Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 1g/vial
Metastatic Islet Cell Cancer of Pancreas
Single agent therapy
- 1000 mg/m² IV qWeek, may increase to no more than 1500 mg/m²
- Risk of azotemia increase with >1500 mg/m²
- Monitor: CBC, LFTs, renal function
Combination therapy
- 500 mg/m²/day IV for 5 days q4-6Weeks
- Monitor: CBC, LFTs, renal function
Renal Impairment
CrCl >50 mL/min: May administer full dose
CrCl: 10-50 mL/min: 75% of regular dose
CrCl: <10 mL/min: 50% of regular dose
Other Indications & Uses
Metastatic islet cell cancer of pancreas
Off-label: carcinoid syndrome
Not recommended
Metastatic islet cell cancer of pancreas
Single agent therapy
1000 mg/m² IV qWeek, may increase to no more than 1500 mg/m²
Risk of azotemia increase with >1500 mg/m²
Monitor: CBC, LFTs, renal function
Combination therapy
500 mg/m²/day IV for 5 days q4-6Weeks
Risk of azotemia increase with >1500 mg/m²
Monitor: CBC, LFTs, renal function
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- amphotericin B deoxycholate
amphotericin B deoxycholate and streptozocin both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- tenofovir DF
streptozocin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Contraindicated. Streptozocin should not be used in combination with or concomitantly with other potential nephrotoxins.
Serious - Use Alternative (12)
- axicabtagene ciloleucel
streptozocin, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- brexucabtagene autoleucel
streptozocin, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- cidofovir
cidofovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.
- ciltacabtagene autoleucel
streptozocin, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- deferiprone
deferiprone, streptozocin. 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.
- idecabtagene vicleucel
streptozocin, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ioversol
ioversol and streptozocin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- lisocabtagene maraleucel
streptozocin, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- palifermin
palifermin increases toxicity of streptozocin 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.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, streptozocin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- tisagenlecleucel
streptozocin, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tofacitinib
streptozocin, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
Monitor Closely (44)
- acalabrutinib
acalabrutinib, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.
- acyclovir
acyclovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- adefovir
adefovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amikacin
amikacin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- bendamustine
bendamustine, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- busulfan
busulfan, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- capreomycin
capreomycin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- carboplatin
carboplatin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
carboplatin, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression. - carmustine
carmustine, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- chlorambucil
chlorambucil, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- cholera vaccine
streptozocin 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.
- cisplatin
cisplatin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
cisplatin, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression. - colistin
colistin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cyclophosphamide
cyclophosphamide, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- cyclosporine
cyclosporine and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- dacarbazine
dacarbazine, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- dengue vaccine
streptozocin 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.
- doxorubicin
streptozocin increases levels of doxorubicin by decreasing metabolism. Use Caution/Monitor.
- doxorubicin liposomal
streptozocin increases levels of doxorubicin liposomal by decreasing metabolism. Use Caution/Monitor.
- fingolimod
streptozocin 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. .
- foscarnet
foscarnet and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- gentamicin
gentamicin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ifosfamide
ifosfamide, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- influenza A (H5N1) vaccine
streptozocin decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.
- influenza virus vaccine (H5N1), adjuvanted
streptozocin decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.
- isavuconazonium sulfate
streptozocin and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.
- lomustine
lomustine, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- methotrexate
methotrexate and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- neomycin PO
neomycin PO and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ofatumumab SC
ofatumumab SC, streptozocin. 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.
- oxaliplatin
oxaliplatin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
oxaliplatin, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression. - paromomycin
paromomycin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- pentamidine
pentamidine and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- polymyxin B
polymyxin B and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- siponimod
siponimod and streptozocin 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
streptozocin decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.
- streptomycin
streptomycin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
streptozocin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- thiotepa
streptozocin, thiotepa. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.
- tobramycin
streptozocin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- trastuzumab
trastuzumab, streptozocin. 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, streptozocin. 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.
- vancomycin
streptozocin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- voclosporin
voclosporin, streptozocin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (2)
- vitamin A
vitamin A, streptozocin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin A enhance the efficacy, and reduce toxicity, of antineoplastic drugs.
- vitamin E
vitamin E, streptozocin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin E enhance the efficacy, and reduce toxicity, of antineoplastic drugs.
Adverse Effects
>10%
Nephrotoxicity (up to 75%)
Vomiting (up to 90% if no antiemetic)
Metabolic changes, including elevated LFTs, increased LDH (25%)
Hypoglycemia (20%)
Myelosuppression (10-20%)
Frequency Not Defined
Confusion Lethargy Depression
Nausea
Fever
Chills
Hematologic toxicity (fatal reported)
Injection site reactions
Decreased liver function
Jaundice
Nail changes
Nephrogenic diabetes insipidus (rare)
Warnings
Black Box Warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to monitor drug tolerance and to protect and maintain a patient compromised by drug toxicity
Renal toxicity is dose-related and cumulative and may be severe or fatal
Nausea and vomiting may be severe and treatment limiting at times
Liver dysfunction, diarrhea, and hematologic changes reported
Parenteral streptozocin is mutagenic and found to be tumorigenic in some rodents
The physician must weigh risks versus benefits to the patient
Contraindications
Hypersensitivity; pregnancy
Cautions
Risk of severe nephrotoxicity, dose-related & cumulative (ie, >1500 mg/m²/dose may cause azotemia)
Risk of severe nausea/vomiting
Rapid infusion may cause burning sensation
May alter glucose metabolism in some patients
Avoid pregnancy
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.Pharmacology
Mechanism of Action
Nitrosurea agent that contains a glucose moiety and interferes with DNA function; alkylates DNA, crosslinks DNA strands, may modify proteins and inhibit enzymes involved in DNA synthesis.
Pharmacokinetics
Half-Life: 35-40 min
Bioavailability: 17-25%
Onset: 17 days (with dose schedule of 1500 mg/m²)
Peak Response: 35 days (with dose schedule of 1500 mg/m²)
Vd: 43.8 L
Metabolism: Liver
Clearance: 478 mcg/min (range 173-718 mcg/min)
Excretion: Urine (60-70%)
Administration
IV Incompatibilities
Y-site: allopurinol, aztreonam, cefepime, piperacillin/tazobactam
IV Compatibilities
Solution: D5W, NS
Y-site: amifostine, etoposide PO4, filgrastim, gemcitabine, granisetron, melphalan, ondansetron, teniposide, thiotepa, vinorelbine
IV Preparation
Reconstitute in 9.5 mL D5W or NS to obtain a 100 mg/mL pale gold solution
Stable for 48 hr at room temp and 96 hr under refrigeration, BUT manufacturer recommends use within 12 hr because no preservatives
IV Administration
Vesicant
IV infusion in >100 mL D5W or NS over 15 min-6 hr
Continuous infusion over 5 days have been given, but may be associated with increased CNS toxicity
Storage
Refrigerate vials
Protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Zanosar intravenous - | 1 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
streptozocin intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your 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: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
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: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.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 for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2022 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.
Formulary
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