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Plicamycin Side Effects

Medically reviewed by Last updated on May 13, 2022.

Applies to plicamycin: intravenous powder for injection


Hematologic effects including a bleeding syndrome which usually begins with an episode of epistaxis, comprise the major form of toxicity associated with the use of plicamycin. Thrombocytopenia which is sometime rapid in onset, may occur at any time during therapy or within several days following the last dose. Depression of platelet count, white count, hemoglobin, and prothrombin time, elevation of clotting and bleeding times, and abnormal clot retraction have been reported. Leukopenia (6%) has been reported. Depression in levels of serum calcium, phosphorus, and potassium have also been reported.[Ref]

The hemorrhagic syndrome may start with an episode of hematemesis which may progress to more widespread hemorrhage in the gastrointestinal tract or to a more generalized bleeding tendency. This may be due to abnormalities in multiple clotting factors. The hemorrhagic syndrome has been dose related.

If severe thrombocytopenia occurs, infusion of platelet concentrates of platelet-rich plasma may of help in elevating the platelet count.

Laboratory abnormalities have generally been upon discontinuation of therapy.[Ref]


Gastrointestinal effects including anorexia, nausea, vomiting, diarrhea, and stomatitis are among the most common effects reported with the use of plicamycin.[Ref]


General effects including fever, weakness, lethargy, malaise, and drowsiness have been reported.[Ref]

Nervous system

Nervous system effects including headache have been reported.[Ref]


Psychiatric effects including depression have been reported.[Ref]


Cardiovascular effects including phlebitis have been reported. A case has also been reported of multiple arterial occlusive episodes in association the courses of drug therapy.[Ref]


Dermatologic effects including facial flushing an skin rash have been reported. A case of toxic epidermal necrolysis have also been reported.[Ref]


Hepatic effects including increased levels of serum glutamic oxalacetic transaminase, serum glutamic pyruvic transaminase, lactic dehydrogenase, alkaline phosphatase, serum bilirubin, ornithine carbamyl transferase, isocitric dehydrogenase, an increased retention of bromsulphalein have been reported.[Ref]

Laboratory abnormalities have generally been reported to be reversible upon discontinuation of therapy.[Ref]


Genitourinary effects including increased blood urea nitrogen, increased serum creatinine, and proteinuria have been reported.[Ref]

Laboratory abnormalities have generally been reported to be reversible upon discontinuation of therapy.[Ref]


1. "Product Information. Mithracin (plicamycin)." Bayer (2001):

2. Yamreudeewong W, Henann NE, Fazio A, Rangaraj U "Possible severe thrombocytopenia associated with a single dose of plicamycin." Ann Pharmacother 26 (1992): 1369-73

3. Ahr DJ, Scialla SJ, Kimbali DB Jr "Acquired platelet dysfunction following mithramycin therapy." Cancer 41 (1978): 448-54

4. Margileth DA, Smith FE, Lane M "Sudden arterial occlusion associated with mithramycin therapy." Cancer 31 (1973): 708-12

5. Purpora D, Ahern MJ, Silverman N "Toxic epidermal necrolysis after mithramycin [letter]." N Engl J Med 299 (1978): 1412

Further information

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Some side effects may not be reported. You may report them to the FDA.