thiotepa (Rx)

Brand and Other Names:tespa, Thioplex, more...Triethylenethiophosphoramide, TSPA
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 15mg
more...

Bladder Cancer

Intravesical (superficial bladder cancer): 30-60 mg in 30-60 mL NS qWeek for 4 weeks; retain for 2 hours; if patient can not retain for 2 hr, dilute and use successive doses in 30 mL of sodium chloride 0.9% instead of 60 mL

Ovarian Cancer

0.3-0.4 mg/kg q1-4Weeks OR 0.2 mg/kg for 4-5 days q2-4Weeks

Effusions

Intracavitary: 0.6-0.8 mg/kg or 30-60 mg weekly

Leptomeningeal Metastases

1-10 mg/m² intrathecal in qWeek to 2 times/week as 1 mg/mL in sterile water for injection

High-dose IV Therapy for Bone Marrow Transplant

500 mg/m², up to 1,125 mg/m²

General Dosing Information

Refer to individual protocols

IM (unlabeled): 15-30 mg in various schedules

Interpericardial (unlabeled): 15-30 mg

Intratumor (unlabeled): 0.6-0.8 mg/kg q1-4Weeks

Monitor

CBC

Discontinue if WBC <3000/mm³ or platelets <150,000/mm³

Renal function

Renal Impairment

Caution; may require lower dose; limit use to cases where benefit outweigh risk

Hepatic Impairment

Caution; may require lower dose; limit use to cases where benefit outweigh risk

Other Indications & Uses

Bladder cancer, breast or ovary adenocarcinoma, Hodgkin's disease, NHL (largely superseded by other drugs)

Control of malignant pericardial/pleural/peritoneal effusions (intracavitary)

Off-label: meningeal neoplasms

Dosage Forms & Strengths

powder for injection

  • 15mg
more...

Sarcomas (Unlabeled)

25-65 mg/m² IV q3-4weeks

Hematopoietic Stem Cell Transplantation (Unlabeled)

300 mg/m qDay for 3 days (900 mg/m total) in chemotherapy combinations have been used

Bladder cancer

Intravesical (superficial bladder cancer): 30-60 mg in 30-60 mL NS qWeek for 4 weeks; retain for 2 hours; if patient can not retain for 2 hr, dilute and use successive doses in 30 mL of sodium chloride 0.9% instead of 60 mL

Ovarian cancer 

0.3-0.4 mg/kg q1-4Weeks OR 0.2 mg/kg for 4-5 days q2-4Weeks

Effusions

Intracavitary: 0.6-0.8 mg/kg or 30-60 mg weekly

Leptomeningeal metastases

1-10 mg/m² intrathecal in qWeek to 2 times/week as 1 mg/mL in sterile water for injection

High-dose IV therapy for bone marrow transplant

500 mg/m², up to 1,125 mg/m²

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Interactions

Interaction Checker

and thiotepa

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Asthenia

            Fatigue

            Seizures

            Fever

            Nausea

            Vomiting

            Loss of appetite

            Stomatitis

            Diarrhea

            Myelosuppression

            Leukemia

            Immune hypersensitivity reaction

            Oligozoospermia

            Amenorrhea

            Alopecia (slow)

            Hyperpigmentation

            Rash

            Injection site pain

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            Warnings

            Contraindications

            Hypersensitivity

            Hepatic, renal, bone marrow damage (maybe used in low dose if benefit>risk)

            Cautions

            Avoid pregnancy

            May be mutagenic and teratogenic

            Myelosuppression may occur

            Secondary malignancies may develop (potentially carcinogenic)

            Caution in hepatic impairment (may require dose reduction; use may also be contraindicated depending on type of hepatic impairment)

            Caution in renal impairment (may require dose reduction; use may also be contraindicated depending on type of hepatic impairment)

            Use appropriate precautions for handling and disposal

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: not known if excreted in breast milk, do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Alkylating agent that produces crosslinking of DNA strands by reacting with phosphate groups to inhibit protein synthesis, DNA, and RNA

            Pharmacokinetics

            Half-life elimination: 2.4 hour (parent drug), 17.6 hr (metabolite)

            Metabolism: Liver

            Total body clearance: 446-419 mL/min

            Excretion: Urine

            Dialyzable: Yes

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            Administration

            IV Incompatibilities

            Additive: cisplatin

            Y-site: cisplatin, filgrastim, minocycline, vinorelbine

            IV Compatibilities

            Solution: D5W(?), NS(?)

            Y-site (partial list): acyclovir, allopurinol, ampicillin/sulbactam, bleomycin, carboplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, dopamine, etoposide, etoposide phosphate, filgrastim, fluconazole, fluorouracil, gemcitabine, heparin, idarubicin, lorazepam, MgSO4, metronidazole, mitomycin, morphine, ondansetron, KCl, prochlorperazine, teniposide, tobramycin, vancomycin, vinblastine, vincristine

            IV Preparation

            Reconstitute in 1.5 mL SWI to 10 mg/mL which is stable for 8 hr at refrigeration; further dilution in NS, D5W, or LR should be used immediately (within 1 hr of preparation)

            Standard IV dilution

            • IVP: use 10 mg/mL solution
            • IVPB: dose/250 mL D5W; further dilution in NS, D5W, or LR should be used immediately (within 1 hr of preparation)
            • Continuous 24 hr IV infusion Dose >250 mg: QS to 50 mL (total volume) in NSDose 230-250 mg: QS to 45 mL (total volume) in NSDose 200-230 mg: QS to 40 mL (total volume) in NS

            IV Administration

            Administer over 1 min

            Solutions should be filtered through a 0.22 micron filter prior to administration

            1 mg/mL solution is considered isotonic

            Storage

            Store intact vials under refrigeration (2-8°C)

            Protect from light

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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