Amifostine – Uses, Dosage, Side Effects, Interactions

Use in Cancer

Amifostine is approved to prevent:

• Renal? (kidney) toxicity. It is used to reduce the nephrotoxic effects caused by repeated treatment with cisplatin for advanced ovarian cancer.
• Xerostomia (dry mouth). It is used to decrease dryness in the mouth caused by radiation therapy after surgery in some patients with head and neck cancer.

Amifostine is also being studied in the treatment of other types of cancer.

Contraindications

• Contraindicated in patients with low BP, dehydration?, patients with kidney or liver disease, children and elderly >70 years, and hypersensitivity.

Dosage?

Strengths: 500 mg

Chemotherapy Toxicity

To reduce the cumulative renal? toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer:

• 910 mg/m2 IV over 15 minutes once daily starting 30 minutes prior to chemotherapy

The infusion should be interrupted if the systolic blood pressure decreases significantly from the baseline value:

• If baseline systolic blood pressure is less than 100 mm Hg and decreases by 20 mm Hg during the infusion.
• If baseline systolic blood pressure is 100 to 119 mm Hg and decreases by 25 mm Hg during the infusion.
• If baseline systolic blood pressure is 120 to 139 mm Hg and decreases by 30 mm Hg during the infusion.
• If baseline systolic blood pressure is 140 to 179 mm Hg and decreases by 40 mm Hg during the infusion
• If baseline systolic blood pressure is 180 mm Hg or greater and decreases by 50 mm Hg during infusion.
• If the infusion is interrupted and blood pressure returns to normal within 5 minutes and the patient is asymptomatic, the infusion may be restarted so that the full dose may be administered. If the full dose cannot be administered, the dose for subsequent chemotherapy cycles should be 740 mg/m2.

Xerostomia

For reduction of moderate to severe xerostomia from the radiation of the head and neck:

• 200 mg/m2 IV over 3 minutes once daily, starting 15 to 30 minutes prior to standard fraction radiation therapy (1.8 to 2 Gy)

Side Effects

The Most Common

• nausea?
• vomiting?
• flushing or feeling of warmth
• chills or feeling of coldness
• general feeling of tiredness
• fever?
• drowsiness
• sneezing
• hiccups
• shortness of breath
• dizziness
• blurred vision
• fainting
• seizures
• chest tightness
• chest pain?
• rash?
• hives
• itching
• difficulty breathing or swallowing
• peeling or blistering skin
• fast, slow, or pounding heartbeat

More Common

• Low blood pressure (hypotension?);
• Nausea?/Vomiting? (may be severe)
• Flushing or redness of the face or neck
• Dizziness
• Sleepiness
• Sneezing
• Hiccups
• Feeling hot or cold, chills

Drug Interactions

Pregnancy and Lactation

AU TGA pregnancy category B3:

Pregnancy

Drugs that have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription? drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help healthcare providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D and X are being phased out.

Breastfeeding

Use is contraindicated.

Excreted into human milk: Unknown
Excreted into animal milk: Data not available

References