Dacarbazine – Uses, Dosage, Side Effects, Interactions

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Dacarbazine (also known as DTIC) is an intravenously administered alkylating agent used in the therapy of Hodgkin's disease and malignant melanoma. Dacarbazine therapy has been associated with serum enzyme elevations during therapy and occasional cases of severe and distinctive acute hepatic failure, probably caused by...

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বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

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Article Summary

Dacarbazine (also known as DTIC) is an intravenously administered alkylating agent used in the therapy of Hodgkin's disease and malignant melanoma. Dacarbazine therapy has been associated with serum enzyme elevations during therapy and occasional cases of severe and distinctive acute hepatic failure, probably caused by acute sinusoidal obstruction syndrome. Dacarbazine is a triazene derivative with antineoplastic activity. Dacarbazine alkylates and cross-links DNA during all phases of...

Key Takeaways

  • This article explains Mechanism of Action in simple medical language.
  • This article explains Indications in simple medical language.
  • This article explains Contraindications in simple medical language.
  • This article explains Dosage in simple medical language.
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Mechanism of Action

The mechanism of action is not known but appears to exert cytotoxic effects via its action as an alkylating agent. Other theories include DNA synthesis inhibition by its action as a purine analog and interaction with SH groups. Dacarbazine is not celled cycle-phase specific.

Dacarbazine functions as an alkylating agent after metabolic activation in the liver. It appears to inhibit the synthesis of RNA and protein more than it inhibits the synthesis of DNA. It kills cells slowly, and there appears to be no phase of the cell cycle in which sensitivity is increased

Dacarbazine is a synthetic analog of naturally occurring purine precursor 5-amino-1H-imidazole-4-carboxamide (AIC). After intravenous administration of dacarbazine, the volume of distribution exceeds total body water content suggesting localization in some body tissue, probably the liver. Its disappearance from the plasma is biphasic with an initial half-life of 19 minutes and a terminal half-life of 5 hours. 1 In a patient with renal and hepatic dysfunctions, the half-lives were lengthened to 55 minutes and 7.2 hours. 1 The average cumulative excretion of unchanged DTIC in the urine is 40% of the injected dose in 6 hours. 1 DTIC is subject to renal tubular secretion rather than glomerular filtration. At therapeutic concentrations, dacarbazine is not appreciably bound to human plasma protein.

Indications

  • For the treatment of metastatic malignant melanoma. In addition, dacarbazine is also indicated for Hodgkin’s disease as a secondary-line therapy when used in combination with other antineoplastic agents.
  • Hodgkin lymphoma in patients whose disease has not gotten better with other chemotherapy.
  • Melanoma that has metastasized(spread to other parts of the body).
  • Dacarbazine is also being studied in the treatment of other types of cancer.
  • Dacarbazine is used as an antineoplastic agent in the treatment of diseases such as malignant melanomas, Hodgkin’s disease, soft-tissue sarcomas, osteogenic sarcomas, and neuroblastomas.
  • Advanced Pancreatic Neuroendocrine Tumors (pNET)
  • Lymphoma, Hodgkins
  • Metastatic Melanoma
  • Pheochromocytomas
  • Advanced Medullary thyroid cancer
  • Advanced Soft Tissue Sarcoma (STS)

Use in Cancer

Dacarbazine is approved to be used alone or with other drugs to treat:

  • Hodgkin lymphoma in patients whose disease has not gotten better with other chemotherapy.
  • Melanoma that has metastasized (spread to other parts of the body).

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

Contraindications

Dacarbazine for Injection is contraindicated in patients who have demonstrated hypersensitivity to it in the past.

  • decreased function of bone marrow
  • anemia
  • decreased blood platelets
  • low levels of white blood cells
  • a blood clot in a vein of the liver
  • liver tissue death
  • liver problems
  • decreased kidney function
  • a patient who is producing milk and breastfeeding

Dosage

Strengths: 100 mg; 200 mg; 500 mg

Malignant Melanoma

  • 2 to 4.5 mg/kg IV once a day for 10 days; repeat every 4 weeks
  • 250 mg/m2 IV once a day for 5 days; repeat every 3 weeks

Hodgkin’s Disease

  • 150 mg/m2 IV once a day for 5 days in combination therapy; repeat every 4 weeks
  • 375 mg/m2 IV on Day 1 in combination therapy; repeat every 15 days

Side effects

The Most Common

  • nausea, vomiting,
  • bone marrow suppression,
  • leukopenia,
  • platelet count, which can increase bleeding risk. সহজ বাংলা: প্লাটিলেট কম।" data-rx-term="thrombocytopenia" data-rx-definition="Thrombocytopenia means low platelet count, which can increase bleeding risk. সহজ বাংলা: প্লাটিলেট কম।">thrombocytopenia,
  • hepatotoxicity,
  • hepatic vein thrombosis and hepatocellular necrosis.
  • hemopoietic depression,
  • anemia, anaphylaxis,
  • anorexia, diarrhea,
  • facial paresthesias, death, and rarely,
  • erythematous and urticarial rashes, and
  • photosensitivity reactions.
  • It may cause cardiovascular collapse,
  • burning of the throat,
  • abdominal pain, oliguria,
  • anuria,
    delirium,
  • fall of blood pressure,
  • convulsions,
  • muscular weakness with respiratory failure, and collapse.
  • Large doses may cause gastrointestinal bleeding.
  • Exposure may also result in alopecia, facial flushing, and a flu-like syndrome of fever, myalgias and malaise.
  • It can cause chills, dermatological reactions, and neurotoxicity.

More Common

  • nausea
  • vomiting
  • loss of appetite
  • diarrhea
  • sores in the mouth and throat
  • hair loss
  • the feeling of burning or tingling on the face
  • flushing
  • flu-like symptoms
  • redness, pain, swelling or burning at the site where the injection was given
  • hives
  • skin rash
  • itching
  • difficulty breathing or swallowing
  • fever, muscle aches, and general feelings of pain and tiredness

Rare

  • alopecia,
  • facial flushing and paraesthesia,
  • orthostatic hypotension,
  • ECG abnormalities,
  • flu-like syndrome,
  • myalgia,
  • malaise,
  • blurred vision,
  • seizure,
  • pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache,
  • confusion,
  • lethargy,
  • pain at inj site,
  • tissue damage,
  • cellulitis.
  • photosensitivity,
  • stomatitis.

Drug Interactions

Pregnancy and Lactation

Pregnancy

Pregnancy Category C:

Dacarbazine for Injection has been shown to be teratogenic in rats when given in doses 20 times the human daily dose on day 12 of gestation. Dacarbazine when administered in 10 times the human daily dose to male rats (twice weekly for 9 weeks) did not affect the male libido, although female rats mated to male rats had a higher incidence of resorptions than controls. In rabbits, dacarbazine daily dose 7 times the human daily dose given on Days 6 to 15 of gestation resulted in fetal skeletal anomalies. There are no adequate and well-controlled studies in pregnant women. Dacarbazine for Injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for tumorigenicity shown for Dacarbazine for Injection in animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Lactation

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as dacarbazine.[1] It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, no data are available to determine an appropriate period to withhold breastfeeding. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breast milk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.

What special precautions should I follow?

Before receiving dacarbazine,

  • tell your doctor and pharmacist if you are allergic to dacarbazine, any other medications, or any of the ingredients in dacarbazine injection. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
  • tell your doctor if you are breastfeeding.
  • plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Dacarbazine may make your skin sensitive to sunlight.

WARNINGS

Hemopoietic depression is the most common toxicity with Dacarbazine for Injection and involves primarily the leukocytes and platelets, although, anemia may sometimes occur. Leukopenia and thrombocytopenia may be severe enough to cause death. Possible bone marrow depression requires careful monitoring of white blood cells, red blood cells, and platelet levels. Hemopoietic toxicity may warrant temporary suspension or cessation of therapy with Dacarbazine for Injection.

Hepatic toxicity accompanied by hepatic vein thrombosis and hepatocellular necrosis resulting in death has been reported. The incidence of such reactions has been low; approximately 0.01% of patients were treated. This toxicity has been observed mostly when Dacarbazine for Injection has been administered concomitantly with other anti-neoplastic drugs: however, it has also been reported in some patients treated with Dacarbazine for Injection alone.

Anaphylaxis can occur following the administration of Dacarbazine for Injection.

Hospitalization is not always necessary but adequate laboratory study capability must be available. Extravasation of the drug subcutaneously during intravenous administration may result in tissue damage and severe pain. Local pain, burning sensation, and irritation at the site of injection may be relieved by locally applied hot packs.

The carcinogenicity of dacarbazine was studied in rats and mice. Proliferative endocardial lesions, including fibrosarcomas and sarcomas, were induced by dacarbazine in rats. In mice, administration of dacarbazine resulted in the induction of angiosarcomas of the spleen.

References

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Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

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Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

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Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Dacarbazine – Uses, Dosage, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

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When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

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