Drugs that disrupt DNA / Intercalating agents / Toxicities
II. Intercalating agents: ANTHRACYCLINE ANTIBIOTICS
Toxicities
- ANTHRACYCLINE ANTIBIOTICS cause an UNUSUAL CARDIOMYOPATHY that is often IRREVERSIBLE and related to the TOTAL DOSE of the drug
- may be due to production of free radicals within the myocardium - theoretically, can be partially reduced by using exogenous antioxidants to boost normal cell defences
- Cardiomyopathy:
- Acute: increased heart rate, conduction abnormalities, arrhythmias
- Delayed: congestive heart failure that is unresponsive to digitalis (may occur years after treatment)
- Extravasation à necrosis (vesicant)
- Myelosuppression is major dose-limiting complication (individual course of treatment)
- Nausea and vomiting
- Alopecia
- Mutagenic, carcinogenic
- "Radiation recall reaction" - erythema and desquamation of the skin at sites of prior radiation therapy
- Hand-foot syndrome (palmar-plantar erythrodysesthesia)
- Red urine: patients should be warned that their urine will be red/reddish-orange for 24-48 hours after treatment due to a predictable chemical reaction (i.e, it is not blood)
- the exception is MITOXANTONE which turns the urine --- and the whites of the eyes --- blue!