CONTRAINDICATIONS
TRISENOX® is contraindicated in patients who are hypersensitive to arsenic.
WARNINGS
(see boxed WARNING)
TRISENOX® should be administered under the supervision of a physician who is experienced in the management of patients with acute leukemia.
APL Differentiation Syndrome (see boxed WARNING): Nine of 40 patients with APL treated with TRISENOX® , at a dose of 0.15 mg/kg, experienced the APL differenti-ation syndrome (see BOX WARNING and ADVERSE REACTIONS).
Hyperleukocytosis: Treatment with TRISENOX® has been associated with the development of hyperleukocytosis (>/= 10 × 103/µL) in 20 of 40 patients. A relationship did not exist between baseline WBC counts and development of hyperleukocytosis nor baseline WBC counts and peak WBC counts. Hyperleukocytosis was not treated with additional chemotherapy. WBC counts during consolidation were not as high as during induction treatment.
QT Prolongation (see boxed WARNING): QT/QTc prolongation should be expected during treatment with arsenic trioxide and torsade de pointes as well as complete heart block has been reported. Over 460 ECG tracings from 40 patients with refractory or relapsed APL treated with TRISENOX® were evaluated for QTc prolongation. Sixteen of 40 patients (40%) had at least one ECG tracing with a QTc interval greater than 500 msec. Prolongation of the QTc was observed between 1 and 5 weeks after TRISENOX® infusion, and then returned towards baseline by the end of 8 weeks after TRISENOX® infusion. In these ECG evaluations, women did not experience more pronounced QT prolongation than men, and there was no correlation with age. Complete AV block: Complete AV block has been reported with arsenic trioxide in the published literature including a case of a patient with APL. Carcinogenesis: Carcinogenicity studies have not been conducted with TRISENOX® by intravenous administration. The active ingredient of TRISENOX® , arsenic trioxide is a human carcinogen.
Pregnancy: TRISENOX® may cause fetal harm when administered to a pregnant woman. Studies in pregnant mice, rats, hamsters, and primates have shown that inorganic arsenicals cross the placental barrier when given orally or by injection. The reproductive toxicity of arsenic trioxide has been studied in a limited manner. An increase in resorptions, neural-tube defects, anophthalmia and microphthalmia were observed in rats administered 10 mg/kg of arsenic trioxide on gestation day 9 (approximately 10 times the recommended human daily dose on a mg/m2 basis). Similar findings occurred in mice administered a 10 mg/kg dose of a related trivalent arsenic, sodium arsenite, (approximately 5 times the projected human dose on a mg/m2 basis) on gestation days 6, 7, 8 or 9. Intravenous injection of 2 mg/kg sodium arsenite (approximately equivalent to the projected human daily dose on a mg/m2 basis) on gestation day 7 (the lowest dose tested) resulted in neural-tube defects in hamsters.
There are no studies in pregnant women usingTRISENOX® . If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus. One patient who became pregnant while receiving arsenic trioxide had a miscarriage. Women of childbearing potential should be advised to avoid becoming pregnant.
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