Arsenic trioxide
Arsenic trioxide is a commercially available treatment for patients with acute promyelocytic leukemia (a rare form of acute myeloid leukemia). It’s indicated when standard therapy has failed.
Pharmacokinetics
Arsenic trioxide is administered I.V. because it’s inadequately absorbed orally. The metabolism of arsenic trioxide involves reduction via arsenate reductase, with subsequent methylation to inactive metabolites in urine. Arsenic is distributed in the heart, liver, kidney, lung, hair, and nails.
Pharmacodynamics
Arsenic trioxide causes DNA fragmentation.
Pharmacotherapeutics
Arsenic trioxide is used to treat acute promyelocytic leukemia that has relapsed after standard chemotherapy. It’s also being investigated for treatment of multiple myeloma.
Drug interactions
Giving arsenic trioxide with other drugs known to prolong the QT interval may increase the risk of cardiac arrhythmias.
Warning!
Adverse reactions to arsenic trioxide
Arsenic trioxide can cause electrocardiogram abnormalities, which could progress to life-threatening cardiac arrhythmias. Other adverse reactions include:
- anxiety
- dizziness
- headache
- hypocalcemia
- insomnia
- liver damage
- muscle and bone aches
- nausea and vomiting
- rash
- tremor.
Safe and sound
Preventing the fatal effects of arsenic
Arsenic trioxide has been linked to acute promyelocytic leukemia (APL) differentiation syndrome. To prevent its life-threatening effects, follow these guidelines:
- Monitor the patient for signs and symptoms of APL differentiation syndrome, including dyspnea, weight gain, pulmonary infiltrates, and pleural or pericardial effusion with or without leukocytosis.
- If you detect any of these signs or symptoms, notify the prescriber immediately.
- Expect to treat the syndrome with high doses of corticosteroids.
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