Pronunciation:

(am i FOS teen)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

It is recommended that antiemetic medication, including dexamethasone 20 mg I.V. and a serotonin 5-HT3 receptor antagonist be administered prior to and in conjunction with amifostine. Rare hypersensitivity reactions, including anaphylaxis and severe cutaneous reaction, have been reported with a higher frequency in patients receiving amifostine as a radioprotectant. Discontinue if allergic reaction occurs; do not rechallenge.

Reports of clinically relevant hypocalcemia are rare, but serum calcium levels should be monitored in patients at risk of hypocalcemia, such as those with nephrotic syndrome.

Adverse Reactions:

>10%:

Cardiovascular: Flushing; hypotension (62%)

Central nervous system: Chills, dizziness, somnolence

Gastrointestinal: Nausea/vomiting (may be severe)

Respiratory: Sneezing

Miscellaneous: Feeling of warmth/coldness, hiccups

<1%, postmarketing, and/or case reports: Apnea, anaphylactoid reactions, anaphylaxis, arrhythmia, atrial fibrillation, cardiac arrest, erythema multiforme, exfoliative dermatitis; hypersensitivity reactions (fever, rash, hypoxia, dyspnea, laryngeal edema); hypocalcemia, mild rash, myocardial ischemia, rigors, seizure, Stevens-Johnson syndrome, toxic epidermal necrolysis, toxoderma

Overdosage/Toxicology:

Drug Interactions:

Stability:

Compatibility:

Y-site administration: Compatible: Amikacin, aminophylline, ampicillin, ampicillin/sulbactam, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, cimetidine, ciprofloxacin, clindamycin, co-trimoxazole, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, dexamethasone sodium phosphate, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin, doxycycline, droperidol, enalaprilat, etoposide, famotidine, floxuridine, fluconazole, fludarabine, fluorouracil, furosemide, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone sodium phosphate, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, leucovorin, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, methylprednisolone sodium succinate, metoclopramide, metronidazole, mitomycin, mitoxantrone, morphine, nalbuphine, netilmicin, ondansetron, piperacillin, plicamycin, potassium chloride, promethazine, ranitidine, sodium bicarbonate, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, trimetrexate, vancomycin, vinblastine, vincristine, zidovudine. Incompatible: Acyclovir, amphotericin B, cefoperazone, chlorpromazine, cisplatin, ganciclovir, hydroxyzine, minocycline, prochlorperazine edisylate

Mechanism of Action:

Pharmacodynamics/Kinetics:

Distribution: Vd: 3.5 L

Metabolism: Hepatic dephosphorylation to two metabolites (active-free thiol and disulfide)

Half-life elimination: 9 minutes

Excretion: Urine

Clearance, plasma: 2.17 L/minute

Dosage:

Cisplatin-induced renal toxicity, reduction: I.V.: 740-910 mg/m² once daily 30 minutes prior to cytotoxic therapy

Note: Doses >740 mg/m² are associated with a higher incidence of hypotension and may require interruption of therapy or dose modification for subsequent cycles. For 910 mg/m² doses, the manufacturer suggests the following blood pressure-based adjustment schedule:

The infusion of amifostine should be interrupted if the systolic blood pressure decreases significantly from baseline, as defined below:

Decrease of 20 mm Hg if baseline systolic blood pressure <100

Decrease of 25 mm Hg if baseline systolic blood pressure 100-119

Decrease of 30 mm Hg if baseline systolic blood pressure 120-139

Decrease of 40 mm Hg if baseline systolic blood pressure 140-179

Decrease of 50 mm Hg if baseline systolic blood pressure 180

If the blood pressure returns to normal within 5 minutes (assisted by fluid administration and postural management) and the patient is asymptomatic, the infusion may be restarted so that the full dose of amifostine may be administered. If the full dose of amifostine cannot be administered, the dose of amifostine for subsequent cycles should be 740 mg/m².

Xerostomia from head and neck cancer, reduction:

I.V.: 200mg/m²/day during radiation therapy or

SubQ: 500 mg/day during radiation therapy

Administration:

Monitoring Parameters:

Patient Education:

Additional Information:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Oncology: Emetic Potential:

Oncology: Vesicant:

Dosage Forms:

International Brand Names: