Care During Chemotherapy and Beyond



Trade name: Cosmegen®
Other name: Actinomycin-D

Dactinomycin is the generic name for the trade name drug Cosmegen®. In some cases, health care professionals may use the trade name Cosmegen or other name Actinomycin-D when referring to the generic drug name dactinomycin.

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

What Dactinomycin Is Used For:

Dactinomycin is used to treat:

  • Wilms' tumor
  • Childhood Rhabdomyosarcoma
  • Ovarian (germ cell) cancer
  • Gestational trophoblastic neoplasm
  • Ewing's sarcoma
  • Metastatic testicular tumors (nonseminomatous)
  • Gestational trophoblastic neoplasm
  • Locally recurrent or locoregional solid tumors (sarcomas, carcinomas and adenocarcinomas)
  • Soft tissue sarcoma
  • Osteosarcoma

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 Dactinomycin Is Given:

  • Dactinomycin is given through a vein (intravenous, IV)
  • Dactinomycin is classified as a vesicant medication, meaning it can cause damage to tissue that comes in direct contact with the drug. It needs to be given with extreme caution by a qualified medical professional. You should notify medical personnel immediately if you have pain or swelling at the infusion site.

The amount of dactinomycin that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of dactinomycin:

  • Most people do not experience all of the side effects of dactinomycin listed
  • Dactinomycin side effects are often predictable in terms of their onset, duration and severity.
  • Dactinomycin side effects will improve after therapy is complete. 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 of patients receiving dactinomycin:

  • Low blood counts Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
  • Onset: 7 days
  • Nadir: 14-21 days (Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts)
  • Recovery: 21-28 days
  • Hair loss (occurs within weeks).
  • Nausea and vomiting (occurs within hours to days)
  • Fatigue
  • Mouth sores (occurs within weeks)
  • Liver problems (hepatotoxicity and elevated liver enzymes)
  • Diarrhea (occurs within days to weeks)
  • Increased risk of infection
  • Loss of fertility Meaning, your ability to conceive or father a child may be affected by dactinomycin. Discuss this issue with your health care provider.

The following side effects are less common of patients receiving dactinomycin:

Delayed effects:
There is a slight risk of developing a secondary cancer months to years after taking dactinomycin. Talk to your doctor about this risk.

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 health care provider:

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

  • Fever of 100.4° F (38° C) or higher, chills (possible signs of infection).

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

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication).
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Extreme fatigue (unable to carry on self-care activities)
  • Mouth sores (painful redness, swelling or ulcers)
  • Severe skin rash with itching or peeling of the skin
  • Swelling of abdomen
  • Yellowing of eyes or skin
  • Change in the color of stool (pale in color) or urine (tea colored)
  • Pain, redness or swelling at IV site

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


  • Before starting dactinomycin 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 take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Dactinomycin should not be given if you have or have been exposed to chicken pox or if you have recently had shingles.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking dactinomycin.
  • Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (dactinomycin 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 dactinomycin. 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.

Self-Care Tips:

  • Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor.
  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • 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 of baking soda and/or 1/2 to 1 teaspoon of 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.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking dactinomycin, 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.

How Dactinomycin Works:

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 checks and balances in place that control and 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 the 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 called 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 which 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 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.

Chemotherapy (anti-neoplastic drugs) is divided into five classes based on how they work to kill cancer. Although these drugs are divided into groups, there is some overlap among some of the specific drugs. The following are the types of chemotherapy:

Antitumor Antibiotics:
Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces. These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific. There are several types of antitumor antibiotics, dactinomycin belongs to the chromomycin category.

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. is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit