Gemcitabine


Thông tin thuốc gốc
Chỉ định và Liều dùng
Intravenous
Cancer, pancreatic
Adult: Patient w/ locally advanced or metastatic cases: 1,000 mg/m2 once wkly via infusion over 30 min for 7 wk followed by 1 wk rest, then once wkly for 3 consecutive wk out of every 4 wk cycle. Dosage may reduce w/ each cycle or w/in a cycle based on toxicity.

Intravenous
Breast cancer
Adult: Patient w/ unresectable, locally recurrent, or metastatic cases: Combination therapy w/ paclitaxel: 1,250 mg/m2 via infusion over 30 min on days 1 and 8 of a 21-day cycle. Dosage may reduce w/ each cycle or w/in a cycle based on toxicity. Patients should have absolute granulocyte count of ≥1,500 x 106/L prior to initiation of therapy.

Intravenous
Bladder cancer
Adult: Patient w/ locally advanced or metastatic cases: Combination therapy w/ cisplatin: 1,000 mg/m2 via infusion over 30 min on days 1, 8 and 15 of a 28-day cycle. This 4-wk cycle is then repeated. Dosage may reduce w/ each cycle or w/in a cycle based on toxicity.

Intravenous
Non-small cell lung cancer
Adult: Patient w/ locally advanced or metastatic cases: Monotherapy: 1,000 mg/m2 once wkly via infusion over 30 min for 3 wk followed by 1 wk rest for locally advanced or metastatic cases. This 4-wk cycle is then repeated. Combination therapy w/ cisplatin: 1,000 mg/m2 via infusion over 30 min on days 1, 8, and 15 of a 28-day cycle. Alternatively, 1,250 mg/m2 via infusion over 30 min on days 1 and 8 of a 21-day cycle. Dosage may reduce w/ each cycle or w/in a cycle based on toxicity.

Intravenous
Ovarian cancer
Adult: Patient w/ locally advanced or metastatic epithelial cases: Combination therapy w/ carboplatin: 1,000 mg/m2 via infusion over 30 min on days 1 and 8 of a 21-day cycle. Dosage may reduce w/ each cycle or w/in a cycle based on toxicity.
Hướng dẫn pha thuốc
Add 5 or 25 mL of NaCl 0.9% inj in a vial labelled as containing 200 or 1,000 mg respectively, to provide a soln containing 38 mg/mL.
Chống chỉ định
Admin of yellow fever and other live attenuated vaccines.
Thận trọng
Patient w/ history of cirrhosis, hepatitis, alcoholism, CV events. Patients on radiotherapy. Hepatic (e.g. hepatic metastases) and renal impairment. Pregnancy. Prolonged infusion duration of >60 min or more frequent than wkly dosing may increase toxicity.
Tác dụng không mong muốn
Significant: Bone marrow suppression manifested by neutropenia, thrombocytopaenia, and anaemia; capillary leak syndrome, posterior reversible encephalopathy syndrome (PRES).
Nervous: Somnolence, flu-like symptoms, paraesthesia.
CV: Peripheral oedema.
GI: Nausea, vomiting, diarrhoea, stomatitis, constipation.
Resp: Dyspnoea.
Hepatic: Transient liver enzyme elevations (e.g. AST, ALT, bilirubin, alkaline phosphatase).
Genitourinary: Haematuria, proteinuria, increased BUN.
Haematologic: Haemorrhage.
Musculoskeletal: Myalgia.
Dermatologic: Rash, pruritus, oedema, thrombocytopenic purpura, alopecia, peripheral vasculitis, gangrene.
Immunologic: Infection.
Others: Pain, fever, extravasation, injection site reaction.
Potentially Fatal: Severe hepatotoxicity (e.g. liver failure), pulmonary toxicity (e.g. pulmonary oedema, pulmonary fibrosis, interstitial pneumonitis, adult resp distress syndrome), ischaemic colitis w/ necrosis. Rarely, haemolytic uremic syndrome leading to renal failure.
Thông tin tư vấn bệnh nhân
This drug may cause somnolence, if affected, do not drive or operate machinery.
Chỉ số theo dõi
Monitor CBC w/ differential and platelet count prior to each dose. Monitor pulmonary, hepatic, and renal function; electrolytes (i.e. K, Mg, Ca) when in combination therapy w/ cisplatin. Monitor for signs and symptoms of capillary leak syndrome and PRES.
Quá liều
Symptoms: Myelosuppression, severe rash, paraesthesia. Management: Supportive treatment. Monitor CBC.
Tương tác
May cause pulmonary toxicity w/ concurrent use of bleomycin. May enhance anticoagulant effect of warfarin.
Potentially Fatal: Admin of yellow fever and other live attenuated vaccines may increase risk of systemic disease esp in immunosuppressed patients.
Tác dụng
Description:
Mechanism of Action: Gemcitabine, a synthetic pyrimidine nucleoside and cytarabine analogue, inhibits DNA synthesis by blocking DNA polymerase and ribonucleotide reductase. It is cell-cycle specific acting mainly on the S-phase, but may also block cellular progression at the G1-S border.
Pharmacokinetics:
Distribution: Widely distributed into tissues; present in ascitic fluid. Volume of distribution: 50 L/m2 (<70 min infusion time); 370 L/m2 (70-285 min infusion time).
Metabolism: Rapidly metabolised in the liver, kidney, blood, and other tissues by cytidine deaminase to the inactive metabolite 2’-deoxy-2’,2’-difluorouridine (dFdU); undergoes intracellular metabolism by nucleoside kinases to the active metabolites, gemcitabine diphosphate and triphosphate nucleosides.
Excretion: Mainly via urine (92-98% mainly as dFdU; <10% as unchanged drug) and faeces (<1%). Elimination half-life: Gemcitabine: Approx 42-94 min (≤70 min infusion time); 4-10.5 hr (3-4 hr infusion time). Gemcitabine triphosphate: 1.7-19.4 hr.
Đặc tính

Chemical Structure Image
Gemcitabine

Source: National Center for Biotechnology Information. PubChem Database. Gemcitabine, CID=60750, https://pubchem.ncbi.nlm.nih.gov/compound/Gemcitabine (accessed on Jan. 22, 2020)

Bảo quản
Concentrate soln for infusion: Store between 2-8°C. Powder for soln for infusion: Store between 20-25°C.
Avoid inhalation and contact w/ skin or mucous membranes by wearing gloves and protective equipment. Wash hands before and after handling. Any unused portions should be disposed of in accordance w/ local requirements. Pregnant staff should not handle this product.
Phân loại MIMS
Hóa trị gây độc tế bào
Phân loại ATC
L01BC05 - gemcitabine ; Belongs to the class of antimetabolites, pyrimidine analogues. Used in the treatment of cancer.
Tài liệu tham khảo
Anon. Gemcitabine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/05/2017.

Buckingham R (ed). Gemcitabine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/05/2017.

Gemcitabine Hydrochloride Injection, Powder, Lyophilized, for Soln (Accord Healthcare Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/05/2017.

Joint Formulary Committee. Gemcitabine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/05/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Gemcitabine Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 26/05/2017.

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