The drug is used intravenously. The drug must be administered with caution in order to prevent its exavation, which can cause local pain and soft tissue damage. When there are signs of extravasation, the injection should be stopped immediately, and the remaining dose of the drug should be injected into another vein. The following are the commonly used therapy regimens.
When selecting individual treatment should use the data of special medical literature.
Malignant melanoma
Dakarbazine can be used in monotherapy intravenously in a dose of 200-250 mg / m2 body surface per day for 5 days every 3 weeks.
The drug is administered bolus or as a short (15 - 30 min) infusion. It is also possible to administer the drug intravenously in-fusion at a dose of 850 mg / m2 body surface on the first day of therapy and then once every 3 weeks.
Hodgkin's disease
Dakarbazine is used in a daily dose of 375 mg / m2 body surface intravenously every 15 days in combination with doxorubicin, bleomycin and vinblastine (scheme ABVD).
Soft tissue sarcoma
With soft tissue sarcoma, the drug is used in adults intravenously at a daily dose of 250 mg / m2 body surface on days 1-5 every 3 weeks in combination with doxorubicin (regimen ADIC).
In the process of treatment with dacarbazine, regular monitoring of blood elements and indicators of liver and kidney function is necessary. Since dacarbazine therapy often causes severe adverse reactions from the gastrointestinal tract, it is recommended to prescribe antiemetic therapy and supportive measures.
In view of the possible serious violations of the functions of the gastrointestinal tract and the hematopoietic system, the ratio of benefit / risk to the patient should be weighed before the beginning of each cycle of dacarbazine therapy. The duration of therapy is determined by the attending physician in each case individually, taking into account the disease, the stage of the disease, the therapy, the response to therapy, side effects.
With widespread lymphogranulomatosis, it is usually recommended to assign 6 cycles of therapy according to the scheme ABVD. With metastatic malignant melanoma and common soft tissue sarcoma, the duration of therapy is determined by its effectiveness and tolerability in each specific case.
Method of administration
Doses up to 200 mg / m are intravenously injected slowly. Large doses (from 200 to 850 mgLg) should be administered intravenously infusion for 15-30 minutes. Before the introduction of the drug, it is recommended to check the permeability of the vein by means of a jet injection of 0.9% sodium chloride solution or 5% dextrose solution. The same solutions can be used to remove the remaining drug from a syringe or dropper after the end of the injection.
A solution of a dosage preparation of 100 and 200 mg reconstituted with water for injection (concentration 10 mg / ml) and ready for use without further dilution is hypoosmotic (about 100 mOsmol / kg) and therefore should be administered by slow intravenous injections duration more than 1 min; this method is preferable to rapid intravenous bolus administration lasting several seconds.
Peculiarities of application in separate groups of patients
Patients with renal / hepatic insufficiency
In the presence of mild or moderate degree of failure of the kidney or liver, correction of the dose of dacarbazine is usually not required. In patients with combined failure of renal and hepatic function, excretion of dacarbazine is slowed. However, at present there are no specific recommendations to reduce the dose of the drug in such patients.
Elderly patients
Due to the limited experience of dacarbazine in elderly people, there are no specific recommendations for the use of the drug in this category of patients.
Preparation of solution and use preparation
Handling and disposal of the drug must be carried out in compliance with the rules for handling cytotoxic drugs.
Preparation of the drug solution should be carried out in a specially designated place with the use of special consumables, goggles, masks, gloves, apron. It is necessary to comply with the norms of asepsis.
Preparation of the drug solution is carried out immediately before its use.
Dacarbazine is a photosensitive drug. The solution must be prepared and stored under conditions that exclude the effects of UV light, even during administration.During administration, the drug solution must be protected from exposure to light, for example by using a special light-shielded infusion set of PVC. A typical infusion set should be wrapped in a UV-impermeable foil or film.
Preparation of the drug solution
A) Bottles 100 mg, 200 mg
The preparation is dissolved before use with 10 ml (100 mg bottle) or 20 ml (200 mg bottle) of water for injection (to reach a concentration of 10 mg / ml). The solution is slowly injected.
If the intravenous drip is advisable, the resulting solution is then diluted with 200-300 ml of a 0.9% solution of sodium chloride or 5% glucose solution, after which the drug is administered in the form of a short infusion of 15-30 min.
E) Bottles 500 mg, 1000 mg
The drug is dissolved in 50 ml of water for injection. Further for the preparation of a solution for infusions, the resulting the solution is diluted in 200-300 ml of a 0.9% solution of sodium chloride or 5% solution of dextrose. The concentration of the solution for infusion is 1.4 - 2.0 mg / ml (500 mg bottle) or 2.8 - 4.0 mg / ml (1000 mg bottle). The solution is administered by short infusions for 20-30 minutes.
The prepared solution of the preparation should be transparent and should not contain undissolved particles. Otherwise, the solution can not be used.
The drug is intended for single use only. Unused solution of the drug should be destroyed. The materials used to prepare the solution and its administration must be disposed of in accordance with the rules for the use and disposal of cytotoxic drugs.