Procarbazine is an orally administered alkylating agent used in combination with other antineoplastic agents in the therapy of Hodgkin’s disease and malignant melanoma. Procarbazine therapy has been associated with serum enzyme elevations during therapy and with rare cases of idiosyncratic, clinically apparent acute liver injury.
The main indication is Hodgkin’s disease (lymphadenoma).
Procarbazine may also be useful in other advanced lymphomata and a variety of solid tumours which have proved resistant to other forms of therapy.
Procarbazine is indicated in the treatment of Hodgkin’s lymphoma in children aged 2-18, when associated with other antineoplastic drugs in an appropriate protocol.
How should this medicine be used?
Procarbazine comes as a capsule to take by mouth. It is usually taken one or more times a day. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have. Take procarbazine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take procarbazine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may adjust your dose of procarbazine or stop your treatment for a period of time depending on your response to treatment and any side effects that you experience. Talk to your doctor about how you are feeling during your treatment.
What special precautions should I follow?
Before taking procarbazine,
- tell your doctor and pharmacist if you are allergic to procarbazine, any other medications, or any of the ingredients in procarbazine capsules. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking or you plan to take any of the following prescription or non-prescription medications: certain antidepressants including amitriptyline (Elavil) and imipramine (Tofranil); medications for asthma; medications for allergies, hay fever; medications containing alcohol (cough and cold products, such as Nyquil, and other liquid products); and nasal decongestants, including nose drops and sprays. Your doctor may tell you not to take these medications with procarbazine and may suggest other treatment(s).
- 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 any of the following: barbiturate medications such as phenobarbital; medications for high blood pressure; medications for nausea or mental illness; opioid (narcotic) medications for pain; sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with procarbazine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have received radiation therapy or other chemotherapy within the last 4 weeks.
- tell your doctor if you have or have ever had kidney or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should not become pregnant or breast-feed while you are taking procarbazine. If you become pregnant while receiving procarbazine, call your doctor. Procarbazine may harm the fetus.
- know that you should not drink alcoholic beverages (including beer and wine) while taking this drug. Alcohol may cause an upset stomach, vomiting, stomach cramps, headaches, sweating, and flushing (redness of the face).
- tell your doctor if you use tobacco products. Smoking may increase the risk that you will develop other cancers. You should stop smoking.
What special dietary instructions should I follow?
You will need to avoid eating foods that contain very high amounts of tyramine, such as certain cheeses, yogurt, and bananas during your treatment with procarbazine. Talk to your doctor or dietitian about which foods you should avoid during your treatment or if you do not feel well after eating or drinking certain foods while taking procarbazine.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Procarbazine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- loss of appetite
- stomach pain
- dryness of mouth
- changes in skin color
- hair loss
- difficulty falling asleep or staying asleep
- bone, joint, or muscle pain
- increased urination
Procarbazine is a highly toxic drug and should be used only under constant supervision by a clinician experienced in cancer chemotherapy. When appropriate, procarbazine therapy should be initiated with the patient hospitalized; the patient’s clinical and histologic diagnosis and hematologic, renal, and hepatic status should be carefully considered.
Although appropriate studies with procarbazine have not been performed in the geriatric population, the potential for increased vascular accidents (especially in the event of sudden hypertensive episodes), increased sensitivity to hypotensive effects, and reduced metabolic capacity discourages the first-time use of MAO inhibitors in patients over 60 years of age. When an MAo inhibitor is prescribed for an elderly patient, the patient’s history of depression, ability to comply with prescribing instructions, and any potential drug interactions must also be considered. In addition, elderly patients are more likely to have age-related renal function impairment, which may require a lower dosage or, in severe cases, avoidance of use of procarbazine.
Patients should be warned not to drink alcoholic beverages and to avoid food with high tyramine content, such as yogurt, cheese, and bananas, while receiving procarbazine. Patients should also be instructed to avoid use of over-the-counter preparations containing antihistamine or sympathomimetic drugs and to discuss any prescription medications they are taking with the clinician who is supervising procarbazine therapy.
Pregnancy risk category: D /POSITIVE EVIDENCE OF RISK. Studies in humans, or investigational or post-marketing data, have demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.