arsenic trioxide(Trisenox®)三氧化二砷(砒霜)

別懷疑,妳沒有看錯,就是那個連續劇都會演來毒死人的東西。

最古早以前,他是當做粉餅(女人真可憐),後來是殺鼠藥,後來就殺人了。

不過,東西是無罪的,錯的是使用者,所以用對地方,也能救人一命

臨床用途:

Induction of remission and consolidation in patients with relapsed or refractory acute promyelocytic leukemia (APL) which is specifically characterized by t(15;17) translocation or PML/RAR-alpha gene expression

誘導緩解性與鞏固性化療,專用在對治療無反應或是已經對retinoid產生耐受性及anthrcycline化療之急性骨髓細胞性白血病,通常與 t(15;17) translocation or PML/RAR-alpha 基因表現有關。

 

非核准用法:(上面寫的那些不算)

Treatment of myelodysplastic syndrome (MDS), multiple myeloma

 

看看長相:

trisenox.jpg

 

給藥方式:

Dosing: Adults

 

  APL: I.V.:

 

    Induction: 0.15 mg/kg/day; administer daily until bone marrow remission; maximum induction: 60 doses

 

    Consolidation: 0.15 mg/kg/day starting 3-6 weeks after completion of induction therapy; maximum consolidation: 25 doses over 5 weeks

 

  MDS, multiple myeloma (unlabeled uses): I.V.: 0.25 mg/kg/day 5 consecutive days/week for 2 weeks, followed by a 2-week rest period

 

Dosing: Pediatric

 

APL: Children ≥5 years: Refer to adult dosing.

 

Dosing: Elderly

 

Safety and efficacy have not been established. Clinical trials included patients ≤72 years of age. Use with caution due to the increased risk of renal impairment in the elderly.

 

Dosing: Renal Impairment

 

Safety and efficacy have not been established; use with caution due to renal elimination.

 

Dosing: Hepatic Impairment

 

Safety and efficacy have not been established.


配製方式:

本藥如果需要稀釋或是重新配製,可以是用D5W或是Normal saline稀釋到250mL,在室溫下可以存放24小時或放在冰箱中48小時。


輸注速率:

至少要超過1-2小時,最好可以延長到4小時。另外,不需要特別使用中央靜脈導管(central venous catheter),周邊就可以了。


 

機轉:

Not fully understood; causes in vitro morphological changes and DNA fragmentation to NB4 human promyelocytic leukemia cells; also damages or degrades the fusion protein PML-RAR alpha

 

 

與食物和中草藥併用時要注意:

Herb/Nutraceutical: Avoid homeopathic products (arsenic is present in some homeopathic medications). Avoid hypoglycemic herbs, including alfalfa, aloe, bilberry, bitter melon, burdock, celery, damiana, fenugreek, garcinia, garlic, ginger, ginseng, gymnema, marshmallow, and stinging nettle (may enhance the hypoglycemic effect of arsenic trioxide).

 

懷孕分級:D,不建議哺乳(0.2-6 mcg/kg

 

避免與Amphotericin B和會排除鉀與鎂的利尿劑(例如:loop diuretics)併用 ,會增加心律不整的危險性。

 

由於使用時心臟毒性高,所以必須監測EKG,狀況穩定時,也要監測電解質及血液學數值至少一週兩次。

鉀離子要保持在4mEq/dL,鎂離子要保持在1.8mg/dL

 

如果發現中毒反應出現時,必須以dimercaprol 3mg/kg IM 每4小時一次。直到危及生命的狀況解除後,改用penicillamide 250mg PO 一天四次(<1Gm/day)。

 

最後一定要再次警告看這篇文章的各位:這是藥,而且眾所皆知他的毒性和副作用,所以千萬不要隨便未經醫師診斷使用,也不要自己去買來用。

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