Arsenic Trioxide Dosage
This dosage information may not include all the information needed to use Arsenic Trioxide safely and effectively. See additional information for Arsenic Trioxide.
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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Acute Promyelocytic Leukemia
Induction Treatment Schedule: 0.15 mg/kg intravenously daily until bone marrow remission. Total induction dose should not exceed 60 doses.
Arsenic trioxide should be administered intravenously over 1-2 hours. The infusion duration may be extended up to 4 hours if acute vasomotor reactions are observed. (A central venous catheter is not required.)
Consolidation Treatment Schedule: Consolidation treatment should begin 3 to 6 weeks after completion of induction therapy. Arsenic trioxide should be administered intravenously at a dose of 0.15 mg/kg daily for 25 doses over a period up to 5 weeks.
Renal Dose Adjustments
Exposure of arsenic trioxide may be higher in patients with severe renal impairment. Patients with severe renal impairment (creatinine clearance less than 30 mL/min) should be closely monitored for toxicity and dose reduction may be warranted.
Liver Dose Adjustments
Since limited data are available across all hepatic impairment groups, caution is advised in the use of arsenic trioxide in patients with hepatic impairment. Patients with severe hepatic impairment (Child-Pugh class C) should be closely monitored for toxicity.
Precautions
Prior to initiating therapy with arsenic trioxide, a 12 lead ECG should be performed and serum electrolytes (potassium, calcium, and magnesium) and creatinine should be assessed; preexisting electrolyte abnormalities should be corrected and, if possible, drugs that are known to prolong the QT interval should be discontinued. For QTc greater than 500 msec, corrective measures should be completed and the QTc reassessed with serial ECGs prior to considering using arsenic trioxide. During therapy with arsenic trioxide, potassium concentrations should be kept above 4 mEq/L and magnesium concentrations should be kept above 1.8 mg/dL. Patients who reach an absolute QT interval value > 500 msec should be reassessed and immediate action should be taken to correct concomitant risk factors, if any, while the risk/benefit of continuing versus suspending arsenic trioxide therapy should be considered. If syncope, rapid or irregular heartbeat develops, the patient should be hospitalized for monitoring, serum electrolytes should be assessed, arsenic trioxide therapy should be temporarily discontinued until the QTc interval regresses to below 460 msec, electrolyte abnormalities are corrected, and the syncope and irregular heartbeat cease. There are no data on the effect of arsenic trioxide on the QTc interval during the infusion.
Electrolyte, hematologic and coagulation profiles should be monitored at least twice weekly, and more frequently for clinically unstable patients during the induction phase and at least weekly during the consolidation phase. ECGs should be obtained weekly, and more frequently for clinically unstable patients, during induction and consolidation.
Dialysis
The use of arsenic trioxide in patients on dialysis has not been studied.
Other Comments
Arsenic trioxide should be diluted with 100 to 250 mL of 5% dextrose injection or 0.9% sodium chloride injection immediately after withdrawal from the ampule. Do not mix arsenic trioxide with other medications.
