Pentostatin Side Effects

Brand Names: Nipent

Please note - some side effects for Pentostatin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Pentostatin - for the Consumer

Pentostatin

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Pentostatin:

Diarrhea; fatigue; headache; loss of appetite; muscle pain; nausea; vomiting; weakness.

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chills; cough; eye pain or changes in vision; fever; hoarseness; itching; pain, redness, or swelling at the injection site; sore throat; sores on the mouth or lips; unusual bruising or bleeding; unusual tiredness or weakness

Pentostatin Side Effects - for the Professional

Pentostatin

Most patients treated for hairy cell leukemia in the five NCI-sponsored Phase 2 studies and the Phase 3 SWOG study experienced an adverse event. The following table lists the most frequently occurring adverse events in patients treated with Pentostatin (both frontline and IFN-refractory patients) compared with IFN (frontline only), regardless of drug association. The drug association of some adverse events is uncertain as they may be associated with the disease itself (e.g., infection, hematologic suppression), but other events, such as the gastrointestinal symptoms, rashes, and abnormal liver function tests, can in many cases be attributed to the drug. Most adverse events that were assessed for severity were either mild or moderate, and diminished in frequency with continued therapy.

NR = Not Reported

aOccurring in more than 10% of patients, in any group, regardless of drug association

bIncludes only nausea with vomiting

cThese figures represent only unspecified infections. Refer to infection table.

dElevated liver enzymes and liver disorder for SWOG

The total incidence for all types of infections is considerably higher for both treatment groups in the SWOG 8691 study than is listed in the table above. An intent-to-treat analysis of infections found that 38% of patients treated with Pentostatin and 34% of patients treated with IFN averaged 2.4 and 1.9 documented infections during treatment, respectively. The following table lists the different types of infections that were reported as adverse events during the initial phase of the SWOG study. There were no apparent differences in the types of infection between the 2 treatment groups, with the possible exception of herpes zoster which was reported more frequently for Pentostatin (8%) than for IFN (1%).

The drug relatedness of the adverse events listed below cannot be excluded. The following adverse events occurred in 3% to 10% of Pentostatin-treated patients in the initial phase of the SWOG study:

Body as a Whole—Chest Pain, Death, Face Edema, Peripheral Edema

Cardiovascular System—Hemorrhage, Hypotension

Digestive System—Dental Abnormalities, Dyspepsia, Flatulence, Gingivitis

Hemic and Lymphatic System—Agranulocytosis

Laboratory Deviations—Elevated Creatinine

Musculoskeletal System—Arthralgia

Nervous System—Confusion, Dizziness, Insomnia, Paresthesia, Somnolence

Psychobiologic Function—Anxiety, Depression, Nervousness

Respiratory System—Asthma

Skin and Appendages—Skin Dry, Urticaria

The remaining adverse events which occurred in less than 3% of Pentostatin-treated patients during the initial phase of the SWOG study:

Body as a Whole—Flu-like Symptoms, Hangover Effect, Neoplasm

Cardiovascular System—Angina Pectoris, Arrhythmia, A-V Block, Bradycardia, Extrasystoles Ventricular, Heart Arrest, Heart Failure, Hypertension, Pericardial Effusion, Phlebitis, Pulmonary Embolus, Sinus Arrest, Tachycardia, Thrombophlebitis Deep, Vasculitis

Digestive System—Constipation, Dysphagia, Glossilis, Ileus

Hemic and Lymphatic System—Acute Leukemia, Anemia-Hemolytic, Aplastic Anemia

Laboratory Deviations—Hypercalcemia, Hyponatremia

Musculoskeletal System—Arthritis, Gout

Nervous System—Amnesia, Ataxia, Convulsions, Dreaming Abnormal, Dysarthria, Encephalitis, Hyperkinesia, Meningism, Neuralgia, Neuritis, Neuropathy, Paralysis, Syncope, Twitching, Vertigo

Psychobiologic Function—Decrease/Loss Libido, Emotional Lability, Hallucination, Hostility, Neurosis, Thinking Abnormal

Respiratory System—Bronchospasm, Larynx Edema

Skin and Appendages—Acne, Alopecia, Eczema, Petechial Rash, Photosensitivity Reaction

Special Senses—Amblyopia, Deafness, Earache, Eyes Dry, Labyrinthitis, Lacrimation Disorder, Nonreactive Eye, Photophobia, Retinopathy, Tinnitus, Unusual Taste, Vision Abnormal, Watery Eyes

Urogenital System—Amenorrhea, Breast Lump, Impotence, Kidney Function Abnormal, Nephropathy, Renal Failure, Renal Insufficiency, Renal Stone

One patient with hairy cell leukemia treated with Pentostatin during another clinical study developed unilateral uveitis with vision loss.

Nineteen (5%) patients withdrew from the Phase 3 SWOG 8691 study because of adverse events, 9 during initial Pentostatin treatment, 4 during Pentostatin crossover, 5 during initial IFN treatment, and 1 during both initial IFN treatment and Pentostatin crossover. In the Phase 2 studies in IFN-refractory hairy cell leukemia, 11% of patients withdrew from treatment with Pentostatin due to an adverse event.

Side Effects by Body System

Hematologic

One study reported life-threatening neutropenia in 35 of 50 patients.

Hematologic side effects including leukopenia (60%), anemia, (35%), and thrombocytopenia (32%) have been reported. Ecchymosis, lymphadenopathy, and petechiae have been reported in 3% to 10% of patients. Abnormal erythrocytes, leukocytosis, pancytopenia, purpura, splenomegaly, eosinophilia, hematologic disorders, hemolysis, lymphoma-like reactions, and thrombocythemia have been reported in less than 3% of patients.

Gastrointestinal

Gastrointestinal side effects including nausea with vomiting (50% to 53%), nausea (22%), anorexia (16%), diarrhea (15%), and vomiting (9%) have been reported. Constipation, flatulence, and stomatitis have also been reported in 3% to 10% of patients. Colitis, dysphagia, eructation, gastritis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, hepatomegaly, intestinal obstruction, jaundice, leukoplakia, melena, periodontal abscess, proctitis, abnormal stools, dyspepsia, esophagitis, gingivitis, hepatic failure, and mouth disorders have been reported in less than 3% of patients.

General

General side effects including fever (42%), infection (36%), fatigue (29%), pain (20%), increased cough (17%), headache (13%), myalgia (11%), chills (11%), asthenia (10%), sweating (10%), and malaise (9%) have been reported. Death, sepsis, chest pain, abdominal pain, back pain, flu syndrome, and neoplasm have been reported in 3% to 10% of patients. Abscess, enlarged abdomen, ascites, cellulitis, cyst, face edema, fibrosis, granuloma, hernia, injection-site hemorrhage, injection-site inflammation, moniliasis, neck rigidity, pelvic pain, photosensitivity reaction, anaphylactic reaction, immune system disorder, mucous membrane disorder, and neck pain have been reported in less than 3% of patients.

According to the manufacturer, 11% of patients were withdrawn from treatment due to adverse events which primarily included hematologic toxicity, infection, and rash or pruritus.

Dermatologic

Dermatologic side effects including rash (26%) and skin disorder (17%) have been reported. Eczema, dry skin, herpes simplex, herpes zoster, macropapular rash, pruritus, seborrhea, skin discoloration, sweating, and vesiculobullous rash have been reported in 3% to 10% of patients. Acne, alopecia, contact dermatitis, exfoliative dermatitis, fungal dermatitis, psoriasis, benign skin neoplasm, subcutaneous nodule, skin hypertrophy, and urticaria have been reported in less than 3% of patients.

Hepatic

One study reported severe liver toxicity in two of 50 patients.

Hepatic side effects including hepatic disorders and/or elevated LFTs (19%) have been reported.

Genitourinary

Genitourinary side effects (15%) have been reported. Hematuria and dysuria, increased BUN, and increased creatinine have been reported in 3% to 10% of patients. Albuminuria, fibrocystic breast, glycosuria, gynecomastia, hydronephrosis, kidney failure, oliguria, polyuria, pyuria, toxic nephropathy, urinary frequency, urinary retention, urinary tract infection, urinary urgency, impaired urination, urolithiasis, and vaginitis have been reported in less than 3% of patients.

Respiratory

Respiratory side effects including upper respiratory infection (16%) and lung disorders (12%) have been reported. Pharyngitis, pneumonia, rhinitis, bronchitis, dyspnea, epistaxis, lung edema, and sinusitis have been reported in 3% to 10% of patients. Asthma, atelectasis, hemoptysis, hyperventilation, hypoventilation, laryngitis, larynx edema, lung fibrosis, pleural effusion, pneumothorax, pulmonary embolus, and increased sputum have been reported in less than 3% of patients.

Nervous system

Nervous system side effects (11%) have been reported. Death following the onset of progressive neuropathy has been reported in one patient. Anxiety, confusion, depression, dizziness, insomnia, nervousness, paresthesia, somnolence, and abnormal thinking have also been reported in 3% to 10% of patients. Agitation, amnesia, apathy, ataxia, central nervous system depression, coma, convulsions, abnormal dreams, depersonalization, emotional lability, facial paralysis, abnormal gait, hyperesthesia, hypoesthesia, hypertonia, incoordination, decreased libido, neuropathy, postural dizziness, decreased reflexes, stupor, tremor, and vertigo have been reported in less than 3% of patients.

Cardiovascular

During a 4 year period including over 1,100 patients, eleven patients had significant cardiac events as their major toxicity. The events recorded could be grouped into three categories: 1) angina and myocardial infarction, 2) congestive heart failure and 3) acute arrhythmias. All eleven patients were over 59 years of age. Ten of the eleven patients were males.

Cardiovascular side effects including arrhythmia, abnormal electrocardiogram, thrombophlebitis, and hemorrhage have been reported in 3% to 10% of patients. Aortic stenosis, arterial anomaly, cardiomegaly, congestive heart failure, flushing, cardiac arrest, hypertension, myocardial infarct, palpitation, shock, and varicose veins have been reported in less than 3% of patients.

Hypersensitivity

Hypersensitivity side effects including allergic reactions (11%) have been reported.

Ocular

Ocular side effects including abnormal vision, conjunctivitis and eye pain have been reported in 3% to 10% of patients. Blepharitis, cataract, diplopia, exophthalmos, lacrimation disorder, optic neuritis and retinal detachment have been reported in less than 3% of patients. One patient developed unilateral uveitis with loss of vision.

One study reported keratoconjunctivitis in four of 50 patients.

Musculoskeletal

Musculoskeletal side effects including arthralgia have been reported. Arthritis, bone pain, osteomyelitis, and pathological fractures have been reported in less than 3% of patients.

Other

Other side effects including ear pain have been reported. Peripheral edema, weight loss, and increased lactate dehydrogenase (LDH) have been reported in 3% to 10% of patients. Deafness, otitis media parosmia, taste perversion, tinnitus, acidosis, increased creatine phosphokinase, dehydration, diabetes mellitus, increased gamma globulins, gout, abnormal healing, hypercholesterolemia, weight gain, and hyponatremia have been reported in less than 3% of patients.

Metabolic

Metabolic side effects including a case of possible pentostatin-induced symptomatic hyponatremia have been reported.

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