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Trisenox (Arsenic Trioxide) - Side Effects and Adverse Reactions

 


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ADVERSE REACTIONS

Safety information was available for 52 patients with relapsed or refractory APL who participated in clinical trials of TRISENOX® . Forty patients in the Phase 2 study received the recommended dose of 0.15 mg/kg of which 28 completed both induction and consolidation treatment cycles. An additional 12 patients with relapsed or refractory APL received doses generally similar to the recommended dose. Most patients experienced some drug-related toxicity, most commonly leukocytosis, gastrointestinal (nausea, vomiting, diarrhea, and abdominal pain), fatigue, edema, hyperglycemia, dyspnea, cough, rash or itching, headaches, and dizziness. These adverse effects have not been observed to be permanent or irreversible nor do they usually require interruption of therapy.

Serious adverse events (SAEs), grade 3 or 4 according to version 2 of the NCI Common Toxicity Criteria, were common. Those SAEs attributed to TRISENOX® in the Phase 2 study of 40 patients with refractory or relapsed APL included APL differentiation syndrome (n=3), hyperleukocytosis (n=3), QTc interval >/= 500 msec (n=16, 1 with torsade de pointes), atrial dysrhythmias (n=2), and hyperglycemia (n=2).

The following table describes the adverse events that were observed in patients treated for APL with TRISENOX® at the recommended dose at a rate of 5% or more. Similar adverse event profiles were seen in the other patient populations who received TRISENOX® .

Adverse Events (any grade) Occurring in >/= 5% of 40 Patients with APL who Received TRISENOX® at a dose of 0.15 mg/kg/day
System organ class/ Adverse Event All Adverse Events, Any Grade Grade 3 & 4 Events
n % n %
General disorders and administration site conditions
   Fatigue 25 63   2   5
   Pyrexia (Fever) 25 63   2   5
   Edema--non-specific 16 40
   Rigors 15 38
   Chest pain 10 25   2   5
   Injection site pain   8 20
   Pain--non specific   6 15 1   3
   Injection site erythema   5 13
   Injection site edema   4 10
   Weakness   4 10   2   5
   Hemorrhage 3   8
   Weight gain   5 13
   Weight loss   3   8
   Drug hypersensitivity   2   5   1   3
Gastrointestinal disorders
   Nausea 30 75
   Anorexia   9 23
   Appetite decreased   6 15
   Diarrhea 21 53
   Vomiting 23 58
   Abdominal pain (lower & upper) 23 58   4 10
   Sore throat 14 35
   Constipation 11 28   1   3
   Loose stools   4 10
   Dyspepsia   4 10
   Oral blistering   3   8
   Fecal incontinence   3   8
   Gastrointestinal hemorrhage   3   8
   Dry mouth   3   8
   Abdominal tenderness   3   8
   Diarrhea hemorrhagic   3   8
   Abdominal distension   3   8
Metabolism and nutrition disorders
   Hypokalemia 20 50   5 13
   Hypomagnesemia 18 45   5 13
   Hyperglycemia 18 45   5 13
   ALT increased 8 20   2   5
   Hyperkalemia   7 18   2   5
   AST increased   5 13   1   3
   Hypocalcemia   4 10
   Hypoglycemia   3   8
   Acidosis   2   5
Nervous system disorders
   Headache 24 60   1   3
   Insomnia 17 43   1   3
   Paresthesia 13 33   2   5
   Dizziness (excluding vertigo)   9 23
   Tremor   5 13
   Convulsion   3   8   2   5
   Somnolence   3   8
   Coma   2   5   2   5
Respiratory
   Cough 26 65
   Dyspnea 21 53   4 10
   Epistaxis 10 25
   Hypoxia   9 23   4 10
   Pleural effusion   8 20 1   3
   Post nasal drip   5 13
   Wheezing   5 13
   Decreased breath sounds   4 10
   Crepitations   4 10
   Rales   4 10
   Hemoptysis   3   8
   Tachypnea   3   8
   Rhonchi   3   8
Skin & subcutaneous tissue disorders
   Dermatitis 17 43
   Pruritus 13 33   1   3
   Ecchymosis   8 20
   Dry Skin   6 15
   Erythema--non-specific   5 13
   Increased sweating   5 13
   Facial edema   3   8
   Night sweats   3   8
   Petechiae   3   8
   Hyperpigmentation   3   8
   Non-specific skin lesions   3   8
   Urticaria   3   8
   Local exfoliation   2   5
   Eyelid edema   2   5
Cardiac disorders
   Tachycardia 22 55
   ECG QT corrected interval prolonged > 500 msec 16 40
   Palpitations   4 10
   ECG abnormal other than QT interval prolongation   3   8
Infections and infestations
   Sinusitis   8 20
   Herpes simplex   5 13
   Upper respiratory tract infection   5 13   1   3
   Bacterial infection--non-specific   3   8   1   3
   Herpes zoster   3   8
   Nasopharyngitis   2   5
   Oral candidiasis   2   5
   Sepsis   2   5   2   5
Musculoskeletal, connective tissue and bone disorders
   Arthralgia 13 33   3   8
   Myalgia 10 25   2   5
   Bone pain   9 23   4 10
   Back pain   7 18   1   3
   Neck Pain   5 13
   Pain in limb   5 13   2   5
Hematologic disorders
   Leukocytosis 20 50   1   3
   Anemia   8 20   2   5
   Thrombocytopenia   7 18   5 13
   Febrile neutropenia   5 13   3   8
   Neutropenia   4 10   4 10
   Disseminated intravascular coagulation   3   8   3   8
   Lymphadenopathy   3   8
Vascular disorders
   Hypotension 10 25   2   5
   Flushing   4 10
   Hypertension   4 10
   Pallor 4 10
Psychiatric disorders
   Anxiety 12 30
   Depression   8 20
   Agitation   2   5
   Confusion   2   5
Ocular disorders
   Eye irritation   4 10
   Blurred vision   4 10
   Dry eye   3   8
   Painful red eye   2   5
Renal and urinary disorders
   Renal failure   3   8   1   3
   Renal impairment   3   8
   Oliguria   2   5
   Incontinence   2   5
Reproductive system disorders
   Vaginal hemorrhage   5 13
   Intermenstrual bleeding   3   8
Ear Disorders
   Earache   3   8
   Tinnitus   2   5

Page last updated: 2006-08-24

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