Drug reference

Procarbazine

MAO Inhibitor · Antineoplastic

Also known as Procarbazine hydrochloride

MAO InhibitorAntineoplasticATC null

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Avoid. Procarbazine is teratogenic in animal studies and isolated reports in humans. Most cytotoxic drugs are teratogenic and should not be administered during pregnancy, especially during the first trimester. Pregnancy should be excluded before treatment, and effective contraception is required during and after treatment.

FDA category + note

Top interactionssee all 12 →

SympathomimeticsContraindicatedTextbookG&G 14e
Tyramine Containing FoodsContraindicatedTextbookG&G 14e
5ht Reuptake Inhibiting AntidepressantsSevereTextbookG&G 14e
AlbuterolSevereTextbookG&G 14e · p264

Mechanism

Procarbazine is classified as a mild monoamine-oxidase inhibitor. While its direct antineoplastic mechanism is not explicitly detailed in the provided text, this pharmacological action is noted.

Indications

Hodgkin's lymphomamalignant brain tumorsHodgkin disease (in combination regimens like MOPP)gliomas (as part of the PVC regimen)Hodgkin’s lymphomaBrain tumours

Dosing

Adult: By mouth: consult local protocol. Refer to important safety information regarding risks of incorrect dosing of oral anti-cancer medicines.
Renal adjustment: Caution in mild to moderate impairment; avoid in severe impairment.
Hepatic adjustment: Caution in mild to moderate impairment; avoid in severe impairment.

Pharmacokinetics

Onset

not specified

Peak effect

not specified

Protein binding

not specified

Metabolism

extensively metabolized by CYPs to azo, methylazoxy, and benzylazoxy intermediates, which yield the alkylating metabolites in tumor cells

Contraindications

Pre-existing severe leucopenia
Pre-existing severe thrombocytopenia

Side effects

Common

Appetite decreasedleukopenia (most common, begins during second week, reverses within 2 weeks off treatment)thrombocytopenia (most common, begins during second week, reverses within 2 weeks off treatment)mild nauseavomitingdiarrhea (5-10% of cases)rash (5-10% of cases)behavioral disturbancesinfertility (particularly in males)SedationCNS effectsLeucopeniaThrombocytopeniaSterility in males

Serious

Azoospermia
Hepatic disorders
Infection
Lethargy
Leucopenia
Nausea
Neutropenia
Ovarian failure
Pneumonitis
Skin reactions
Thrombocytopenia
Vomiting
hypertension (may be provoked by monoamine oxidase inhibitor action with concurrent catecholamines, sympathomimetics, or dietary tyramine)
disulfiram-like actions (avoid alcohol)
highly carcinogenic
mutagenic
teratogenic
acute leukemia (5-10% risk with MOPP, highest with concurrent radiation therapy)
potent immunosuppressive agent
Mutagenic potential
Carcinogenic potential

Pregnancy & lactation

Pregnancy

Lactation

Discontinue breast-feeding.

Drug interactions

Sympathomimetics

Contraindicated

Textbook

Potentially life-threatening elevation of blood pressure (hypertensive crisis).

Avoid concurrent use of MAOIs and medications containing sympathomimetic compounds.

Source: G&G 14e

Tyramine Containing Foods

Contraindicated

Textbook

Marked increases in blood pressure (hypertensive crisis).

Patients on MAOIs must avoid foods containing high levels of tyramine, such as soy products, dried meats and sausages, dried fruits, home-brewed and tap beers, red wine, pickled or fermented foods, and aged cheeses.

Source: G&G 14e

5ht Reuptake Inhibiting Antidepressants

Severe

Textbook

Serotonin syndrome, characterized by hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, and agitation, which can progress to coma and death.

SSRIs should not be started until at least 14 days following discontinuation of treatment with an irreversible MAOI. For all SSRIs except fluoxetine, at least 14 days should pass prior to beginning treatment with an MAOI following the end of SSRI treatment. For fluoxetine, at least 5 weeks should pass. For venlafaxine, a 7-day interval is considered safe between ending MAOI therapy and starting venlafaxine. For duloxetine, a 5-day waiting period is needed before beginning MAOI treatment after ending duloxetine.

Source: G&G 14e

Albuterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Altretamine

Severe

Textbook

Severe, life-threatening orthostatic hypotension.

Not specified, but implies avoidance due to severe, life-threatening effect.