Drugs List

Therapeutic Indications

Uses

Carcinoma of pancreas

Inoperable, advanced or metastatic, progressive and/or symptomatic, well-differentiated, G1 or G2 neuroendocrine tumours of pancreatic origin, in combination with 5-fluorouracil.

Administration

For intravenous infusion only.
The duration of the infusion should be between 30 minutes and 4 hours.

Contraindications

Children under 18 years
Breastfeeding
Pregnancy
Renal impairment - creatinine clearance below or equal to 30ml/minute

Precautions and Warnings

Patients over 65 years
Hepatic impairment
Renal impairment - creatinine clearance below 60ml/minute

Administration of live vaccines is not recommended
Advise ability to drive/operate machinery may be affected by side effects
Anti-emetics may be required during therapy
Give pre-treatment counselling and consideration of sperm cryopreservation
Maintain adequate hydration during therapy
Treatment to be initiated and supervised by a specialist
Consult local policy on the safe use of anti-cancer drugs
If extravasation occurs follow local policy & seek expert help immediately
Staff: Not to be handled by pregnant staff
Monitor haematological parameters before and during treatment
Monitor renal and hepatic function before and during treatment
Monitor serum creatinine during and for 4 weeks after treatment
Monitor serum electrolytes during and for 4 weeks after treatment
Perform urinalysis during and for 4 weeks after treatment
Consider discontinuing treatment if hepatotoxicity occurs
Potentially mutagenic and carcinogenic
Consider treatment interruption & dose reduction in haematological toxicity
Discontinue or reduce dose if renal impairment worsens
Consider dose reduction in hepatic impairment
May cause impaired fertility
Female: Contraception required during and for 1 month after treatment
Male: Use barrier contraception during and for 3 months after treatment

Pregnancy and Lactation

Pregnancy

Streptozocin is contraindicated in pregnancy.

At the time of writing there is limited data regarding the use of streptozocin during pregnancy. Animal studies have shown reproductive toxicity, as well as mutagenic and carcinogenic effects.

The manufacturer indicates that streptozocin should only be used during pregnancy if the potential benefit to the mother clearly outweighs the potential risks to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Streptozocin is contraindicated in breastfeeding.

It is unknown whether streptozocin is present in human milk. The manufacturer states that a risk to the breastfed infant cannot be excluded.

The molecular weight of streptozocin suggests that the drug may be excreted in breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute renal failure
Altered glucose tolerance
Confusion
Decrease in haematocrit
Depression
Diarrhoea
Elevation of liver enzymes
Extravasation
Haematological toxicity
Hepatotoxicity
Hyperphosphaturia
Hypoalbuminaemia
Injection site reactions
Lethargy
Leucopenia
Nausea
Nephrogenic diabetes insipidus
Proteinuria
Proximal tubulopathy
Reduced platelet count
Renal toxicity
Urinary abnormalities
Vomiting

Presentation

Parenteral formulations of streptozocin.

Drugs List

Therapeutic Indications

Uses

Carcinoma of pancreas

Inoperable, advanced or metastatic, progressive and/or symptomatic, well-differentiated, G1 or G2 neuroendocrine tumours of pancreatic origin, in combination with 5-fluorouracil.

Dosage

Whilst the doses stated below are those recommended by the manufacturer, local cancer network protocols for the relevant indication should be consulted.

Adults

Patients with Renal Impairment

Administration

For intravenous infusion only.
The duration of the infusion should be between 30 minutes and 4 hours.

Contraindications

Children under 18 years
Breastfeeding
Pregnancy
Renal impairment - creatinine clearance below or equal to 30ml/minute

Precautions and Warnings

Patients over 65 years
Hepatic impairment
Renal impairment - creatinine clearance below 60ml/minute

Administration of live vaccines is not recommended
Advise ability to drive/operate machinery may be affected by side effects
Anti-emetics may be required during therapy
Give pre-treatment counselling and consideration of sperm cryopreservation
Maintain adequate hydration during therapy
Treatment to be initiated and supervised by a specialist
Consult local policy on the safe use of anti-cancer drugs
If extravasation occurs follow local policy & seek expert help immediately
Staff: Not to be handled by pregnant staff
Monitor haematological parameters before and during treatment
Monitor renal and hepatic function before and during treatment
Monitor serum creatinine during and for 4 weeks after treatment
Monitor serum electrolytes during and for 4 weeks after treatment
Perform urinalysis during and for 4 weeks after treatment
Consider discontinuing treatment if hepatotoxicity occurs
Potentially mutagenic and carcinogenic
Consider treatment interruption & dose reduction in haematological toxicity
Discontinue or reduce dose if renal impairment worsens
Consider dose reduction in hepatic impairment
May cause impaired fertility
Female: Contraception required during and for 1 month after treatment
Male: Use barrier contraception during and for 3 months after treatment

Pregnancy and Lactation

Pregnancy

Streptozocin is contraindicated in pregnancy.

At the time of writing there is limited data regarding the use of streptozocin during pregnancy. Animal studies have shown reproductive toxicity, as well as mutagenic and carcinogenic effects.

The manufacturer indicates that streptozocin should only be used during pregnancy if the potential benefit to the mother clearly outweighs the potential risks to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Streptozocin is contraindicated in breastfeeding.

It is unknown whether streptozocin is present in human milk. The manufacturer states that a risk to the breastfed infant cannot be excluded.

The molecular weight of streptozocin suggests that the drug may be excreted in breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute renal failure
Altered glucose tolerance
Confusion
Decrease in haematocrit
Depression
Diarrhoea
Elevation of liver enzymes
Extravasation
Haematological toxicity
Hepatotoxicity
Hyperphosphaturia
Hypoalbuminaemia
Injection site reactions
Lethargy
Leucopenia
Nausea
Nephrogenic diabetes insipidus
Proteinuria
Proximal tubulopathy
Reduced platelet count
Renal toxicity
Urinary abnormalities
Vomiting

Overdosage

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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2018.

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Zanosar 1g powder for concentrate for solution for infusion. KEOCYT Revised April 2018.