procarbazine (Rx)

Brand and Other Names:Matulane
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 50mg

Hodgkin's Disease

Part of COPP, BEACOPP and MOPP regimens

2-4 mg/kg/day in single or divided doses for 7 days; increase dose by 4-6 mg/kg/day until maximum response obtained or WBC<4,000 cells/mm³ or platelets<100,000 cells/mm³; reduce dosage to 1-2 mg/kg/day after maximum effect obtained  

Alternatively, 100 mg/m² PO qDay for 7-14 days of each 28 day cycle in combo with other antineoplastics  

Monitor: CBC

Glioma (Orphan)

Treatment of malignant glioma

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Renal Impairment

Use caution; may result in increased toxicity if BUN above 40 mg/dL

Hepatic Impairment

Use caution; may result in increased toxicity if AST or ALT >1.6 ULN

Dosage Forms & Strengths

capsule

  • 50mg

Hodgkin's Disease

50 mg/m² PO qDay for 7 days; increase to 100 mg/m²/day until maximum response obtained or leukopenia or thrombocytopenia observed  

Monitor: CBC

Hodgkin's Disease

Adjust for renal impairment if necessary

Part of COPP, BEACOPP & MOPP regimens

2-4 mg/kg/day in single or divided doses for 7 days; increase dose by 4-6 mg/kg/day until maximum response obtained or WBC<4,000 cells/mm³ or plateletes<100,000 cells/mm³; reduce dosage to 1-2 mg/kg/day after maximum effect obtained  

Alternatively, 100 mg/m² PO qDay for 7-14 days of each 28 day cycle in combo with other antineoplasticsMonitor: CBC  

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Interactions

Interaction Checker

and procarbazine

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            Contraindicated (76)

            • adenovirus types 4 and 7 live, oral

              procarbazine decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • almotriptan

              procarbazine increases levels of almotriptan by serotonin levels. Contraindicated. Concurrent use or use within 2 weeks of MAOI therapy is contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy.

            • amitriptyline

              procarbazine and amitriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • amoxapine

              procarbazine and amoxapine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • atomoxetine

              procarbazine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • BCG vaccine live

              procarbazine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • brimonidine

              procarbazine, brimonidine. Mechanism: unknown. Contraindicated.

            • buspirone

              procarbazine and buspirone both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

              procarbazine, buspirone. Other (see comment). Contraindicated. Comment: Concomitant use of buspirone with MAOIs can increase blood pressure; this combination should be avoided.

            • caffeine

              procarbazine increases effects of caffeine by pharmacodynamic synergism. Contraindicated. Caffeine can produce severe hypertensive crises or dangerous cardiac arrhythmias if administered to patients taking a MAOI. All preparations containing caffeine should be used sparingly.

            • carbamazepine

              carbamazepine increases toxicity of procarbazine by unknown mechanism. Contraindicated. D/C MAO inhibitor 2 weeks before.

            • cholera vaccine

              procarbazine decreases effects of cholera vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • citalopram

              procarbazine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

            • clomipramine

              procarbazine and clomipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • cyproheptadine

              procarbazine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

            • desipramine

              procarbazine and desipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • desvenlafaxine

              procarbazine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drug

            • dexmethylphenidate

              procarbazine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dextroamphetamine

              procarbazine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dextromethorphan

              procarbazine and dextromethorphan both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • diethylpropion

              procarbazine increases effects of diethylpropion by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • doxepin

              procarbazine and doxepin both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • duloxetine

              procarbazine and duloxetine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • ephedrine

              procarbazine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • escitalopram

              procarbazine and escitalopram both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • fluoxetine

              procarbazine and fluoxetine both increase serotonin levels. Contraindicated. Combinations is contraindicated within 5 weeks of MAOI use.

            • imipramine

              procarbazine and imipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • influenza virus vaccine quadrivalent, intranasal

              procarbazine decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • isocarboxazid

              isocarboxazid and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • isoproterenol

              procarbazine increases effects of isoproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • levodopa

              procarbazine, levodopa. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • levomilnacipran

              procarbazine and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • lisdexamfetamine

              procarbazine increases effects of lisdexamfetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • maprotiline

              procarbazine and maprotiline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • measles (rubeola) vaccine

              procarbazine decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • measles mumps and rubella vaccine, live

              procarbazine decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • measles, mumps, rubella and varicella vaccine, live

              procarbazine decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • meperidine

              procarbazine and meperidine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

              procarbazine increases toxicity of meperidine by unknown mechanism. Contraindicated. MAOIs may potentiate CNS depression and hypotension. Do not use meperidine within 14 days of MAOI use. .

            • methamphetamine

              procarbazine increases effects of methamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • milnacipran

              procarbazine and milnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • mirtazapine

              procarbazine and mirtazapine both increase serotonin levels. Contraindicated.

            • nefazodone

              procarbazine and nefazodone both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • norepinephrine

              procarbazine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • nortriptyline

              procarbazine and nortriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • ozanimod

              procarbazine and ozanimod both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of ozanimod with MAO-B inhibitors may decrease exposure of the active metabolites of ozanimod, which may inhibit MAO. The potential for a clinical interaction with MAO inhibitors has not been studied; however, the increased risk of nonselective MAO inhibition may lead to a hypertensive crisis. Allow at least 14 days to elapse between discontinuing ozanimod and initiating with MAO inhibitors.

            • paroxetine

              procarbazine and paroxetine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • phendimetrazine

              procarbazine increases effects of phendimetrazine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • phentermine

              procarbazine increases effects of phentermine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenylephrine

              procarbazine increases effects of phenylephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenylephrine PO

              procarbazine increases effects of phenylephrine PO by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • protriptyline

              procarbazine and protriptyline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • pseudoephedrine

              procarbazine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • rizatriptan

              rizatriptan and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • rotavirus oral vaccine, live

              procarbazine decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • rubella vaccine

              procarbazine decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • selegiline

              selegiline and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • selegiline transdermal

              selegiline transdermal and procarbazine both increase serotonin levels. Contraindicated.

            • sertraline

              procarbazine and sertraline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • smallpox (vaccinia) vaccine, live

              procarbazine decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • solriamfetol

              procarbazine will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.

            • St John's Wort

              procarbazine and St John's Wort both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • sumatriptan

              sumatriptan and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • sumatriptan intranasal

              sumatriptan intranasal and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

              procarbazine increases levels of sumatriptan intranasal by serotonin levels. Contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for the development of serotonin toxicity/serotonin syndrome during such therapy.

            • tetrabenazine

              tetrabenazine, procarbazine. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • tramadol

              procarbazine and tramadol both increase serotonin levels. Contraindicated.

            • tranylcypromine

              procarbazine and tranylcypromine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • trazodone

              procarbazine and trazodone both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • trimipramine

              procarbazine and trimipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • typhoid polysaccharide vaccine

              procarbazine decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • typhoid vaccine live

              procarbazine decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • varicella virus vaccine live

              procarbazine decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • venlafaxine

              procarbazine and venlafaxine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

            • yellow fever vaccine

              procarbazine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            • zolmitriptan

              zolmitriptan and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

              procarbazine increases levels of zolmitriptan by serotonin levels. Contraindicated. Concurrent use or use within 2 weeks of MAOI therapy is contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy.

            • zoster vaccine live

              procarbazine decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.

            Serious - Use Alternative (52)

            • alfentanil

              procarbazine increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • almotriptan

              almotriptan and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug.

            • anakinra

              procarbazine, anakinra. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              procarbazine increases toxicity of benzhydrocodone/acetaminophen by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • buprenorphine

              procarbazine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .

            • buprenorphine buccal

              procarbazine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .

            • butorphanol

              procarbazine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of additive CNS, respiratory and hypotensive effects. .

            • cocaine

              procarbazine and cocaine both increase serotonin levels. Contraindicated.

            • codeine

              procarbazine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • deferiprone

              deferiprone, procarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

            • dextroamphetamine

              procarbazine and dextroamphetamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dihydroergotamine

              procarbazine and dihydroergotamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dihydroergotamine intranasal

              procarbazine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.

            • doxepin cream

              procarbazine increases levels of doxepin cream by pharmacodynamic synergism. Avoid or Use Alternate Drug. D/C MAO inhibitor 2 weeks before.

            • eletriptan

              eletriptan and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug.

            • epinephrine

              procarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • epinephrine racemic

              procarbazine increases effects of epinephrine racemic by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • ergotamine

              procarbazine and ergotamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • fingolimod

              procarbazine increases effects of fingolimod by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of fingolimod with other immunosuppressants when possible. If combined, closely monitor for additive immunosuppressant effects (eg, infections). When switching to fingolimod after discontinuing another immunosuppressant, consider the duration of action of the discontinued drug to avoid additive immunosuppressive effects.

            • fluvoxamine

              fluvoxamine and procarbazine both increase serotonin levels. Contraindicated.

            • frovatriptan

              frovatriptan and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug.

            • hydrocodone

              procarbazine increases toxicity of hydrocodone by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • hydromorphone

              procarbazine increases toxicity of hydromorphone by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • levodopa

              procarbazine and levodopa both increase serotonin levels. Avoid or Use Alternate Drug.

            • levorphanol

              procarbazine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • linezolid

              linezolid and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

            • lithium

              procarbazine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

            • methadone

              procarbazine increases toxicity of methadone by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • methylene blue

              methylene blue and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

            • metoclopramide intranasal

              metoclopramide intranasal increases toxicity of procarbazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Metoclopramide may enhance the hypertensive effect of monoamine oxidase inhibitors.

            • midodrine

              procarbazine increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • morphine

              procarbazine increases toxicity of morphine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • nalbuphine

              procarbazine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • naratriptan

              naratriptan and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug.

            • natalizumab

              procarbazine, natalizumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Monitor for bone marrow suppression at least monthly in patients concomitantly using leflunomide and another immunosuppressant.

            • nivolumab

              procarbazine, nivolumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of immunosuppressants (eg, systemic corticosteroids) prior to initiation of nivolumab. Use of immunosuppressants after administration of nivolumab (eg, for treatment of immune-related adverse reactions) is unlikely to affect nivolumab efficacy.

            • ocrelizumab

              procarbazine, ocrelizumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

            • opium tincture

              procarbazine increases toxicity of opium tincture by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • oxycodone

              procarbazine increases toxicity of oxycodone by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • oxymorphone

              procarbazine increases toxicity of oxymorphone by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • palifermin

              palifermin increases toxicity of procarbazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

            • pentazocine

              procarbazine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.

              procarbazine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • pimecrolimus

              procarbazine, pimecrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

            • rizatriptan

              procarbazine increases levels of rizatriptan by serotonin levels. Avoid or Use Alternate Drug.

            • SAMe

              procarbazine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.

            • sufentanil

              procarbazine increases toxicity of sufentanil by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • sufentanil SL

              procarbazine increases toxicity of sufentanil SL by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • sumatriptan

              procarbazine increases levels of sumatriptan by serotonin levels. Contraindicated. Concurrent use or use within 2 weeks of MAOI therapy is contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy.

            • tacrolimus ointment

              procarbazine, tacrolimus ointment. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

            • tapentadol

              procarbazine increases toxicity of tapentadol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            • tofacitinib

              procarbazine, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted. Agents considered as potent immunosuppressants are not specified, but lower corticosteroid doses (ie, equivalent to prednisone 10 mg/day or less), leflunomide, and antirheumatic doses of methotrexate were permitted in clinical studies.

            • tramadol

              procarbazine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

            Monitor Closely (106)

            • acalabrutinib

              acalabrutinib, procarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

            • albuterol

              procarbazine increases effects of albuterol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • anthrax vaccine adsorbed

              procarbazine decreases effects of anthrax vaccine adsorbed by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • arformoterol

              procarbazine increases effects of arformoterol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • aripiprazole

              procarbazine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • armodafinil

              procarbazine increases effects of armodafinil by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • asenapine

              procarbazine, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • belatacept

              belatacept and procarbazine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

            • belladonna and opium

              procarbazine increases toxicity of belladonna and opium by unknown mechanism. Use Caution/Monitor. Potential for increased CNS depression. Use caution during coadministration.

            • bretylium

              procarbazine increases effects of bretylium by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. Bretylium produces release of catecholamines from nerve endings. This increased catecholamine release is potentiated by MAOIs.

            • cariprazine

              procarbazine, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • chlorpromazine

              procarbazine, chlorpromazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

            • cholera vaccine

              procarbazine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

            • clozapine

              procarbazine, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • dengue vaccine

              procarbazine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

            • denosumab

              procarbazine, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              procarbazine, denosumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • desflurane

              procarbazine increases levels of desflurane by pharmacodynamic synergism. Use Caution/Monitor.

            • digoxin

              procarbazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • disulfiram

              disulfiram, procarbazine. Mechanism: unknown. Use Caution/Monitor. Risk of delirium (case report).

            • dobutamine

              procarbazine increases effects of dobutamine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • dopamine

              procarbazine increases effects of dopamine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • doxapram

              doxapram increases effects of procarbazine by pharmacodynamic synergism. Use Caution/Monitor. Additive pressor effect.

            • echinacea

              echinacea decreases effects of procarbazine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Echinacea is reported possess immunostimulatory activity demonstrated by activation of macrophages (releasing interleukin-1), and proliferation of B-lymphocytes; theoretically, may oppose the therapeutic effects of immunosuppressants.

            • etanercept

              procarbazine, etanercept. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • etomidate

              procarbazine increases levels of etomidate by pharmacodynamic synergism. Use Caution/Monitor.

            • fluphenazine

              procarbazine, fluphenazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

              procarbazine, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • formoterol

              procarbazine increases effects of formoterol by pharmacodynamic synergism. Use Caution/Monitor.

            • green tea

              green tea, procarbazine. Other (see comment). Use Caution/Monitor. Comment: Avoid combination or excessive consumption of green tea. Combination may increase risk of cardiac arrhythmias or severe hypertension can occur due to caffeine component of green tea.

            • haemophilus influenzae type b vaccine

              procarbazine decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. .

            • haloperidol

              procarbazine, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • hepatitis A vaccine inactivated

              procarbazine decreases effects of hepatitis A vaccine inactivated by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • hepatitis a/b vaccine

              procarbazine decreases effects of hepatitis a/b vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • hepatitis b vaccine

              procarbazine decreases effects of hepatitis b vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • HIV vaccine

              procarbazine decreases effects of HIV vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • human papillomavirus vaccine, nonavalent

              procarbazine decreases effects of human papillomavirus vaccine, nonavalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • human papillomavirus vaccine, quadrivalent

              procarbazine decreases effects of human papillomavirus vaccine, quadrivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • hydralazine

              hydralazine, procarbazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • hydroxyurea

              procarbazine, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

            • iloperidone

              procarbazine, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • influenza virus vaccine quadrivalent

              procarbazine decreases effects of influenza virus vaccine quadrivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine quadrivalent, adjuvanted

              procarbazine decreases effects of influenza virus vaccine quadrivalent, adjuvanted by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine quadrivalent, cell-cultured

              procarbazine decreases effects of influenza virus vaccine quadrivalent, cell-cultured by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine quadrivalent, recombinant

              procarbazine decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine trivalent

              procarbazine decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine trivalent, adjuvanted

              procarbazine decreases effects of influenza virus vaccine trivalent, adjuvanted by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • influenza virus vaccine trivalent, recombinant

              procarbazine decreases effects of influenza virus vaccine trivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • insulin aspart

              procarbazine increases effects of insulin aspart by unknown mechanism. Use Caution/Monitor.

            • insulin detemir

              procarbazine increases effects of insulin detemir by unknown mechanism. Use Caution/Monitor.

            • insulin glargine

              procarbazine increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.

            • insulin glulisine

              procarbazine increases effects of insulin glulisine by unknown mechanism. Use Caution/Monitor.

            • insulin lispro

              procarbazine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.

            • insulin NPH

              procarbazine increases effects of insulin NPH by unknown mechanism. Use Caution/Monitor.

            • Japanese encephalitis virus vaccine

              procarbazine decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • ketamine

              procarbazine increases levels of ketamine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

            • leflunomide

              procarbazine increases toxicity of leflunomide by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Monitor for bone marrow suppression at least monthly in patients concomitantly using leflunomide and another immunosuppressant.

            • levalbuterol

              procarbazine increases effects of levalbuterol by pharmacodynamic synergism. Use Caution/Monitor.

            • levodopa inhaled

              levodopa inhaled increases effects of procarbazine by dopaminergic effects. Use Caution/Monitor. Coadministration of selective MAO-B inhibitors with levodopa may be associated with orthostatic hypotension.

            • lithium

              lithium, procarbazine. Mechanism: unknown. Use Caution/Monitor.

            • loxapine

              procarbazine, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • loxapine inhaled

              procarbazine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • lurasidone

              lurasidone increases effects of procarbazine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              procarbazine, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • maraviroc

              maraviroc, procarbazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • meningococcal A C Y and W-135 diphtheria conjugate vaccine

              procarbazine decreases effects of meningococcal A C Y and W-135 diphtheria conjugate vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • meningococcal A C Y and W-135 polysaccharide vaccine combined

              procarbazine decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • meningococcal group B vaccine

              procarbazine decreases effects of meningococcal group B vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • metaproterenol

              procarbazine increases effects of metaproterenol by pharmacodynamic synergism. Use Caution/Monitor.

            • metformin

              procarbazine will increase the level or effect of metformin by unspecified interaction mechanism. Use Caution/Monitor.

            • methotrexate

              procarbazine, methotrexate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of immunosupression.

            • methylphenidate

              procarbazine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • modafinil

              procarbazine increases effects of modafinil by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • molindone

              procarbazine, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • naratriptan

              procarbazine increases levels of naratriptan by serotonin levels. Modify Therapy/Monitor Closely. Closely monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy.

            • ofatumumab SC

              ofatumumab SC, procarbazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • olanzapine

              procarbazine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • paliperidone

              procarbazine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • perphenazine

              procarbazine, perphenazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

              procarbazine, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • phenylephrine ophthalmic

              procarbazine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

            • pimavanserin

              procarbazine, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pimozide

              procarbazine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pirbuterol

              procarbazine increases effects of pirbuterol by pharmacodynamic synergism. Use Caution/Monitor.

            • pneumococcal vaccine 13-valent

              procarbazine decreases effects of pneumococcal vaccine 13-valent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • pneumococcal vaccine heptavalent

              procarbazine decreases effects of pneumococcal vaccine heptavalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • pneumococcal vaccine polyvalent

              procarbazine decreases effects of pneumococcal vaccine polyvalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • poliovirus vaccine inactivated

              procarbazine decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

            • prochlorperazine

              procarbazine, prochlorperazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

            • promethazine

              procarbazine, promethazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

            • propofol

              procarbazine increases levels of propofol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

            • quetiapine

              procarbazine, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • rabies vaccine

              procarbazine decreases effects of rabies vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • rabies vaccine chick embryo cell derived

              procarbazine decreases effects of rabies vaccine chick embryo cell derived by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • risperidone

              procarbazine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • roflumilast

              roflumilast will increase the level or effect of procarbazine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • salmeterol

              procarbazine increases effects of salmeterol by pharmacodynamic synergism. Use Caution/Monitor.

            • sevoflurane

              procarbazine increases levels of sevoflurane by pharmacodynamic synergism. Use Caution/Monitor.

            • siponimod

              siponimod and procarbazine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • sipuleucel-T

              procarbazine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              procarbazine decreases effects of sipuleucel-T by unknown mechanism. Use Caution/Monitor. Consider avoiding such combinations when clinically appropriate. If such a combination is used, monitor the patient closely for clinical response.

            • terbutaline

              procarbazine increases effects of terbutaline by pharmacodynamic synergism. Use Caution/Monitor.

            • tetanus toxoid adsorbed or fluid

              procarbazine decreases effects of tetanus toxoid adsorbed or fluid by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            • thioridazine

              procarbazine, thioridazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

            • thiothixene

              procarbazine, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • trastuzumab

              trastuzumab, procarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, procarbazine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

            • trifluoperazine

              procarbazine, trifluoperazine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Excessive sedation.

              procarbazine, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • yohimbe

              yohimbe increases effects of procarbazine by pharmacodynamic synergism. Use Caution/Monitor.

            • ziprasidone

              procarbazine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • zoster vaccine recombinant

              procarbazine decreases effects of zoster vaccine recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

            Minor (8)

            • amobarbital

              procarbazine increases levels of amobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • butabarbital

              procarbazine increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • celandine

              celandine increases effects of procarbazine by pharmacodynamic synergism. Minor/Significance Unknown. Based on animal studies.

            • panax ginseng

              panax ginseng increases effects of procarbazine by pharmacodynamic synergism. Minor/Significance Unknown.

            • phenobarbital

              procarbazine increases levels of phenobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • pleurisy root

              pleurisy root decreases effects of procarbazine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

            • primidone

              procarbazine increases levels of primidone by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • secobarbital

              procarbazine increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

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            Adverse Effects

            Frequency Not Defined

            Neuropathy

            Neurotoxicity

            Nausea

            Vomiting

            Pleural effusion

            Myelosuppression

            Heinz bodies

            Hepatic dysfunction

            Impairment of fertility

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            Warnings

            Black Box Warnings

            The therapy should be given only by or under the supervision of a physician experienced in the use of potent antineoplastic drugs

            Adequate clinical and laboratory facilities should be available to patients for proper monitoring of treatment

            Contraindications

            Hypersensitivity

            Severe anemia, leukopenia, thrombocytopenia, bone marrow depression

            Cautions

            Discontinue if CNS S/S, hypersensitivity reaction, stomatitis, diarrhea, hemorrhage, hemolysis

            Discontinue if WBC <4000/mm³ &/or platelets <100,000/mm³

            Caution in hepatic/renal impairment

            Avoid alcohol, food high in tyramine

            Avoid pregnancy

            May cause infertility

            Has MAO inhibitor activity (potential for food and drug interactions)

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: 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

            Methylhydrazine derivative; inhibits protein, DNA, RNA synthesis; may suppress mitosis and damage DNA directly

            Some MAOI activity

            Pharmacokinetics

            Half-life elimination: 1 hr

            Peak plasma time: 1 hr

            Metabolism: liver, kidney

            Excretion: Urine

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Matulane oral
            -
            50 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            procarbazine oral

            PROCARBAZINE - ORAL

            (proe-KAR-ba-zeen)

            COMMON BRAND NAME(S): Matulane

            USES: This medication is used to treat Hodgkin's disease (also known as Hodgkin's lymphoma). Procarbazine belongs to a class of drugs known as alkylating agents. It works by slowing or stopping the growth of cancer cells.

            HOW TO USE: See also Precautions and Drug Interactions sections.Read the Patient Information Leaflet if available from your pharmacist before you start taking procarbazine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication as directed by your doctor, usually once or twice daily. It is usually taken for a 2-week period, then stopped for a time and repeated. This is called a treatment cycle. Do not chew or crush the capsules before swallowing. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.The dosage is based on your medical condition, response to treatment, age, body size, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician to limit your intake of tyramine while you are taking this medicine. Avoid foods and beverages that are high in tyramine, including aged cheeses, dried/aged meats and sausages (such as salami, liverwurst), preserved fish (such as pickled herring), products that contain large amounts of yeast (such as bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (such as sauerkraut, kim chee), most soybean products (such as soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, and vermouth. Consult your doctor or dietician for more details and a complete list of other foods that contain tyramine which you should limit or avoid. See also Side Effects section.Do not stop taking this medication, even if you have nausea. If you vomit soon after taking a dose, contact your doctor right away for instructions.

            SIDE EFFECTS: Nausea, vomiting, loss of appetite, constipation, dry mouth, difficulty swallowing, drowsiness, dizziness, headache, trouble sleeping, muscle/joint pain, or darkening of the skin may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: unusual bleeding/bruising, diarrhea, tingling/numbness of hands/feet, mental/mood changes (such as confusion, depression), mouth/lip sores.This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as sore throat that doesn't go away, fever, chills).Get medical help right away if you have any very serious side effects, such as: seizure.This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (see How to Use and Drug Interactions sections). Stop taking procarbazine and get medical help right away if any of these serious side effects occur: severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (such as double/blurred vision), sudden sensitivity to light (photophobia).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Very rarely, people with cancer who are treated with this type of medication have developed other cancers (such as leukemia). Your risk is greater if you have had certain types of chemotherapy or radiation treatment. Talk with your doctor for more details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, such as: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking procarbazine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding/blood problems, current/recent/returning infection, kidney disease, liver disease, radiation treatment.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana (cannabis).Avoid alcoholic drinks and products while taking this medication because severe stomach upset/cramps, nausea, vomiting, headache, and flushing may occur.Avoid smoking while using this medication. Smoking increases the risk of developing lung cancer while using this drug. Talk to your doctor or pharmacist for more details.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Procarbazine can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug, especially shaking (tremors), loss of consciousness, or seizures.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using procarbazine. Procarbazine may harm an unborn baby. Ask about reliable forms of birth control while using this medication. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: diet pills/appetite suppressants (such as diethylpropion), drugs for attention deficit hyperactivity-ADHD (such as atomoxetine, methylphenidate), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, deutetrabenazine, dextromethorphan, methyldopa, metoclopramide, tetrabenazine, valbenazine, certain opioid medications (such as meperidine, methadone, tapentadol), certain supplements (such as tryptophan, tyramine), certain "triptans" used to treat migraine headaches (such as rizatriptan, sumatriptan), certain drugs for Parkinson's disease (entacapone, levodopa, tolcapone).The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/ "ecstasy," St. John's wort, certain antidepressants (including maprotiline, mirtazapine, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine, tricyclics such as amitriptyline/doxepin), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Some products can interact with procarbazine if you take them together, or even if you take them weeks before or after taking procarbazine. Tell your doctor or pharmacist if you take anything in the list of products that may interact with this drug, or any of the products that increase serotonin, within 2 weeks before or after taking procarbazine. Also tell them if you have taken fluoxetine within 5 weeks before starting procarbazine. Ask your doctor how much time to wait between starting or stopping any of these drugs and starting procarbazine.Taking other MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.Before using procarbazine, report the use of drugs that may increase the risk of extremely high blood pressure (hypertensive crisis) when combined with procarbazine, including herbal products (such as ephedra/ma huang), allergy and cough-and-cold products (including dextromethorphan, decongestants such as phenylephrine/pseudoephedrine), and stimulants (such as amphetamines, ephedrine, epinephrine, phenylalanine). Procarbazine should not be used with any of these medications. Talk to your doctor or pharmacist for more details.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood counts, kidney/liver/lung function) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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

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

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • 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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.