pentostatin (Rx)

Brand and Other Names:Nipent, DCF, more...2Deoxycoformycin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 10mg/vial

Hairy Cell Leukemia

4 mg/m2 IV (bolus or infusion) q2Weeks; optimal duration not determined  

Dosing considerations

  • Monitor: CBC, serum creatinine

Chronic lymphocytic leukemia (Off-label)

Previously treated: 4 mg/m2 IV q3wk; in combination with rituximab and cyclophosphamide, for 6 cycles

Previously untreated: 2 mg/m2 IV q3wk, in combination with rituximab and cyclophosphamide, for 6 cycles

Acute graft-versus-host disease (GVHD), steroid-refractory (Off-label)

1.5 mg/m2 IV days 1-3 and days 15-17 in combination with corticosteroids, initially

Steroid refractory disease: 1.5 mg/m2 IV qDay for 3 days; may repeat after 2 weeks if necessary

Orphan Indications

Peripheral T-cell lymphomas

Cutaneous T-Cell lymphoma

Chronic lymphocytic leukemia

Orphan indications sponsor

  • SuperGen, Inc; 4140 Dublin Blvd, Suite 200; Dublin, CA 94568

Safety & efficacy not established

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Interactions

Interaction Checker

and pentostatin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • fludarabine

              fludarabine, pentostatin. Either increases toxicity of the other by unknown mechanism. Contraindicated. Risk of pulmonary toxicity.

            Serious - Use Alternative (7)

            • adenovirus types 4 and 7 live, oral

              pentostatin decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. 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 3mo after cessation of immunosuppressive therapy.

            • deferiprone

              deferiprone, pentostatin. 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.

            • influenza virus vaccine quadrivalent, adjuvanted

              pentostatin decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

            • influenza virus vaccine trivalent, adjuvanted

              pentostatin decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

            • palifermin

              palifermin increases toxicity of pentostatin 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.

            • pegademase

              pentostatin decreases effects of pegademase by Other (see comment). Avoid or Use Alternate Drug. Comment: Pentostatin is a potent inhibitor of adenosine deaminase (pegademase).

            • tofacitinib

              pentostatin, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            Monitor Closely (18)

            • acalabrutinib

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

            • belatacept

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

            • betrixaban

              pentostatin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • cholera vaccine

              pentostatin 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.

            • dengue vaccine

              pentostatin 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

              pentostatin, 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.

            • fingolimod

              pentostatin increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

            • hydroxyurea

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

            • influenza A (H5N1) vaccine

              pentostatin decreases effects of influenza A (H5N1) vaccine by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

            • influenza virus vaccine (H5N1), adjuvanted

              pentostatin decreases effects of influenza virus vaccine (H5N1), adjuvanted by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

            • meningococcal group B vaccine

              pentostatin decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

            • ofatumumab SC

              ofatumumab SC, pentostatin. 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.

            • olaparib

              pentostatin and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

            • siponimod

              siponimod and pentostatin 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

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

            • tobramycin inhaled

              tobramycin inhaled and pentostatin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • trastuzumab

              trastuzumab, pentostatin. 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, pentostatin. 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.

            Minor (4)

            • maitake

              maitake increases effects of pentostatin by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

            • taurine

              pentostatin decreases levels of taurine by unspecified interaction mechanism. Minor/Significance Unknown.

            • vitamin A

              vitamin A, pentostatin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin A enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

            • vitamin E

              vitamin E, pentostatin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin E enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

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            Adverse Effects

            >10%

            Nausea/vomiting (63%)

            Fever (46%)

            Rash (43%)

            Fatigue (42%)

            Leukopenia (22%)

            Pruritus (21%)

            Cough (20%)

            Chills (19%)

            Myalgia (19%)

            Diarrhea (17%)

            Headache (17%)

            Abdominal pain (16%)

            Anorexia (13%)

            Upper respiratory infection (13%)

            Asthenia (12%)

            Stomatitis (12%)

            Dyspnea (11%)

            Rhinitis (11%)

            Immune hypersensitivity reaction (2-11% )

            Neurotoxicity (1-11% )

            1-10%

            Hyponatremia (<3% )

            Renal failure (<3% )

            Pain

            Pharyngitis

            Thrombocytopenia

            Anemia

            Arthralgia

            Elevated LFT's

            Hypersensitivity

            Skin disorders

            Sweating

            Viral infections

            Frequency Not Defined

            Microangiopathic hemolytic anemia

            Thrombotic thrombocytopenic purpura

            Febrile neutropenia

            Hemolytic uremic syndrome

            Thrombotic thrombocytopenic purpura

            Autoimmune thrombocytopenia

            Acute respiratory failure

            Exfoliative dermatitis

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            Warnings

            Black Box Warnings

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications

            Do not exceed recommended doses. Nephrotoxicity, hepatotoxicity, CNS, and pulmonary toxicity occurred in phase 1 studies that used higher doses than recommended

            Do not use with concurrent fludarabine because of increased risk of pulmonary toxicity

            Contraindications

            Hypersensitivity

            Concomitant fludarabine: risk of fatal pulmonary toxicity

            Relative: active infections

            Cautions

            Epilepsy, liver dz, bone marrow depression

            Weigh risk/benefit for pts w/ infections

            Withhold if elevated SCr, renal dysfunction

            Withhold or discontinue if evidence of CNS toxicity

            Avoid pregnancy

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            Pregnancy & Lactation

            Pregnancy Category: D

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

            Pregnancy Categories

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

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

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

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

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

            NA: Information not available.

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            Pharmacology

            Half-Life: 5.7 hr

            Peak Plasma: 3.2-9.7 ng/mL

            Protein Bound: 4%

            Vd: 42 L

            Clearance: 68 mL/min/sq.meter

            Excretion: urine (30-90%)

            Mechanism of Action

            Inhibits adenosine deaminase -> incr dATP -> inhibits ribonucleotide reductase -> blocks DNA synthesis

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            Administration

            IV Compatibilities

            Solution: D5W, NS, LR

            Y-site: fludarabine, melphalan, ondansetron, paclitaxel, sargramostim

            IV Preparation

            Reconstitute 10 mg in 5 mL SWI for a final concentration 2 mg/mL

            May be given by bolus or diluted to 25-50 mL with D5W to reach a final concentration of 0.33-0.16 mg/mL

            IV Administration

            Give 500-1000 mL of D5/½NS before infusion & 500 mL postinfusion

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Nipent intravenous
            -
            10 mg vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            pentostatin intravenous

            PENTOSTATIN - INJECTION

            (PEN-toe-STAT-in)

            COMMON BRAND NAME(S): Nipent

            USES: Pentostatin is used to treat a certain type of cancer (hairy cell leukemia). It works by slowing or stopping the growth of cancer cells.

            HOW TO USE: This medication is given by injection into a vein by a health care professional, usually every other week or as directed by your doctor. Dosage is based on your medical condition, body size, and response to treatment.To help reduce side effects to the kidneys, your doctor may prescribe IV fluids before and after you receive pentostatin.

            SIDE EFFECTS: Mild rash/itching may occur. Tell your doctor or pharmacist promptly if any of these effects occur. Nausea, vomiting, diarrhea, loss of appetite, increased sweating, or mouth sores may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.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: signs of kidney problems (such as change in the amount of urine), dark urine, yellowing eyes/skin, severe stomach/abdominal pain, dizziness, drowsiness, headache, trouble sleeping, shortness of breath, cough, unusual weakness/tiredness, swelling ankles/feet, muscle/joint pain, muscle spasm, mental/mood changes (e.g., depression, anxiety), numbness/tingling of the skin, decreased sexual ability/interest, fainting, fast/slow/irregular heartbeat, vision/hearing changes, pain/redness/swelling of arms or legs.Get medical help right away if any of these rare but very serious side effects occur: seizures, chest pain.This medication may cause very serious blood disorders (decreased bone marrow function leading to low number of blood cells such as red cells, white cells, and platelets). This effect can cause anemia, decrease your body's ability to fight an infection, or cause your body to bruise or bleed more easily. Tell your doctor right away if you develop any of the following symptoms: signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, unusual tiredness, fast/pounding heartbeat.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, including: 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 using pentostatin, 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: kidney disease, liver disease, recent/current infections, blood/bone marrow disorder.Before having surgery, tell your doctor or dentist that you are using this medication.Do not have immunizations/vaccinations without the consent of your doctor, and avoid contact with people who have recently received oral polio vaccine or flu vaccine inhaled through the nose.Wash your hands well to prevent the spread of infections.To lower your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.This medication is not recommended for use during pregnancy. It may harm an unborn baby. It is important to prevent pregnancy while using this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control (e.g., condoms, birth control pills) while using this medication. If you become pregnant or think you may be pregnant, tell your doctor right away.It is not known whether 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: 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 include: allopurinol, drugs that may decrease bone marrow function (e.g., azathioprine), drugs that may weaken the immune system (e.g., cyclosporine), fludarabine, vidarabine.

            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. Symptoms of overdose may include: trouble breathing, seizures, fainting, change in the amount of urine, severe stomach/abdominal pain.

            NOTES: Laboratory and/or medical tests (e.g., blood count, kidney/liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

            STORAGE: Not applicable. This medication is given in a clinic and will not be stored at home.

            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

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

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            NC NOT COVERED – Drugs that are not covered by the plan.
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            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
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