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streptozocin (Rx)Brand and Other Names:Zanosar

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 1g/vial
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Metastatic Islet Cell Cancer of Pancreas

Single agent therapy

  • 1000 mg/m² IV qWeek, may increase to no more than 1500 mg/m² 
  • Risk of azotemia increase with >1500 mg/m²
  • Monitor: CBC, LFTs, renal function

Combination therapy

  • 500 mg/m²/day IV for 5 days q4-6Weeks
  • Monitor: CBC, LFTs, renal function

Renal Impairment

CrCl >50 mL/min: May administer full dose

CrCl: 10-50 mL/min: 75% of regular dose

CrCl: <10 mL/min: 50% of regular dose

Other Indications & Uses

Metastatic islet cell cancer of pancreas

Off-label: carcinoid syndrome

Not recommended

Metastatic islet cell cancer of pancreas

Single agent therapy

1000 mg/m² IV qWeek, may increase to no more than 1500 mg/m²  

Risk of azotemia increase with >1500 mg/m²

Monitor: CBC, LFTs, renal function

Combination therapy

500 mg/m²/day IV for 5 days q4-6Weeks

Risk of azotemia increase with >1500 mg/m²

Monitor: CBC, LFTs, renal function

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Interactions

Interaction Checker

streptozocin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Nephrotoxicity (up to 75%)

            Vomiting (up to 90% if no antiemetic)

            Metabolic changes, including elevated LFTs, increased LDH (25%)

            Hypoglycemia (20%)

            Myelosuppression (10-20%)

            Frequency Not Defined

            Confusion Lethargy Depression

            Nausea

            Fever

            Chills

            Hematologic toxicity (fatal reported)

            Injection site reactions

            Decreased liver function

            Jaundice

            Nail changes

            Nephrogenic diabetes insipidus (rare)

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            Warnings

            Black Box Warnings

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to monitor drug tolerance and to protect and maintain a patient compromised by drug toxicity

            Renal toxicity is dose-related and cumulative and may be severe or fatal

            Nausea and vomiting may be severe and treatment limiting at times

            Liver dysfunction, diarrhea, and hematologic changes reported

            Parenteral streptozocin is mutagenic and found to be tumorigenic in some rodents

            The physician must weigh risks versus benefits to the patient

            Contraindications

            Hypersensitivity; pregnancy

            Cautions

            Risk of severe nephrotoxicity, dose-related & cumulative (ie, >1500 mg/m²/dose may cause azotemia)

            Risk of severe nausea/vomiting

            Rapid infusion may cause burning sensation

            May alter glucose metabolism in some patients

            Avoid pregnancy

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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

            Nitrosurea agent that contains a glucose moiety and interferes with DNA function; alkylates DNA, crosslinks DNA strands, may modify proteins and inhibit enzymes involved in DNA synthesis.

            Pharmacokinetics

            Half-Life: 35-40 min

            Bioavailability: 17-25%

            Onset: 17 days (with dose schedule of 1500 mg/m²)

            Peak Response: 35 days (with dose schedule of 1500 mg/m²)

            Vd: 43.8 L

            Metabolism: Liver

            Clearance: 478 mcg/min (range 173-718 mcg/min)

            Excretion: Urine (60-70%)

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            Administration

            IV Incompatibilities

            Y-site: allopurinol, aztreonam, cefepime, piperacillin/tazobactam

            IV Compatibilities

            Solution: D5W, NS

            Y-site: amifostine, etoposide PO4, filgrastim, gemcitabine, granisetron, melphalan, ondansetron, teniposide, thiotepa, vinorelbine

            IV Preparation

            Reconstitute in 9.5 mL D5W or NS to obtain a 100 mg/mL pale gold solution

            Stable for 48 hr at room temp & 96 hr under refrigeration, BUT mfr recommends use within 12 hr because no preservatives

            IV Administration

            Vesicant

            IV infusion in >100 mL D5W or NS over 15 min-6 hr

            Continous infusion over 5 days have been given, but may be associated with increased CNS toxicity

            Storage

            Refrigerate vials

            Protect from light

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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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            Select a class to view formulary status for similar drugs

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