Streptozocin

Streptozocin is used to treat metastatic islet cell cancer of the pancreas. Streptozocin is used off-label to treat carcinoid syndrome.

Streptozocin is available under the following different brand names: Zanosar.

Dosages of Streptozocin:

Dosage Forms and Strengths

Powder for Injection

• 1 g/vial

Dosage Considerations – Should be Given as Follows:

Metastatic Islet Cell Cancer of Pancreas

Single-agent therapy

• 1000 mg/m² intravenously (IV) once weekly, may increase to no more than 1500 mg/m²
• Risk of azotemia increase with greater than 1500 mg/m²
• Monitor: complete blood count, liver function tests, renal function

Combination therapy

• 500 mg/m²/day IV for 5 days every 4-6 weeks
• Monitor: complete blood count, liver function tests, renal function

Renal Impairment

• CrCl greater than 50 mL/min: May administer the full dose
• CrCl: 10-50 mL/min: 75% of regular dose
• CrCl: less than 10 mL/min: 50% of regular dose

Other Indications and Uses

• Metastatic islet cell cancer of the pancreas
• Off-label: carcinoid syndrome

Not recommended for pediatric patients

Common side effects of streptozocin include:

• Kidney toxicity (up to 75%)
• Vomiting (up to 90% if no antiemetic)
• Metabolic changes, including elevated liver functions tests, increased lactate dehydrogenase (LDH)
• Low blood sugar (hypoglycemia)
• Myelosuppression

Other side effects of streptozocin include:

• Confusion
• Lethargy
• Depression
• Nausea
• Fever
• Chills
• Hematologic toxicity (fatal reported)
• Injection site reactions
• Decreased liver function
• Yellowing skin and eyes (jaundice)
• Nail changes

Rare side effects of streptozocin include:

• Nephrogenic diabetes insipidus

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe interactions of streptozocin include:
  • amphotericin B deoxycholate
  • tenofovir DF
• Serious interactions of streptozocin include:
  • cidofovir
  • deferiprone
  • ioversol
  • palifermin
  • tofacitinib
• Streptozocin has moderate interactions with at least <41 different drugs.
• Mild interactions of streptozocin include:
  • vitamin A
  • vitamin E

Warnings

• This medication contains streptozocin. Do not take Zanosar if you are allergic to streptozocin or any ingredients contained in this drug.

Black Box Warnings

• The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to monitor drug tolerance and to protect and maintain a patient compromised by drug toxicity
• Renal toxicity is dose-related and cumulative and may be severe or fatal
• Nausea and vomiting may be severe and treatment-limiting at times
• Liver dysfunction, diarrhea, and hematologic changes reported
• Parenteral streptozocin is mutagenic and found to be tumorigenic in some rodents
• The physician must weigh risks versus benefits to the patient

Contraindications

• Hypersensitivity
• Pregnancy

Effects of Drug Abuse

• No information is available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Streptozocin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Streptozocin?"

Cautions

• Risk of severe nephrotoxicity, dose-related and cumulative (i.e., greater than 1500 mg/m²/dose may cause azotemia)
• Risk of severe nausea/vomiting
• Rapid infusion may cause a burning sensation
• May alter glucose metabolism in some patients
• Avoid pregnancy

Pregnancy and Lactation

• Use streptozocin during pregnancy in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk.
• It is not known if streptozocin is excreted in breast milk. Breastfeeding is not recommended while using streptozocin.