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arsenic trioxide

Generic Name: arsenic trioxide (AR sen ik trye OX ide)
Brand Name: Trisenox

What is arsenic trioxide?

Arsenic trioxide is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Arsenic trioxide is used to treat a cancer of the blood and bone marrow called acute promyelocytic (pro-MYE-loe-SIT-ik) leukemia, or APL.

Arsenic trioxide may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about arsenic trioxide?

Arsenic trioxide can cause a serious and sometimes fatal complication by changing the way your immune system works. Call your doctor at once if you have any signs of this condition, including fever, swelling, weight gain, pain when you breathe, rapid heart rate, feeling short of breath, or feeling like you might pass out.

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Arsenic trioxide can also have harmful effects on your heart rhythm. This effect is increased when you also use certain other drugs. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with arsenic trioxide.

Get emergency medical help if you have a headache with chest pain and severe dizziness, and fast or pounding heartbeats.

What should I discuss with my healthcare provider before taking arsenic trioxide?

You should not use arsenic trioxide if you are allergic to it.

To make sure arsenic trioxide is safe for you, tell your doctor if you have:

  • a history of heart disease;

  • a heart rhythm disorder or history of Long QT syndrome;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • kidney disease; or

  • liver disease.

FDA pregnancy category D. Do not use arsenic trioxide if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Arsenic trioxide can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How is arsenic trioxide given?

Arsenic trioxide is injected into a vein through an IV. A healthcare provider will give you this injection.

While using arsenic trioxide, you may need frequent blood tests at your doctor's office. Your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG).

You must remain under the care of a doctor while you are using arsenic trioxide. Do not miss any follow-up appointments.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your arsenic trioxide injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving arsenic trioxide?

This medicine can pass into body fluids (including urine, feces, vomit, semen, vaginal fluid). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Patients and caregivers should wear rubber gloves while cleaning up body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Body fluids should not be handled by a woman who is pregnant or who may become pregnant. Use condoms during sexual activity to avoid exposure to body fluids.

Arsenic trioxide side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Arsenic trioxide can cause a serious and sometimes fatal complication by changing the way your immune system works. Call your doctor at once if you have any signs of this condition, including:

  • fever, weight gain, feeling weak or tired;

  • swelling in your ankles or feet;

  • cough, pain when you breathe, rapid heart rate, feeling short of breath; or

  • feeling like you might pass out.

Also call your doctor right away if you have:

  • pale skin, easy bruising or bleeding;

  • cough, sore throat;

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss).

Common side effects may include:

  • stomach pain, nausea, vomiting;

  • constipation, diarrhea;

  • headache, dizziness, anxiety, numbness or tingly feeling;

  • joint or muscle pain, tired feeling, trouble sleeping; or

  • mild itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Arsenic trioxide dosing 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.

What other drugs will affect arsenic trioxide?

Arsenic trioxide can have harmful effects on your heart rhythm. This effect is increased when you also use certain other drugs. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with arsenic trioxide, especially:

  • amphotericin B;

  • methadone;

  • tacrolimus;

  • vandetanib;

  • an antibiotic--azithromycin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine;

  • an antidepressant--amitriptyline, citalopram, clomipramine, desipramine;

  • anti-malaria medication--chloroquine, halofantrine, mefloquine;

  • a diuretic or "water pill";

  • heart rhythm medicine--amiodarone, dofetilide, disopyramide, dronedarone, flecainide, ibutilide, procainamide, propafenone, quinidine, sotalol;

  • medicine to prevent or treat nausea and vomiting--dolasetron, droperidol, ondansetron;

  • medicine to treat a psychiatric disorder--chlorpromazine, clozapine, haloperidol, mesoridazine, pimozide, thioridazine, ziprasidone; or

  • migraine headache medicine--sumatriptan, zolmitriptan.

This list is not complete. Other drugs may interact with arsenic trioxide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about arsenic trioxide.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.02. Revision Date: 2013-07-01, 11:12:26 AM.

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