Nurses Compass
Drug Guide
Arsenic Trioxide
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Differentiating agent
FDA Approved Indications
- Acute Promyelocytic Leukemia (APL), specifically in cases with relapsed or refractory disease
Mechanism of Action
Induces apoptosis and promotes differentiation of leukemic cells by targeting the PML-RARα fusion protein, disrupting abnormal cell proliferation.
Dosage and Administration
Adult: 0.15 mg/kg/day IV over 2 hours for 5 days, repeated every 4 weeks until remission or intolerable toxicity.
Pediatric: Dose based on body weight, typically 0.15 mg/kg/day IV over 2 hours, with adjustments based on response and toxicity.
Geriatric: Use cautiously; monitor for toxicity due to decreased organ function.
Renal Impairment: Adjust dose based on renal function; closely monitor renal parameters.
Hepatic Impairment: No specific adjustment available; monitor liver function tests.
Pharmacokinetics
Absorption: Poor oral absorption; administered intravenously.
Distribution: Widely distributed, crosses the blood-brain barrier.
Metabolism: Metabolized partially in the liver.
Excretion: Primarily via urine, with some fecal excretion.
Half Life: Approximately 1 to 3 days, variable depending on individual patient factors.
Contraindications
- Known hypersensitivity to arsenic compounds
Precautions
- Monitor for QT prolongation and arrhythmias, hepatic and renal impairment, electrolyte imbalances, secondary infections, and signs of differentiation syndrome. Use with caution in pregnancy and lactation, as safety is not fully established.
Adverse Reactions - Common
- Nausea, vomiting, diarrhea (Common)
- Electrolyte imbalances (hypokalemia, hypomagnesemia) (Common)
- QT prolongation, arrhythmias (Uncommon)
Adverse Reactions - Serious
- QTc prolongation leading to torsades de pointes (Rare)
- Differentiation syndrome (fever, weight gain, respiratory distress, effusions) (Potentially serious but rare)
- Hepatotoxicity, hepatocellular injury (Rare)
- Myelosuppression (Common)
Drug-Drug Interactions
- QT prolonging agents (e.g., certain antiarrhythmics, antidepressants)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor cardiac status (ECGs), electrolytes, liver and kidney function, and signs of differentiation syndrome.
Diagnoses:
- Risk for cardiac arrhythmias
- Risk for infection due to myelosuppression
- Altered nutrition related to gastrointestinal symptoms
Implementation: Administer IV as prescribed, monitor vital signs and labs closely, correct electrolyte imbalances, and provide supportive care.
Evaluation: Assess for remission of leukemia, resolution of symptoms, and monitor for adverse effects.
Patient/Family Teaching
- Inform about the importance of regular blood tests and cardiac monitoring.
- Report any signs of arrhythmias, abnormal bleeding, or infection immediately.
- Avoid concomitant use of other QT-prolonging medications unless supervised by healthcare provider.
Special Considerations
Black Box Warnings:
- QT prolongation and serious arrhythmias, including torsades de pointes.
- Differentiation syndrome, which can be life-threatening.
- Pregnancy category D: risk to fetus; use only if benefits outweigh risks.
Genetic Factors: None specific beyond general pharmacogenomic considerations.
Lab Test Interference: May cause transient increases in liver enzymes; monitor labs regularly.
Overdose Management
Signs/Symptoms: Severe nausea, vomiting, diarrhea, hypotension, arrhythmias, CNS effects including ataxia and encephalopathy.
Treatment: Discontinue arsenic; manage supportive care including electrolyte correction, cardiac monitoring, and symptomatic treatment. Consider chelation therapy with dimercaprol in severe cases.
Storage and Handling
Storage: Store in a secure, well-ventilated area at controlled room temperature. Keep out of reach of children.
Stability: Stable when stored properly; do not use beyond expiration date.