Talc

Pronunciation: (TALK)
Class: Antineoplastic agent

Trade Names

Sclerosol
- Aerosol 4 g talc

Sterile Talc Powder
- Powder 5 g talc

Pharmacology

Induces an inflammatory reaction, which promotes adherence of the visceral and parietal pleura, obliterating the pleural space and preventing reaccumulation of pleural fluid.

Indications and Usage

Decrease or prevent recurrence of malignant pleural effusions.

Contraindications

Standard considerations.

Dosage and Administration

Adults

Intrapleural Powder 5 g dissolved in 50 to 100 mL sodium chloride injection is recommended. Intrapleural Aerosol Single 4 to 8 g dose delivered from spray canister (1 to 2 cans), which delivers talc at a rate of 0.4 g/sec.

General Advice

• Aerosol
• Insert delivery tube through pleural trocar, taking care not to place distal end of delivery tube adjacent to the lung parenchyma or directly against chest wall. Hold delivery tube and pleural trocar together in 1 hand and gently apply pressure to actuator button on the canister. Aerosol is not delivered by metered dose but depends on the extent and duration of manual compression of the actuator button on the canister. Point the distal end of the delivery tube in several different directions while administering short bursts in order to distribute talc powder equally and extensively on all visceral and parietal pleural surfaces. Discard canister and delivery tube after application is complete.
• Keep canister in upright position during talc instillation to ensure optimal distribution of talc powder.

• Powder
• Prepare talc slurry by adding 50 mL sodium chloride injection to talc bottle following manufacturer's instructions. Divide the content of the talc bottle into two 60 mL irrigation syringes by withdrawing 25 mL of the slurry into each syringe while swirling the bottle to prevent the talc from settling. Add sufficient quantity of sodium chloride injection to each syringe so that total volume is 50 mL. Draw air into each syringe to the 60 mL mark to provide a headspace for mixing prior to administration.
• Use slurry within 12 h or discard and prepare a fresh slurry.

Storage/Stability

Store aerosol at controlled room temperature (59° to 86°F). Avoid freezing. Protect against sunlight. Do not expose to temperature greater than 120°F or canister may rupture. Contents under pressure. Do not puncture or incinerate canister. Store powder at controlled room temperature (64° to 77°F). Protect against sunlight.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; MI; hypotension; hypovolemia; asystolic arrest.

Respiratory

Hypoxemia; dyspnea; unilateral pulmonary edema; pneumonia; acute respiratory distress syndrome; bronchopleural fistula; hemoptysis; pulmonary emboli.

Miscellaneous

Fever; empyema; pain; infection at site of thoracostomy or thoracoscopy; localized bleeding; subcutaneous emphysema.

Precautions

Pregnancy

Category B .

Children

Safety and efficacy not established.

Curable diseases

Because talc has no antineoplastic activity, it should not be used alone for potentially curable malignancies where systemic therapy is appropriate.

Future procedures

Sclerosis of the pleural space may preclude subsequent diagnostic procedures of the pleura on the treated side.

Pulmonary complications

Acute pneumonitis and acute respiratory distress syndrome may occur.

Patient Information

• Advise patient that medication will be prepared and administered by a health care provider in a medical setting.

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