streptozocin (Rx)

Brand and Other Names:Zanosar
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Dosing & Uses

AdultPediatricGeriatric

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

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Interactions

Interaction Checker

and streptozocin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            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 (5)

            • 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.

            • 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.

            • ioversol

              ioversol and streptozocin both increase nephrotoxicity and/or ototoxicity. 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.

            • 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.

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            Adverse Effects

            >10%

            Nephrotoxicity (up to 75%)

            Vomiting (up to 90% if no antiemetic)

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

            Hypoglycemia (20%)

            Myelosuppression (10-20%)

            Frequency Not Defined

            Confusion Lethargy Depression

            Nausea

            Fever

            Chills

            Hematologic toxicity (fatal reported)

            Injection site reactions

            Decreased liver function

            Jaundice

            Nail changes

            Nephrogenic diabetes insipidus (rare)

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            Warnings

            Black Box Warnings

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

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

            Nausea and vomiting may be severe and treatment limiting at times

            Liver dysfunction, diarrhea, and hematologic changes reported

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

            The physician must weigh risks versus benefits to the patient

            Contraindications

            Hypersensitivity; pregnancy

            Cautions

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

            Risk of severe nausea/vomiting

            Rapid infusion may cause burning sensation

            May alter glucose metabolism in some patients

            Avoid pregnancy

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            Pregnancy & Lactation

            Pregnancy Category: D

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

            Pregnancy Categories

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

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

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

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

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

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

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

            Pharmacokinetics

            Half-Life: 35-40 min

            Bioavailability: 17-25%

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

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

            Vd: 43.8 L

            Metabolism: Liver

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

            Excretion: Urine (60-70%)

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            Administration

            IV Incompatibilities

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

            IV Compatibilities

            Solution: D5W, NS

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

            IV Preparation

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

            Stable for 48 hr at room temp 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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Zanosar intravenous
            -
            1 gram vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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) 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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            • 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.