavitary Administration
0.6-0.8 mg/kg q 1-4 weeks; through the same tubing used to remove fluid from the cavity.
?Intravesical Administration (Bladder Cancer)
After dehydrating client with papillary carcinoma of the bladder for 8-12 hr, instill 60 mg thiotepa in 30-60 mL of sterile water for injection in the bladder using a catheter. Retain, if possible, for 2 hr. If it is not possible to retain 60 mL, give the dose in a volume of 30 mL. Reposition client q 15 min for maximum contact area. This dose is given once a week for 4 weeks.