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Amsacrine parenteral

Updated 2 Feb 2023 | Amsacrine


Infusions of amsacrine

Drugs List

  • amsacrine 75mg/1.5ml concentrate for solution for infusion
  • amsacrine 75mg/1.5ml concentrate+solvent for solution for infusion vial
  • AMSIDINE 75mg/1.5ml concentrate for solution for infusion
  • AMSIDINE 75mg/1.5ml concentrate+solvent for solution for infusion vial
  • Therapeutic Indications


    Leukaemia - acute

    For the induction and maintenance of remission in acute leukaemia of adults.

    Effective in patients refractory to anthracycline monotherapy or in combination, and in patients who were formerly treated with maximum cumulative doses of anthracyclines.



    Induction of remission phase:
    The recommended dose is 90 mg/square metre body surface area every day for 5 consecutive days (total dose 450 mg/square metre). The course may be extended for an additional 3 days if a bone marrow biopsy performed on day 6 displays over 50% cellularity and the blast count is over 30%.

    Subsequent courses are given at 2 to 4 week intervals depending on the effectiveness of first cycle at producing myelosuppression. If a hypocellular marrow has not been achieved after the first course, the daily dose may be increased to 120 mg/square metre, provided this is not contraindicated by non-myelosuppressive toxicity.

    Maintenance Phase:
    Maintenance dose is approximately one third of the total induction dose, (i.e. 150 mg/square metre) given either as a single intravenous infusion or divided (i.e. of 50 mg/square metre per day) over 3 consecutive days.
    This should be repeated every 3 to 4 weeks.

    Each maintenance course should bring the granulocyte count to 1,000 to 1,500 per microlitre and the platelet count to 50,000 to 100,000 per microlitre. If this is not achieved, the maintenance dose may be increased by 20% every second course. The granulocyte and platelet counts should be allowed to recover between the courses to over 1,500 per microlitre and 100,000 per microlitre respectively.

    The leucopenia nadir usually occurs after 5 to 12 days, with recovery usually following by the 25th day.

    Patients with Renal Impairment

    Decrease the dose by 20 to 30% (to 60 to 75 mg/square metre) in patients with GFR below 50 ml/minute.

    Patients with Hepatic Impairment

    Decrease the dose by 20 to 30% (to 60 to 75 mg/square metre) in patients with hepatic impairment.


    For intravenous infusion (after dilution)


    Children under 12 years
    Myelosuppression secondary to chemotherapy
    Myelosuppression secondary to radiotherapy

    Precautions and Warnings

    Cardiac disorder
    Hepatic impairment
    Renal impairment

    Reduce dose in patients with hepatic impairment
    Reduce dose in patients with renal impairment
    Consider premedication with hypouricaemic agent
    Treatment to be initiated and supervised by a specialist
    Accidental contact of soln with skin/mucous membranes-rinse well with water
    Consult local policy on the safe use of anti-cancer drugs
    If extravasation occurs follow local policy & seek expert help immediately
    Incompatible with plastic
    Staff: Not to be handled by pregnant staff
    Correct serum potassium levels before commencing treatment
    Monitor serum electrolytes before and during treatment
    Monitor cardiac function
    Monitor hepatic function
    Monitor patients for signs of tumour lysis syndrome
    Monitor renal function
    Monitor uric acid levels
    Perform regular white blood cell and platelet counts
    May cause tissue irritation
    Suspend / reduce dose if excessive drop in WBC / bone marrow occurs
    Suspend treatment if granulocyte count is less than 1500 per cubic mm
    Suspend treatment if platelet count is less than 100,000 per cubic mm
    May cause impaired fertility
    Female: Contraception required during and for 3 months after treatment
    Male: Contraception required during and for 6 months after treatment

    Complete blood counts should be performed frequently as the drug may cause severe bone marrow depression. If an exceedingly large fall in white cell count and excessive depression of bone marrow occurs it may be necessary to suspend treatment or reduce dose. Appropriate transfusions should be available.

    Pregnancy and Lactation


    Amsacrine is contraindicated during pregnancy.
    The manufacturer discourages the use of amsacrine during pregnancy, especially during the first trimester. There are no data on the use of amsacrine in pregnant women, however, animal studies have indicated that amsacrine is teratogenic and has shown reproductive toxicity.


    Amsacrine is contraindicated during breastfeeding.
    The manufacturer recommends that breastfeeding is contraindicated during amsacrine treatment. It is unclear whether amsacrine is excreted in the mother's milk.

    Side Effects

    Abdominal pain
    Acute renal insufficiency
    Anaphylactic reaction
    Atrial fibrillation
    Blood urea increased
    Congestive cardiac failure
    Decreased ejection fraction
    ECG changes
    Grand mal seizure
    Hepatic impairment
    Hypersensitivity reactions
    Increase in alkaline phosphatase
    Increases in hepatic enzymes
    Irritation (injection site)
    Lability of affect
    Necrosis (injection site)
    Peripheral neuropathy
    Phlebitis (injection site)
    Serum bilirubin increased
    Serum creatinine increased
    Sinus tachycardia
    Skin inflammation
    Ventricular arrhythmias
    Ventricular fibrillation
    Visual disturbances
    Weight gain
    Weight loss


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: August 2022

    Reference Sources

    Summary of Product Characteristics: Amsidine 75mg/1.5ml concentrate and solvent for solution for infusion. Eurocept International BV. Revised March 2020.

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