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COSMEGEN (DACTINOMYCIN)
- Ewing's sarcoma
- Gestational trophoblastic neoplasia
- Refractory malignant tumor of testis
- Rhabdomyosarcoma
- Wilms' tumor
0.5 mg intravenous solution
- Inject 15 mcg/kg by intravenous route once daily for 5 days
0.5 mg intravenous solution
- Inject 15 mcg/kg by intravenous route once daily for 5 days
Ewing's sarcoma
- Inject 15 mcg/kg by intravenous route once daily for 5 days
- Inject 400 mcg/m2 by intravenous route once daily for 5 days
- Inject 600 mcg/m2 by intravenous route once daily for 5 days
- Inject 1,250 mcg/m2 by intravenous route on day 1 of a 21-day treatment cycle
- Infuse 1,250 mcg/m2 over 10-15 minute(s) by intravenous route on day 1 of a 21-day treatment cycle
- Infuse 400 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 600 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 15 mcg/kg over 10-15 minute(s) by intravenous route once dailyfor 5 days
Gestational trophoblastic neoplasia
- Inject 12 mcg/kg by intravenous route once daily for 5 days
- Inject 1,250 mcg/m2 by intravenous route every 2 weeks
- Infuse 1,250 mcg/m2 over 10-15 minute(s) by intravenous route every 2Weeks
- Infuse 12 mcg/kg over 10-15 minute(s) by intravenous route once dailyfor 5 days
Rhabdomyosarcoma
- Inject 15 mcg/kg by intravenous route once daily for 5 days
- Inject 400 mcg/m2 by intravenous route once daily for 5 days
- Inject 600 mcg/m2 by intravenous route once daily for 5 days
- Infuse 400 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 600 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 15 mcg/kg over 10-15 minute(s) by intravenous route once dailyfor 5 days
Wilms' tumor
- Inject 15 mcg/kg by intravenous route once daily for 5 days
- Inject 400 mcg/m2 by intravenous route once daily for 5 days
- Inject 600 mcg/m2 by intravenous route once daily for 5 days
- Infuse 400 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 600 mcg/m2 over 10-15 minute(s) by intravenous route once daily for 5 days
- Infuse 15 mcg/kg over 10-15 minute(s) by intravenous route once dailyfor 5 days
- adenovirus vac live type-4 & 7
- adenovirus vaccine live type-4
- adenovirus vaccine live type-7
- BCG vaccine, live (PF)
- flu vac,qval 2013-14 (2-49yrs)
- Flumist 2013-2014
- M-m-r Ii (pf)
- measles,mumps&rubella vacc(PF)
- measles,mumps,rub,varicel(PF)
- natalizumab
- Proquad (pf)
- Rotateq Vaccine
- rotavirus vaccine live, penta
- typhoid vaccine
- Tysabri
- varicella virus vacc live (PF)
- Varivax (pf)
- Vivotif Berna Vaccine
- yellow fever vaccine live (PF)
- Yf-vax (pf)
- Zostavax (pf)
- zoster vaccine live (PF)
Contraindicated
- clozapine
- Clozaril
- deferiprone
- Fazaclo
- Ferriprox
- Versacloz
Severe
Moderate
- None
- Herpes zoster
- Lactating mother
- Varicella contact
- Varicella zoster virus infection
Contraindicated
- Abnormal hepatic function tests
- Anemia
- Aplastic anemia
- Disease of liver
- Hepatic vein thrombosis
- Leukopenia
- Neutropenic disorder
- Pregnancy
- Severe infection
- Thrombocytopenic disorder
Severe
Moderate
- Ascites
COSMEGEN (DACTINOMYCIN)
- Ewing's sarcoma
- Gestational trophoblastic neoplasia
- Refractory malignant tumor of testis
- Rhabdomyosarcoma
- Wilms' tumor
- Abnormal hepatic function tests
- Anemia
- Aphthous stomatitis
- Aplastic anemia
- Esophagitis
- Neutropenic disorder
- Proctitis
- Thrombocytopenic disorder
- Acne vulgaris
- Alopecia
- Dysphagia
- Fatigue
- Fever
- Nausea
- Pharyngitis
- Skin rash
- Stomatitis
- Vomiting
More Frequent
Severe
Less Severe
- Gastrointestinal ulcer
- Hepatitis
- Leukopenia
- Acute abdominal pain
- Anorexia
- Diarrhea
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute hepatic failure
- Anaphylaxis
- Ascites
- Bronchospastic pulmonary disease
- Chemotherapy-induced hyperuricemia
- Disseminated intravascular coagulation
- Erythema
- Erythema multiforme
- Extravasation injury
- Hemorrhage
- Hepatic veno-occlusive disease
- Hepatomegaly
- Hypersensitivity drug reaction
- Hypocalcemia
- Infection
- Injection site sequelae
- Interstitial pneumonitis
- Jaundice
- Kidney disease with reduction in GFR
- Optic neuropathy
- Pancytopenia
- Pneumothorax
- Radiation recall syndrome
- Renal failure
- Sepsis
- Stevens-johnson syndrome
- Thrombophlebitis
- Toxic epidermal necrolysis
Less Severe
- Cheilitis
- Constipation
- Dyschromia
- Malaise
- Myalgias
- Peripheral neuropathy
- Skin inflammation
Contraindicated
None
Severe Precaution
None
Management or Monitoring Precaution
None
Dactinomycin
- Severity Level:
D
- Additional Notes: Based on drug pharmacology developmental toxicity is possible.
Contraindicated
Dactinomycin
Avoid breastfeeding during treatment and for 14 days after last dose.
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Unknown | Not known; no or inclusive data | Avoid breastfeeding during treatment and for 14 days after last dose. |
Precaution Exists
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Dactinomycin
Increased risk of myelosuppression.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | N | N | N | N | N |
BEERS: N HEDIS: N STOPP: N
No Known Risk
None
- None
| Ewing's sarcoma | |
| C40 | Malignant neoplasm of bone and articular cartilage of limbs |
| C40.0 | Malignant neoplasm of scapula and long bones of upper limb |
| C40.00 | Malignant neoplasm of scapula and long bones of unspecified upper limb |
| C40.01 | Malignant neoplasm of scapula and long bones of right upper limb |
| C40.02 | Malignant neoplasm of scapula and long bones of left upper limb |
| C40.1 | Malignant neoplasm of short bones of upper limb |
| C40.10 | Malignant neoplasm of short bones of unspecified upper limb |
| C40.11 | Malignant neoplasm of short bones of right upper limb |
| C40.12 | Malignant neoplasm of short bones of left upper limb |
| C40.2 | Malignant neoplasm of long bones of lower limb |
| C40.20 | Malignant neoplasm of long bones of unspecified lower limb |
| C40.21 | Malignant neoplasm of long bones of right lower limb |
| C40.22 | Malignant neoplasm of long bones of left lower limb |
| C40.3 | Malignant neoplasm of short bones of lower limb |
| C40.30 | Malignant neoplasm of short bones of unspecified lower limb |
| C40.31 | Malignant neoplasm of short bones of right lower limb |
| C40.32 | Malignant neoplasm of short bones of left lower limb |
| C40.8 | Malignant neoplasm of overlapping sites of bone and articular cartilage of limb |
| C40.80 | Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb |
| C40.81 | Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb |
| C40.82 | Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb |
| C40.9 | Malignant neoplasm of unspecified bones and articular cartilage of limb |
| C40.90 | Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb |
| C40.91 | Malignant neoplasm of unspecified bones and articular cartilage of right limb |
| C40.92 | Malignant neoplasm of unspecified bones and articular cartilage of left limb |
| C41 | Malignant neoplasm of bone and articular cartilage of other and unspecified sites |
| C41.0 | Malignant neoplasm of bones of skull and face |
| C41.1 | Malignant neoplasm of mandible |
| C41.2 | Malignant neoplasm of vertebral column |
| C41.3 | Malignant neoplasm of ribs, sternum and clavicle |
| C41.4 | Malignant neoplasm of pelvic bones, sacrum and coccyx |
| C41.9 | Malignant neoplasm of bone and articular cartilage, unspecified |
| Gestational trophoblastic neoplasia | |
| C58 | Malignant neoplasm of placenta |
| D39.2 | Neoplasm of uncertain behavior of placenta |
| O01 | Hydatidiform mole |
| O01.0 | Classical hydatidiform mole |
| O01.1 | Incomplete and partial hydatidiform mole |
| O01.9 | Hydatidiform mole, unspecified |
| Refractory malignant tumor of testis | |
| C62 | Malignant neoplasm of testis |
| C62.0 | Malignant neoplasm of undescended testis |
| C62.00 | Malignant neoplasm of unspecified undescended testis |
| C62.01 | Malignant neoplasm of undescended right testis |
| C62.02 | Malignant neoplasm of undescended left testis |
| C62.1 | Malignant neoplasm of descended testis |
| C62.10 | Malignant neoplasm of unspecified descended testis |
| C62.11 | Malignant neoplasm of descended right testis |
| C62.12 | Malignant neoplasm of descended left testis |
| C62.9 | Malignant neoplasm of testis, unspecified whether descended or undescended |
| C62.90 | Malignant neoplasm of unspecified testis, unspecified whether descended or undescended |
| C62.91 | Malignant neoplasm of right testis, unspecified whether descended or undescended |
| C62.92 | Malignant neoplasm of left testis, unspecified whether descended or undescended |
| Rhabdomyosarcoma | |
| C49 | Malignant neoplasm of other connective and soft tissue |
| C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
| C49.1 | Malignant neoplasm of connective and soft tissue of upper limb, including shoulder |
| C49.10 | Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder |
| C49.11 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
| C49.12 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
| C49.2 | Malignant neoplasm of connective and soft tissue of lower limb, including hip |
| C49.20 | Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip |
| C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
| C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
| C49.3 | Malignant neoplasm of connective and soft tissue of thorax |
| C49.4 | Malignant neoplasm of connective and soft tissue of abdomen |
| C49.5 | Malignant neoplasm of connective and soft tissue of pelvis |
| C49.6 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
| C49.8 | Malignant neoplasm of overlapping sites of connective and soft tissue |
| C49.9 | Malignant neoplasm of connective and soft tissue, unspecified |
| Wilms' tumor | |
| C64 | Malignant neoplasm of kidney, except renal pelvis |
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis |
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis |
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis |
| 0-9 | A-Z |
|---|---|
| C40 | Malignant neoplasm of bone and articular cartilage of limbs |
| C40.0 | Malignant neoplasm of scapula and long bones of upper limb |
| C40.00 | Malignant neoplasm of scapula and long bones of unspecified upper limb |
| C40.01 | Malignant neoplasm of scapula and long bones of right upper limb |
| C40.02 | Malignant neoplasm of scapula and long bones of left upper limb |
| C40.1 | Malignant neoplasm of short bones of upper limb |
| C40.10 | Malignant neoplasm of short bones of unspecified upper limb |
| C40.11 | Malignant neoplasm of short bones of right upper limb |
| C40.12 | Malignant neoplasm of short bones of left upper limb |
| C40.2 | Malignant neoplasm of long bones of lower limb |
| C40.20 | Malignant neoplasm of long bones of unspecified lower limb |
| C40.21 | Malignant neoplasm of long bones of right lower limb |
| C40.22 | Malignant neoplasm of long bones of left lower limb |
| C40.3 | Malignant neoplasm of short bones of lower limb |
| C40.30 | Malignant neoplasm of short bones of unspecified lower limb |
| C40.31 | Malignant neoplasm of short bones of right lower limb |
| C40.32 | Malignant neoplasm of short bones of left lower limb |
| C40.8 | Malignant neoplasm of overlapping sites of bone and articular cartilage of limb |
| C40.80 | Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb |
| C40.81 | Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb |
| C40.82 | Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb |
| C40.9 | Malignant neoplasm of unspecified bones and articular cartilage of limb |
| C40.90 | Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb |
| C40.91 | Malignant neoplasm of unspecified bones and articular cartilage of right limb |
| C40.92 | Malignant neoplasm of unspecified bones and articular cartilage of left limb |
| C41 | Malignant neoplasm of bone and articular cartilage of other and unspecified sites |
| C41.0 | Malignant neoplasm of bones of skull and face |
| C41.1 | Malignant neoplasm of mandible |
| C41.2 | Malignant neoplasm of vertebral column |
| C41.3 | Malignant neoplasm of ribs, sternum and clavicle |
| C41.4 | Malignant neoplasm of pelvic bones, sacrum and coccyx |
| C41.9 | Malignant neoplasm of bone and articular cartilage, unspecified |
| C49 | Malignant neoplasm of other connective and soft tissue |
| C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
| C49.1 | Malignant neoplasm of connective and soft tissue of upper limb, including shoulder |
| C49.10 | Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder |
| C49.11 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
| C49.12 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
| C49.2 | Malignant neoplasm of connective and soft tissue of lower limb, including hip |
| C49.20 | Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip |
| C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
| C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
| C49.3 | Malignant neoplasm of connective and soft tissue of thorax |
| C49.4 | Malignant neoplasm of connective and soft tissue of abdomen |
| C49.5 | Malignant neoplasm of connective and soft tissue of pelvis |
| C49.6 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
| C49.8 | Malignant neoplasm of overlapping sites of connective and soft tissue |
| C49.9 | Malignant neoplasm of connective and soft tissue, unspecified |
| C58 | Malignant neoplasm of placenta |
| C62 | Malignant neoplasm of testis |
| C62.0 | Malignant neoplasm of undescended testis |
| C62.00 | Malignant neoplasm of unspecified undescended testis |
| C62.01 | Malignant neoplasm of undescended right testis |
| C62.02 | Malignant neoplasm of undescended left testis |
| C62.1 | Malignant neoplasm of descended testis |
| C62.10 | Malignant neoplasm of unspecified descended testis |
| C62.11 | Malignant neoplasm of descended right testis |
| C62.12 | Malignant neoplasm of descended left testis |
| C62.9 | Malignant neoplasm of testis, unspecified whether descended or undescended |
| C62.90 | Malignant neoplasm of unspecified testis, unspecified whether descended or undescended |
| C62.91 | Malignant neoplasm of right testis, unspecified whether descended or undescended |
| C62.92 | Malignant neoplasm of left testis, unspecified whether descended or undescended |
| C64 | Malignant neoplasm of kidney, except renal pelvis |
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis |
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis |
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis |
| D39.2 | Neoplasm of uncertain behavior of placenta |
| O01 | Hydatidiform mole |
| O01.0 | Classical hydatidiform mole |
| O01.1 | Incomplete and partial hydatidiform mole |
| O01.9 | Hydatidiform mole, unspecified |
Formulary Reference Tool