Mechlorethamine
Jeneng merek: Valchlor
Kelas obat:
Agen Antineoplastik , Agen Antineoplastik
Panganggone Mechlorethamine
Mycosis Fungoides-type Cutaneous T-cell Lymphoma (CTCL)
Pengobatan topikal lesi kulit ing pasien kanthi awal (tahap IA lan IB) mycosis fungoides-type CTCL sing wis nampa terapi terarah kulit sadurunge . Ditunjuk minangka obat yatim piatu dening FDA kanggo digunakake ing kondisi iki.
Pandhuan perawatan ahli kalebu mechlorethamine topikal minangka salah siji saka sawetara opsi perawatan sing disaranake kanggo pasien kanthi tahap awal saka mycosis fungoides-type CTCL.
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Carane nggunakake Mechlorethamine
Administrasi
Administrasi Topi
Gunakake ing kulit minangka gel mechlorethamine 0,016% sing kasedhiya ing komersil.
Wis ditrapake ing kulit minangka solusi banyu utawa persiapan adhedhasar salep sing diracik sacara ekstemporan nggunakake mechlorethamine hydrochloride kanggo injeksi.
Mung kanggo panggunaan topikal dermatologis. Aja nggunakake cedhak utawa ing mripat, irung, utawa tutuk. (Waca Mucosal utawa Mripat Ciloko ing Ati-ati.)
Wisuh tangan sak tenane nganggo sabun lan banyu sawise nangani utawa aplikasi tamba. (Deleng Pènget / Pancegahan ing Caution.)
Aplikasi dening CaregiverProdusen nyatakake caregiver kudu nganggo sarung tangan nitril sing bisa digunakake nalika aplikasi lan wisuh tangan sak tenane nganggo sabun lan banyu sawise nyopot sarung tangan.
Ing yen ora sengaja kena kulit, enggal-enggal wisuh area sing katon nganggo sabun lan banyu nganti ≥15 menit lan copot sandhangan sing kena kontaminasi.
Yen ora disengaja katon ing mripat, tutuk, utawa irung, enggal-enggal irigasi area sing kena kanggo ≥ 15 menit kanthi banyu sing akeh banget.
GelAplikasi gel langsung (utawa sajrone 30 menit) sawise dicopot saka kulkas; bali gel menyang kulkas sanalika sawise saben nggunakake.
Aplikasi gel kanggo kulit garing ≥4 jam sadurunge utawa ≥30 menit sawise adus utawa ngumbah wilayah sing kena pengaruh. Sawise aplikasi, ngidini wilayah sing diobati nganti garing nganti 5-10 menit sadurunge ditutupi nganggo sandhangan.
Bisa olesake emolien (pelembab) ing wilayah sing diobati 2 jam sadurunge utawa 2 jam sawise aplikasi gel.
Aja nganggo balutan occlusive ing wilayah sing diobati.
Aja geni, geni, lan udud nganti gel wis garing.
Ointment Extemporaneously CompoundedBiasane disiapake kanthi nglarutake mechlorethamine hydrochloride ing alkohol dehidrasi. , nyaring solusi kanggo mbusak natrium klorida sing ora larut sing ana ing persiapan komersial (sanajan filtrasi bisa uga ora perlu), lan nyampur solusi obat-alkohol menyang petrolatum utawa basa salep anhidrat liyane (contone, petrolatum hidrofilik). Konsentrasi mechlorethamine hidroklorida biasa yaiku 0,01 utawa 0,02%. Rujuk referensi khusus kanggo informasi rinci babagan nyiapake salep topikal.
Solusi Ekstemporan CompoundedBiasane disiapake kanthi larut 10 mg mechlorethamine hydrochloride ing 50-100 ml banyu. Hubungi referensi khusus kanggo informasi rinci babagan nyiapake solusi topikal.
Amarga stabilitas sing winates, nyiyapake solusi sadurunge digunakake.
Dosis
Kasedhiya minangka mechlorethamine hydrochloride; dosis gel sing ditulis nganggo mechlorethamine.
Dewasa
Mycosis Fungoides-type CTCL TopikalOlesake film tipis mechlorethamine 0,016% gel menyang wilayah sing kena pengaruh sapisan dina.
Ngganggu perawatan yen ana ulcer kulit utawa blistering, utawa dermatitis cukup abot utawa abot (yaiku, eritema sing ditandhani kanthi edema), kedadeyan.
Sawise perbaikan, bisa diterusake kanthi frekuensi suda saben 3 dina. Yen reintroduksi ditoleransi kanggo ≥1 minggu, bisa nambah frekuensi aplikasi kanggo saben dina liyane kanggo ≥1 minggu lan banjur sapisan saben dina yen ditoleransi.
Konsentrasi mechlorethamine hidroklorida ing solusi topikal lan ointments, frekuensi aplikasi, lan Duration saka perawatan wis adhedhasar respon dermatologic lan toleransi. Konsentrasi salep biasa yaiku 0,01 utawa 0,02%; Bisa nggunakake konsentrasi sing luwih murah ing wiwitane ing pasien kanthi dermatitis utawa riwayat reaksi hipersensitivitas kanggo obat sing ditrapake sacara topikal, utawa nggunakake konsentrasi sing luwih dhuwur ing pasien kanthi lesi ekstensif utawa tahan.
Aplikasi topikal preparat mechlorethamine umume diulang sepisan saben dina nganti lesi ilang. Durasi optimal terapi sawise remisi klinis durung ditetepake kanthi lengkap.
Populasi Khusus
Saiki ora ana rekomendasi dosis populasi khusus.
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Sensitivitas
Reaksi hipersensitivitas, kalebu anafilaksis, dilapurake sawise paparan formulasi topikal mechlorethamine.
Desensitisasi nggunakake mechlorethamine topikal wis digunakake kanthi sukses kanggo nyegah dermatitis kontak alergi kanthi terapi tambahan.
Cedera Mukosa utawa Mripat
Paparan ing mripat nyebabake rasa nyeri, kobong, inflamasi, fotofobia, lan paningal kabur, lan bisa uga wuta lan ciloko mata anterior sing ora bisa dibalèkaké.
Yen cahya mripat ana. , langsung irigasi mripat sing kena pengaruh nganggo banyu sing akeh banget, natrium klorida 0,9%, utawa larutan irigasi ophthalmic uyah sing seimbang kanggo ≥15 menit lan entuk perawatan medis langsung, kalebu konsultasi ophthalmologic.
Paparan mukosa nyebabake nyeri , eritema, lan ulkus, sing bisa dadi abot.
Yen katon saka mukosa, enggal-enggal irigasi wilayah sing kena pengaruh kanthi banyu akeh nganti ≥15 menit lan golek rembugan medis.
Paparan Sekunder kanggo Mechlorethamine Topikal
Paparan sekunder bisa nyebabake dermatitis, ciloko mukosa, lan kanker sekunder.
Aja kontak kulit langsung karo gel dening sapa wae kajaba pasien. Tindakake pandhuan aplikasi kanthi ati-ati kanggo nyegah paparan sekunder (pirsani Administrasi Topi ing Dosis lan Administrasi).
Dermatitis
Efek sing paling umum saka mechlorethamine topikal. Kacarita ing 56% pasien sing nampa gel; cukup abot utawa abot ing 23% pasien.
Pantau pasien kanggo eritema, bengkak, inflamasi, pruritus, lepuh, ulcerasi, lan infeksi kulit sekunder. Pasuryan, alat kelamin, anus, lan wilayah intertriginous sing gegandhèngan karo risiko tambah.
Bisa uga mbutuhake gangguan perawatan utawa panyesuaian dosis (pirsani Dosis ing Dosis lan Administrasi). Emolien topikal, antihistamin oral, lan kortikosteroid topikal wis digunakake kanggo nambani dermatitis.
Kanker Kulit NOnmelanoma
Kanker kulit nonmelanoma dilapurake sajrone uji klinis utawa setaun sawise perawatan ing 4% pasien sing nampa gel mechlorethamine utawa salep gabungan ekstemporan (2 utawa 6% pasien, masing-masing. ). Sawetara pasien sadurunge wis nampa terapi sing dikenal bisa nyebabake kanker kasebut.
Bisa kedadeyan ing sembarang area kulit, kalebu wilayah sing ora diobati.
Ngawasi pasien kanker kulit nonmelanoma sajrone lan sawise perawatan.
Morbiditas lan Mortalitas Janin/Neonatal
Mechlorethamine bisa nyebabake cilaka janin. Yen digunakake nalika meteng utawa yen pasien ngandhut, kabar babagan potensial bebaya janin.
Mechlorethamine sistemik sing ana hubungane karo malformasi ing bocah-bocah sing kena obat ing utero; dosis sub-Q tunggal ing kewan sing ana gandhengane karo retardasi pertumbuhan, teratogenisitas, lan embriolethalitas.
Gel sing gampang kobong
Gel adhedhasar alkohol lan gampang kobong. Tindakake pandhuan aplikasi kanthi ati-ati (pirsani Administrasi Topikal ing Dosis lan Administrasi).
Populasi Spesifik
KandhutanKategori D. (Deleng Morbiditas lan Mortalitas Janin/Neonatal miturut Ati-ati.)
LaktasiOra dingerteni manawa mechlorethamine disebarake menyang susu manungsa. Mungkasi nyusoni utawa obat kasebut.
Panggunaan PediatrikKeamanan lan khasiat durung ditemtokake.
Panggunaan GeriatrikAntawis pasien sing nampa gel mechlorethamine kanggo CTCL tipe mycosis fungoides ing uji klinis, tingkat respon katon dadi luwih murah (44 lawan 66%) lan tingkat reaksi kulit sing saleh (70 lawan 58%) lan mandheg amarga efek saleh (38 lawan 14%) luwih dhuwur ing pasien ≥65 taun dibandhingake karo pasien sing luwih enom.
Efek Sabar sing Umum
Dermatitis, pruritus, kelainan laboratorium (anemia, Neutropenia, trombositopenia), infeksi kulit bakteri, ulcerasi utawa blistering kulit, hiperpigmentasi kulit.
Apa obatan liyane bakal mengaruhi Mechlorethamine
Studi interaksi obat sing durung ditindakake nganti saiki. Interaksi obat sistemik ora mungkin.
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