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Care During Chemotherapy and Beyond

Altretamine

(al-TRET-ah-meen)

Generic name: Altretamine

Trade name:Hexalen®

Other names:Hexamethylmelamine, HMM

Altretamine is the generic name for the trade drug name Hexalen. Hexamethylmelamine and HMM are other names for Altretamine. In some cases, health care professionals may use the trade name Hexalen or other names Hexamethylmelamine or HMM when referring to the generic drug name Altretamine.

Drug type: Altretamine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "alkylating agent." (For more detail, see "How this drug works" section below).

What Altretamine Is Used For:

  • Ovarian cancer

Note: if a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Altretamine Is Given:

  • Altretamine is taken by mouth in capsule form.
  • Altretamine should be taken after meals and at bedtime as directed
  • The amount of altretamine that you will receive depends on many factors, including your height, weight and tolerance of altretamine side effects. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of altretamine:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking altretamine:

These side effects are less common side effects (occuring in about 10-29%) of patients receiving altretamine:

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or heatlh care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Signs of infection, such as fever of 100.4°F (38°C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with urination, mouth sores, or wound that will not heal
  • Signs of an allergic reaction, like hives, itching, wheezing, tightness in the chest or throat, trouble breathing or talking, unusual hoarseness, or sweeling of the mouth, face, lips, or throat

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours after noticing any of the following:

  • Neusea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools or urine
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Extreme fatigue (unable to carry on self-care activities)
  • Excessive sleepiness, dizziness, confusion, or mood changes
  • Change in balance or trouble walking
  • A burning, numbness, or tingling feeling that is not normal

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting altretamin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking altretamine.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (altretamine may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.)
  • For both men and women: Do not conceive a child (get pregnant) while taking altretamine. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking this medication
  • Avoid taking a daily multivitamin while on altretamine, as certain vitamins such as vitamin B6 (pyridoxine) can decrease the effects of the medication

Self-Care Tips:

  • Take medication after meals - this decreases stomach problems.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon or baking soda and/or salt mixed with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • Avoid driving and tasks that require being alert until your response to this drug is well understood.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty or rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe several medications that can help you tolreate these side effects, significantly reduce their impact, and make you feel better.

Monitoring and Testing While Taking Altretamine:

You will be checked regularly by your doctor while you are taking altretamine, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. You will also have an exam of your reflexes and nerve function done before each cycle.

How Altretamine Works:

Chemotherapy (anti-neoplastic drugs)

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal check and balances in place that control an limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are call cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at whcih they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is often most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Altretamine is classified as an alkylating agent. Alkylating agenst are most active in the resting phase of the cell. These drugs are cell cycle non-specific and work by damaging DNA Altretamine has been shown to work on tumors resistant to other alkylating agents.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References:

Lexicomp: Altretamine.Lexicomp Online® [9/1/15; 10/12/15]. Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.; 10/12/15

Hexalen (package insert on the internet). Bloomington, MN: MGI Pharma, Inc ; [11/1/03; 10/12/15)]. Available from: http://hemonc.org/docs/packageinsert/altretamine.pdf

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