Dactinomycin, Cosmegen

  • Contraindications
  1. Active Varicella Zoster Virus (Chicken Pox)
  2. Active Shingles (Herpes Zoster)
  3. Age <6 months
  • Mechanism
  1. See Antibiotic Chemotherapy
  2. Dactinomycin is a chromopeptide Antineoplastic Antibiotic extracted from the bacterium Streptomyces parvulus
  3. Dactinomycin inserts between adjacent guanine-cytosine base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  4. Dactinomycin also induces single stranded DNA breaks by several postulated mechanisms
    1. Free-radical intermediate
    2. Topoisomerase 2 interaction
  • Medications
  1. Dactinomycin injection powder for solution in 0.5 mg vials
  • Dosing
  1. See other references for disease specific dosing protocols
  2. Caution that dosing units may be written in either mg or mcg
  • Adverse Effects
  1. Alopecia
  2. Myelosuppression
  3. Severe skin and soft tissue necrosis on extravasation
    1. Dactinomycin is a strong Vesicant (causes Blistering)
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  • Resources