Generic Name

Pentostatin

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Classification

FDA Approved Indications

• Hairy cell leukemia

Mechanism of Action

Pentostatin inhibits adenosine deaminase, leading to accumulation of deoxyadenosine triphosphate, which is toxic to lymphocytes, thus suppressing lymphocyte proliferation.

Dosage and Administration

Adult: 4 mg/m² IV every 2 weeks for up to 6 doses; dosage may vary based on response and tolerability.

Pediatric: Use not well established; consult specialist.

Geriatric: Dosage adjustments not usually required but monitor renal function closely.

Renal Impairment: Adjust dose based on renal function; consult specific guidelines.

Hepatic Impairment: Use with caution; no specific adjustment guidelines available.

Pharmacokinetics

Absorption: Not applicable (intravenous administration).

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Minimal metabolism; mainly excreted unchanged.

Excretion: Renally excreted; monitor renal function.

Half Life: Approximately 20 hours.

Contraindications

• Hypersensitivity to pentostatin or its components.

Precautions

• Use with caution in patients with renal impairment, as drug is renally excreted.
• Monitor blood counts regularly due to risk of myelosuppression.
• Use caution in patients with active infections or immunodeficiency.

Adverse Reactions - Common

• Myelosuppression (neutropenia, thrombocytopenia, anemia) (Common)
• Nausea, vomiting (Common)
• Rash, fever (Common)

Adverse Reactions - Serious

• Severe myelosuppression leading to infection or bleeding (Less common)
• Liver toxicity (Rare)
• Pulmonary toxicity (Rare)
• Secondary malignancies (Rare)

Drug-Drug Interactions

• Other myelosuppressive agents, immunosuppressants, nephrotoxic drugs.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection (fever, chills), bleeding, or severe fatigue immediately.
• Adhere to scheduled blood tests.
• Use caution to prevent injury due to bleeding risk.

Special Considerations

Black Box Warnings:

• Myelosuppression may be severe and life-threatening.
• Infection risk is increased.
• Secondary malignancies, including skin cancers, may occur.

Genetic Factors: N/A

Lab Test Interference: May cause anemia, leukopenia, thrombocytopenia, which requires careful interpretation of CBCs.

Overdose Management

Signs/Symptoms: Severe myelosuppression, infection, bleeding.

Treatment: Supportive care, blood product transfusions, antibiotics if infections develop, and monitoring in an intensive setting.

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable for specified period as per manufacturer guidelines.