Amifostine Anhydrous is a phosphorylated aminosulfhydryl compound with cytoprotective activity. Amifostine is dephosphorylated by alkaline phosphatase to an active free sulfhydryl (thiol) metabolite in the body. The thiol metabolite binds to and detoxifies cytotoxic platinum-containing metabolites of cisplatin and scavenges free radicals induced by cisplatin and ionizing radiation. The elevated activity of this agent in normal tissues results from both the relative abundance of alkaline phosphatase in normal tissues and the greater vascularity of normal tissues compared to tumor tissues. This compound belongs to the class of organic compounds known as organothiophosphorus compounds. These are organic derivatives of thiophosphonic acid, thiophosphoric acid, dithiophosphoric acid, or phosphorotrithioic acid, or derivatives thereof.
Amifostine is an organic thiophosphate that is the S-phospho derivative of 2-[(3-aminopropyl)amino]ethanethiol. A prodrug for the free thiol, WR-1065, is used as a cytoprotectant in cancer chemotherapy and radiotherapy. It has a role as a prodrug, a radiation protective agent, and an antioxidant. It is a diamine and an organic thiophosphate. It is functionally related to a cysteamine. Amifostine anhydrous is a Cytoprotective Agent. The mechanism of action of amifostine anhydrous is a Free Radical Scavenging Activity.
Amifostine is the trihydrate form of a phosphorylated aminosulfhydryl compound. After dephosphorylation of amifostine by alkaline phosphatase to an active free sulfhydryl (thiol) metabolite, the thiol metabolite binds to and detoxifies cytotoxic platinum-containing metabolites of cisplatin and scavenges free radicals induced by cisplatin and ionizing radiation. The elevated activity of this agent in normal tissues results from both the relative abundance of alkaline phosphatase in normal tissues and the greater vascularity of normal tissues compared to tumor tissues.
Mechanism of Action
The thiol metabolite is responsible for most of the cytoprotective and radioprotective properties of amifostine. It is readily taken up by cells where it binds to and detoxifies reactive metabolites of platinum and alkylating agents as well as scavenges free radicals. Other possible effects include inhibition of apoptosis, alteration of gene expression, and modification of enzyme activity.
Amifostine is a prodrug that is dephosphorylated by alkaline phosphatase to an active free sulfhydryl (thiol) metabolite (WR-1065). The pharmacologically active free sulfhydryl is believed to bind to and detoxify cytotoxic platinum-containing metabolites of cisplatin and scavenge free radicals induced by the drug. Cytoprotection against cisplatin-induced toxicity appears to result from prevention and/or, to a lesser extent, reversal of DNA plastination by the drug (cisplatin-DNA adducts). Healthy cells appear to be protected preferentially because of the increased cellular uptake of amifostine and more rapid generation of the active free sulfhydryl metabolite in these cells compared with malignant cells. Because healthy cells have better perfusion, higher capillary alkaline phosphatase activity, and higher pH than malignant cells, and actively concentrate amifostine while malignant cells absorb the drug passively, there is increased cellular uptake of amifostine and more rapid generation of the free active sulfhydryl; therefore, compared with malignant cells, healthy cells appear to be selectively protected by amifostine against cisplatin-induced cytotoxicity.
Indications
- For reduction in the cumulative renal toxicity in patients with ovarian cancer (using cisplatin) and moderate to severe xerostomia in patients undergoing post-operative radiation treatment for head and neck cancer.
- For reduction in the cumulative renal toxicity in patients with ovarian cancer (using cisplatin) and moderate to severe xerostomia in patients undergoing post-operative radiation treatment for head and neck cancer.
- Radiation-protective agents
- Drugs used to protect against ionizing radiation.
- Amifostine is indicated to reduce the cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer.
- Amifostine is indicated to reduce the cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced solid tumors of non-germ cell origin.
- Amifostine is indicated to reduce the incidence of moderate to severe xerostomia in patients undergoing post-operative radiation treatment for head and neck cancer, where the radiation port includes a substantial portion of the parotid gland.
- A phosphorothioate is proposed as a radiation-protective agent. It causes splenic vasodilation and may block autonomic ganglia.
- Dry Mouth
- Nephrotoxicity
- Prophylaxis of Radiation proctitis
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
| DRUG | INTERACTION |
|---|---|
| Acebutolol | Acebutolol may increase the hypotensive activities of Amifostine. |
| Aldesleukin | The risk or severity of adverse effects can be increased when Aldesleukin is combined with Amifostine. |
| Aliskiren | Aliskiren may increase the hypotensive activities of Amifostine. |
| Ambrisentan | Ambrisentan may increase the hypotensive activities of Amifostine. |
| Amiloride | The risk or severity of adverse effects can be increased when Amiloride is combined with Amifostine. |
| Amiodarone | The risk or severity of adverse effects can be increased when Amiodarone is combined with Amifostine. |
| Amlodipine | Amlodipine may increase the hypotensive activities of Amifostine. |
| Amobarbital | Amobarbital may increase the hypotensive activities of Amifostine. |
| Amphotericin B | The risk or severity of adverse effects can be increased when Amphotericin B is combined with Amifostine. |
| Amyl Nitrite | The risk or severity of adverse effects can be increased when Amifostine is combined with Amyl Nitrite. |
| Apomorphine | The risk or severity of adverse effects can be increased when Apomorphine is combined with Amifostine. |
| Aripiprazole | Aripiprazole may increase the hypotensive activities of Amifostine. |
| Aripiprazole lauroxil | Aripiprazole lauroxil may increase the hypotensive activities of Amifostine. |
| Arsenic trioxide | The risk or severity of adverse effects can be increased when Amifostine is combined with Arsenic trioxide. |
| Atenolol | Atenolol may increase the hypotensive activities of Amifostine. |
| Avanafil | The risk or severity of hypotension can be increased when Avanafil is combined with Amifostine. |
| Azilsartan medoxomil | Azilsartan medoxomil may increase the hypotensive activities of Amifostine. |
| Benazepril | Benazepril may increase the hypotensive activities of Amifostine. |
| Bendroflumethiazide | Bendroflumethiazide may increase the hypotensive activities of Amifostine. |
| Bepridil | Bepridil may increase the hypotensive activities of Amifostine. |
| Betaxolol | Betaxolol may increase the hypotensive activities of Amifostine. |
| Bethanidine | Bethanidine may increase the hypotensive activities of Amifostine. |
| Bisoprolol | Bisoprolol may increase the hypotensive activities of Amifostine. |
| Bosentan | Bosentan may increase the hypotensive activities of Amifostine. |
| Bretylium | Bretylium may increase the hypotensive activities of Amifostine. |
| Bromocriptine | The risk or severity of adverse effects can be increased when Amifostine is combined with Bromocriptine. |
| Bumetanide | The risk or severity of adverse effects can be increased when Bumetanide is combined with Amifostine. |
| Bupivacaine | The risk or severity of adverse effects can be increased when Bupivacaine is combined with Amifostine. |
| Butabarbital | Butabarbital may increase the hypotensive activities of Amifostine. |
| Butalbital | Butalbital may increase the hypotensive activities of Amifostine. |
| Canagliflozin | The risk or severity of adverse effects can be increased when Amifostine is combined with Canagliflozin. |
| Candesartan cilexetil | Candesartan cilexetil may increase the hypotensive activities of Amifostine. |
| Captopril | Captopril may increase the hypotensive activities of Amifostine. |
| Carbetocin | The risk or severity of adverse effects can be increased when Amifostine is combined with Carbetocin. |
| Carvedilol | Carvedilol may increase the hypotensive activities of Amifostine. |
| Celiprolol | Celiprolol may increase the hypotensive activities of Amifostine. |
| Chlorothiazide | Chlorothiazide may increase the hypotensive activities of Amifostine. |
| Chlorpromazine | The risk or severity of adverse effects can be increased when Chlorpromazine is combined with Amifostine. |
| Chlorthalidone | Chlorthalidone may increase the hypotensive activities of Amifostine. |
| Cilazapril | Cilazapril may increase the hypotensive activities of Amifostine. |
| Clevidipine | The adverse effects’ risk or severity can increase when Amifostine is combined with Clevidipine. |
| Clofarabine | The risk or severity of adverse effects can be increased when Clofarabine is combined with Amifostine. |
| Clomipramine | The risk or severity of adverse effects can be increased when Amifostine is combined with Clomipramine. |
| Clonidine | Clonidine may increase the hypotensive activities of Amifostine. |
| Clozapine | The adverse effects’ risk or severity can increase when Clozapine is combined with Amifostine. |
| Conivaptan | The adverse effects’ risk or severity can increase when Conivaptan is combined with Amifostine. |
| Cryptenamine | Cryptenamine may increase the hypotensive activities of Amifostine. |
| Cyclopenthiazide | Cyclopenthiazide may increase the hypotensive activities of Amifostine. |
| Cyclothiazide | Cyclothiazide may increase the hypotensive activities of Amifostine. |
| Dapagliflozin | The adverse effects’ risk or severity can increase when Amifostine is combined with Dapagliflozin. |
| Dasiglucagon | Dasiglucagon may increase the hypotensive activities of Amifostine. |
| Debrisoquine | Debrisoquine may increase the hypotensive activities of Amifostine. |
| Deserpidine | Deserpidine may increase the hypotensive activities of Amifostine. |
| Desflurane | The adverse effects’ risk or severity can increase when Amifostine is combined with Desflurane. |
| Dexmedetomidine | The risk or severity of adverse effects can be increased when Dexmedetomidine is combined with Amifostine. |
| Diazoxide | Diazoxide may increase the hypotensive activities of Amifostine. |
| Diclofenamide | The adverse effects’ risk or severity can increase when Amifostine is combined with Diclofenamide. |
| Dihydralazine | Dihydralazine may increase the hypotensive activities of Amifostine. |
| Diltiazem | Diltiazem may increase the hypotensive activities of Amifostine. |
| Dinutuximab | The adverse effects’ risk or severity can increase when Amifostine is combined with Dinutuximab. |
| Dipyridamole | The adverse effects’ risk or severity can increase when Dipyridamole is combined with Amifostine. |
| Doxazosin | Doxazosin may increase the hypotensive activities of Amifostine. |
| Duloxetine | The risk or severity of orthostatic hypotension and syncope can be increased when Amifostine is combined with Duloxetine. |
| Empagliflozin | The risk or severity of adverse effects can be increased when Amifostine is combined with Empagliflozin. |
| Enalapril | Enalapril may increase the hypotensive activities of Amifostine. |
| Enalaprilat | Enalaprilat may increase the hypotensive activities of Amifostine. |
| Eplerenone | Eplerenone may increase the hypotensive activities of Amifostine. |
| Epoprostenol | Epoprostenol may increase the hypotensive activities of Amifostine. |
| Eprosartan | Eprosartan may increase the hypotensive activities of Amifostine. |
| Esmolol | Esmolol may increase the hypotensive activities of Amifostine. |
| Etacrynic acid | The adverse effects’ risk or severity can increase when Etacrynic acid is combined with Amifostine. |
| Ethanol | Ethanol may increase the hypotensive activities of Amifostine. |
| Felodipine | Felodipine may increase the hypotensive activities of Amifostine. |
| Fenoldopam | Fenoldopam may increase the hypotensive activities of Amifostine. |
| Fosinopril | Fosinopril may increase the hypotensive activities of Amifostine. |
| Fostamatinib | The risk or severity of hypotension can be increased when Fostamatinib is combined with Amifostine. |
| Furosemide | Furosemide may increase the hypotensive activities of Amifostine. |
| Guanabenz | Guanabenz may increase the hypotensive activities of Amifostine. |
| Guanadrel | Guanadrel may increase the hypotensive activities of Amifostine. |
| Guanethidine | Guanethidine may increase the hypotensive activities of Amifostine. |
| Guanfacine | Guanfacine may increase the hypotensive activities of Amifostine. |
| Guanoxan | Guanoxan may increase the hypotensive activities of Amifostine. |
| Halothane | The risk or severity of adverse effects can be increased when Amifostine is combined with Halothane. |
| Hydralazine | Hydralazine may increase the hypotensive activities of Amifostine. |
| Hydrochlorothiazide | Hydrochlorothiazide may increase the hypotensive activities of Amifostine. |
| Hydroflumethiazide | Hydroflumethiazide may increase the hypotensive activities of Amifostine. |
| Iloprost | The risk or severity of adverse effects can be increased when Iloprost is combined with Amifostine. |
| Imipramine | The risk or severity of adverse effects can be increased when Imipramine is combined with Amifostine. |
| Indapamide | Indapamide may increase the hypotensive activities of Amifostine. |
| Indoramin | Indoramin may increase the hypotensive activities of Amifostine. |
| Irbesartan | Irbesartan may increase the hypotensive activities of Amifostine. |
| Isocarboxazid | Isocarboxazid may increase the orthostatic hypotensive activities of Amifostine. |
| Isoflurane | The adverse effects’ risk or severity can increase when Isoflurane is combined with Amifostine. |
| Isosorbide dinitrate | The adverse effects’ risk or severity can increase when Isosorbide dinitrate is combined with Amifostine. |
| Isosorbide mononitrate | The adverse effects’ risk or severity can increase when Isosorbide mononitrate is combined with Amifostine. |
| Isoxsuprine | The adverse effects’ risk or severity can increase when Amifostine is combined with Isoxsuprine. |
| Isradipine | Isradipine may increase the hypotensive activities of Amifostine. |
| Labetalol | Labetalol may increase the hypotensive activities of Amifostine. |
| Lacidipine | Lacidipine may increase the hypotensive activities of Amifostine. |
| Lercanidipine | Lercanidipine may increase the hypotensive activities of Amifostine. |
| Levamlodipine | Levamlodipine may increase the hypotensive activities of Amifostine. |
| Levobupivacaine | The adverse effects’ risk or severity can increase when Levobupivacaine is combined with Amifostine. |
| Levodopa | The risk or severity of hypotension and orthostatic hypotension can be increased when Amifostine is combined with Levodopa. |
| Levosimendan | The risk or severity of adverse effects can be increased when Levosimendan is combined with Amifostine. |
| Linezolid | Linezolid may increase the orthostatic hypotensive activities of Amifostine. |
| Lisinopril | Lisinopril may increase the hypotensive activities of Amifostine. |
| Lofexidine | Lofexidine may increase the hypotensive activities of Amifostine. |
| Losartan | Losartan may increase the hypotensive activities of Amifostine. |
| Macitentan | Macitentan may increase the hypotensive activities of Amifostine. |
| Manidipine | Manidipine may increase the hypotensive activities of Amifostine. |
| Mannitol | The risk or severity of adverse effects can be increased when Mannitol is combined with Amifostine. |
| Mecamylamine | Mecamylamine may increase the hypotensive activities of Amifostine. |
| Methazolamide | The risk or severity of adverse effects can be increased when Methazolamide is combined with Amifostine. |
| Methohexital | Methohexital may increase the hypotensive activities of Amifostine. |
| Methyldopa | Methyldopa may increase the hypotensive activities of Amifostine. |
| Methylene blue | Methylene blue may increase the orthostatic hypotensive activities of Amifostine. |
| Methylphenobarbital | Methylphenobarbital may increase the hypotensive activities of Amifostine. |
| Metolazone | Metolazone may increase the hypotensive activities of Amifostine. |
| Metoprolol | Metoprolol may increase the hypotensive activities of Amifostine. |
| Metyrosine | Metyrosine may increase the hypotensive activities of Amifostine. |
| Minaprine | Minaprine may increase the orthostatic hypotensive activities of Amifostine. |
| Minoxidil | Minoxidil may increase the hypotensive activities of Amifostine. |
| Moclobemide | Moclobemide may increase the orthostatic hypotensive activities of Amifostine. |
| Moexipril | Moexipril may increase the hypotensive activities of Amifostine. |
| Morphine | The risk or severity of adverse effects can be increased when Morphine is combined with Amifostine. |
| Moxonidine | Moxonidine may increase the hypotensive activities of Amifostine. |
| Muzolimine | Muzolimine may increase the hypotensive activities of Amifostine. |
| Nabilone | The risk or severity of adverse effects can be increased when Nabilone is combined with Amifostine. |
| Nadolol | Nadolol may increase the hypotensive activities of Amifostine. |
| Nebivolol | Nebivolol may increase the hypotensive activities of Amifostine. |
| Nesiritide | The risk or severity of adverse effects can be increased when Amifostine is combined with Nesiritide. |
| Nialamide | Nialamide may increase the orthostatic hypotensive activities of Amifostine. |
| Nicardipine | Nicardipine may increase the hypotensive activities of Amifostine. |
| Nicorandil | Nicorandil may increase the hypotensive activities of Amifostine. |
| Nifedipine | The risk or severity of adverse effects can be increased when Nifedipine is combined with Amifostine. |
| Nilvadipine | Nilvadipine may increase the hypotensive activities of Amifostine. |
| Nimodipine | Nimodipine may increase the hypotensive activities of Amifostine. |
| Nisoldipine | Nisoldipine may increase the hypotensive activities of Amifostine. |
| Nitrendipine | Nitrendipine may increase the hypotensive activities of Amifostine. |
| Nitric Oxide | The risk or severity of adverse effects can be increased when Nitric Oxide is combined with Amifostine. |
| Nitroglycerin | Nitroglycerin may increase the hypotensive activities of Amifostine. |
| Nitroprusside | Nitroprusside may increase the hypotensive activities of Amifostine. |
| Nitrous acid | The risk or severity of adverse effects can be increased when Amifostine is combined with Nitrous acid. |
| Obinutuzumab | The risk or severity of adverse effects can be increased when Amifostine is combined with Obinutuzumab. |
| Olanzapine | The risk or severity of adverse effects can be increased when Olanzapine is combined with Amifostine. |
| Olmesartan | Olmesartan may increase the hypotensive activities of Amifostine. |
| Opicapone | The risk or severity of adverse effects can be increased when Amifostine is combined with Opicapone. |
| Oxprenolol | Oxprenolol may increase the hypotensive activities of Amifostine. |
| Paclitaxel | The risk or severity of adverse effects can be increased when Amifostine is combined with Paclitaxel. |
| Papaverine | The risk or severity of adverse effects can be increased when Papaverine is combined with Amifostine. |
| Pargyline | Pargyline may increase the hypotensive activities of Amifostine. |
| Penbutolol | Penbutolol may increase the hypotensive activities of Amifostine. |
| Pentobarbital | Pentobarbital may increase the hypotensive activities of Amifostine. |
| Pentolinium | Pentolinium may increase the hypotensive activities of Amifostine. |
| Perindopril | Perindopril may increase the hypotensive activities of Amifostine. |
| Phenelzine | Phenelzine may increase the orthostatic hypotensive activities of Amifostine. |
| Phenobarbital | Phenobarbital may increase the hypotensive activities of Amifostine. |
| Phenoxybenzamine | Phenoxybenzamine may increase the hypotensive activities of Amifostine. |
| Phentolamine | Phentolamine may increase the hypotensive activities of Amifostine. |
| Pinacidil | Pinacidil may increase the hypotensive activities of Amifostine. |
| Pindolol | Pindolol may increase the hypotensive activities of Amifostine. |
| Polythiazide | Polythiazide may increase the hypotensive activities of Amifostine. |
| Practolol | Practolol may increase the hypotensive activities of Amifostine. |
| Pramipexole | The risk or severity of adverse effects can be increased when Pramipexole is combined with Amifostine. |
| Prazosin | Prazosin may increase the hypotensive activities of Amifostine. |
| Primidone | Primidone may increase the hypotensive activities of Amifostine. |
| Procaine | Procaine may increase the orthostatic hypotensive activities of Amifostine. |
| Procarbazine | Procarbazine may increase the orthostatic hypotensive activities of Amifostine. |
| Propofol | The risk or severity of adverse effects can be increased when Propofol is combined with Amifostine. |
| Propranolol | Propranolol may increase the hypotensive activities of Amifostine. |
| Quetiapine | The risk or severity of adverse effects can be increased when Amifostine is combined with Quetiapine. |
| Quinapril | Quinapril may increase the hypotensive activities of Amifostine. |
| Ramipril | Ramipril may increase the hypotensive activities of Amifostine. |
| Rasagiline | Rasagiline may increase the orthostatic hypotensive activities of Amifostine. |
| Remifentanil | The risk or severity of adverse effects can be increased when Remifentanil is combined with Amifostine. |
| Rescinnamine | Rescinnamine may increase the hypotensive activities of Amifostine. |
| Reserpine | Reserpine may increase the hypotensive activities of Amifostine. |
| Rilmenidine | Rilmenidine may increase the hypotensive activities of Amifostine. |
| Riociguat | Riociguat may increase the hypotensive activities of Amifostine. |
| Risperidone | Amifostine may increase the hypotensive activities of Risperidone. |
| Ropinirole | The risk or severity of adverse effects can be increased when Ropinirole is combined with Amifostine. |
| Ropivacaine | The risk or severity of adverse effects can be increased when Ropivacaine is combined with Amifostine. |
| Rotigotine | The risk or severity of adverse effects can be increased when Amifostine is combined with Rotigotine. |
| Sacubitril | The risk or severity of adverse effects can be increased when Amifostine is combined with Sacubitril. |
| Safinamide | Safinamide may increase the orthostatic hypotensive activities of Amifostine. |
| Secobarbital | Secobarbital may increase the hypotensive activities of Amifostine. |
| Selegiline | Selegiline may increase the orthostatic hypotensive activities of Amifostine. |
| Selexipag | Selexipag may increase the hypotensive activities of Amifostine. |
| Sevoflurane | The risk or severity of adverse effects can be increased when Amifostine is combined with Sevoflurane. |
| Sildenafil | The risk or severity of hypotension can be increased when Sildenafil is combined with Amifostine. |
| Sitaxentan | Sitaxentan may increase the hypotensive activities of Amifostine. |
| Sodium ferric gluconate complex | The risk or severity of hypotension can be increased when Sodium ferric gluconate complex is combined with Amifostine. |
| Sotalol | The risk or severity of adverse effects can be increased when Sotalol is combined with Amifostine. |
| Spirapril | Spirapril may increase the hypotensive activities of Amifostine. |
| Spironolactone | The risk or severity of adverse effects can be increased when Spironolactone is combined with Amifostine. |
| Streptokinase | The risk or severity of adverse effects can be increased when Streptokinase is combined with Amifostine. |
| Sufentanil | The risk or severity of adverse effects can be increased when Sufentanil is combined with Amifostine. |
| Tadalafil | Tadalafil may increase the hypotensive activities of Amifostine. |
| Tamsulosin | The risk or severity of adverse effects can be increased when Tamsulosin is combined with Amifostine. |
| Telmisartan | Telmisartan may increase the hypotensive activities of Amifostine. |
| Terazosin | Terazosin may increase the hypotensive activities of Amifostine. |
| Thalidomide | The risk or severity of adverse effects can be increased when Thalidomide is combined with Amifostine. |
| Thiamylal | Thiamylal may increase the hypotensive activities of Amifostine. |
| Thiopental | Thiopental may increase the hypotensive activities of Amifostine. |
| Thioridazine | The risk or severity of adverse effects can be increased when Thioridazine is combined with Amifostine. |
| Timolol | Timolol may increase the hypotensive activities of Amifostine. |
| Tizanidine | The risk or severity of adverse effects can be increased when Tizanidine is combined with Amifostine. |
| Tolazoline | Tolazoline may increase the hypotensive activities of Amifostine. |
| Tolcapone | The risk or severity of adverse effects can be increased when Tolcapone is combined with Amifostine. |
| Torasemide | Torasemide may increase the hypotensive activities of Amifostine. |
| Trandolapril | Trandolapril may increase the hypotensive activities of Amifostine. |
| Tranylcypromine | Tranylcypromine may increase the orthostatic hypotensive activities of Amifostine. |
| Treprostinil | Treprostinil may increase the hypotensive activities of Amifostine. |
| Tretinoin | The risk or severity of adverse effects can be increased when Tretinoin is combined with Amifostine. |
| Triamterene | The risk or severity of adverse effects can be increased when Triamterene is combined with Amifostine. |
| Trichlormethiazide | Trichlormethiazide may increase the hypotensive activities of Amifostine. |
| Trimethaphan | Trimethaphan may increase the hypotensive activities of Amifostine. |
| Udenafil | The risk or severity of hypotension can be increased when Udenafil is combined with Amifostine. |
| Valsartan | Valsartan may increase the hypotensive activities of Amifostine. |
| Vardenafil | The risk or severity of hypotension can be increased when Vardenafil is combined with Amifostine. |
| Verapamil | The adverse effects’ risk or severity can increase when Verapamil is combined with Amifostine. |
| Vericiguat | The adverse effects’ risk or severity can increase when Amifostine is combined with Vericiguat. |
| Zofenopril | Zofenopril may increase the hypotensive activities of Amifostine. |
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
What special precautions should I follow?
Before receiving amifostine,
- tell your doctor and pharmacist if you are allergic to amifostine, any other medications, or any of the ingredients in an amifostine 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. Be sure to mention medications for high blood pressure. Your doctor will tell you to stop taking your blood pressure medicine 24 hours before you receive an amifostine injection. Many other medications may also interact with amifostine, so be sure to tell your doctor about all the medications you are taking.
- tell your doctor if you have or have ever had heart disease, an irregular heartbeat, heart failure, or a stroke or ministroke.
- tell your doctor if you are pregnant or plan to become pregnant, or are breastfeeding. If you become pregnant while receiving amifostine, call your doctor. You should not breastfeed during your treatment with amifostine.
When To Contact Your Doctor of Health Care Provider:
If you experience any of the infusion-related side effects listed above, make sure you tell your healthcare provider right away.
Always inform your healthcare provider if you experience any unusual symptoms
Precautions
- Before starting amifostine treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter drugs, vitamins, or herbal remedies).
- Amifostine may be inadvisable if you have had a hypersensitivity (allergic) reaction to aminothiol compounds or mannitol.
- Your blood pressure medication will likely be stopped for 24 hours before treatment with amifostine. You should discuss this with your doctor.
- Inform your healthcare professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only if the benefit to the mother outweighs risk to fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking amifostine. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breastfeed while taking this medication.
Self-Care Tips
- Drink plenty of fluids (at least 2-3 quarts every 24 hours) prior to therapy with amifostine, unless you are instructed otherwise.
- To reduce nausea, take anti-nausea medications as prescribed, and eat small, frequent meals.
- If you experience symptoms or side effects, be sure to discuss them with your healthcare team right away. This may develop weeks after treatment with amifostine.
References
