Indications
Arsenic Trioxide is an anticancer medicine used to treat acute promyelocytic leukaemia (APL), a type of blood cancer. It is used together with Tretinoin as first treatment in some patients, and in patients whose APL has come back or has not responded to other treatment.
How It Works
Arsenic Trioxide breaks down an abnormal protein (PML-RARA) that drives APL. This allows the leukaemia cells to mature into normal-looking cells and also causes many of them to die (apoptosis), clearing the cancer cells from the blood and bone marrow.
Dosage and Administration
Arsenic Trioxide is given as a slow intravenous infusion by a doctor or nurse in hospital, usually once a day. The dose is worked out from body weight and the treatment phase, and is given as prescribed by a specialist in blood cancers. Heart tracing (ECG) and blood salts are checked before and during treatment.
Interactions
- Medicines that prolong the QT interval, such as some antiarrhythmics (Amiodarone), antipsychotics, Macrolide antibiotics and Fluoroquinolones: increase the risk of dangerous heart rhythm problems.
- Medicines that lower potassium or magnesium, such as diuretics and Amphotericin B: increase heart rhythm risk.
- Medicines that can harm the liver: may add to liver toxicity.
Tell your doctor about all medicines and supplements you take.
Contraindications
Not to be used in people allergic to arsenic or any ingredient. It is generally avoided or used with great care in people with a long QT interval or serious uncorrected salt imbalances.
Side Effects
Common side effects include tiredness, nausea, vomiting, diarrhoea, headache, cough, fever, swelling, high blood sugar, raised liver enzymes, low potassium or magnesium, tingling or numbness of hands and feet, and skin rash.
Get urgent medical help for fever with breathlessness, sudden weight gain or swelling, chest pain or low blood pressure (signs of differentiation syndrome), fainting, palpitations or an irregular heartbeat, seizures, confusion or severe headache.
Pregnancy and Lactation
Arsenic Trioxide can harm an unborn baby and must not be used in pregnancy. Women and men should use effective contraception during and for some months after treatment, as advised by the doctor. Do not breastfeed during treatment and for a period afterwards, as advised.
Precautions and Warnings
Treatment needs close hospital monitoring of ECG, potassium, magnesium, calcium, blood counts, liver and kidney function. Differentiation syndrome and QT prolongation can be life threatening and need quick treatment. Use with caution in kidney or liver disease. Avoid activities needing alertness if you feel dizzy.
Overdose
Overdose may cause seizures, muscle weakness, confusion and severe heart rhythm problems. Treatment is stopped and specialist care, including chelation therapy, is given in hospital.
Therapeutic Class
Antineoplastic agent (anticancer medicine for leukaemia).
Storage
Hospital medicine: store as directed on the pack, usually below 30°C and not frozen. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.