Trade Name: Matulane ^®

Drug type:

Procarbazine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Procarbazine is classified as an "alkylating agent."  (For more detail, see "How Procarbazine Works" section below).

What Procarbazine Is Used For:

• Treatment of Hodgkin's disease. 
• Other uses include non-Hodgkin's lymphoma, brain tumors, melanoma, lung cancer, and multiple myeloma.

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

How Procarbazine Is Given:

• Procarbazine is taken in capsule form by mouth.  It comes in 50 mg capsule strength. 
• The amount of Procarbazine you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer you have.  Your doctor will determine your exact dosage and schedule.

Side Effects:

Important things to remember about the side effects of Procarbazine:

• 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 Procarbazine:

• Low white blood cell count (can put you at increased risk for infection).
• Low platelet count (can put you at increased risk for bleeding).

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: none noted
Nadir: 3 to 6 weeks after therapy.
Recovery: platelets 4-6 weeks

• Nausea and vomiting may occur early in therapy
• Poor appetite

The following are less common side effects (occurring in 10 -29%) for patients receiving Procarbazine:

• Hair loss.
• Mouth sores.
• Diarrhea.
• Constipation.
• Flu-like symptoms (fever, chills, generalized aches and pains). Usually in the first days of treatment then resolves.
• Central neurotoxicity: weakness, loss of balance, headache, unsteadiness, drowsiness or dizziness.
• Hypersensitivity reaction (see allergic reaction) rash, itching, hives, flushing.  If pneumonitis (see lung problems) occurs treatment may be stopped.
• Loss of fertility.  Meaning, your ability to conceive or father a child may be affected by Procarbazine.  Discuss this issue with your health care provider.

Delayed Effects of Procarbazine:

• There is a slight risk of developing a blood cancer such as leukemia years after taking Procarbazine.  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:

Seek emergency help immediately and notify your health care provider, it you experience the following symptoms:

• Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

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), chills (possible signs of infection)

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

• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• 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)
• Constipation unrelieved by laxative use
• Severe abdominal pain
• Mouth sores (painful redness, swelling or ulcers)
• Painful urination
• Severe numbness, bone or joint pain
• Feeling faint or dizzy
• Extreme fatigue (unable to carry on self-care activities)
• Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.

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

Precautions:

• Before starting Procarbazine treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  Do not take aspirin or products containing aspirin unless your doctor permits this.

There are certain foods and beverages that may cause bad side effects when taken in combination with this medicine. Your blood pressure may become too high. While you are taking this medicine, and for 2 weeks after you stop taking it, do not eat or drink any of the following: 

• Beverages: Avoid caffeine (as found in coffee, tea, colas, and chocolate), beer (even some non-alcoholic brands), red wine, sherry, distilled spirits, and all liqueurs.
• Dairy and Grains: Avoid most types of strong, aged cheeses and yogurt. Stay away from fava beans; especially if they are over ripened).
• Meat or fish: Avoid anchovies, shrimp paste, caviar, beef and chicken livers, or wild game meat. Also avoid using meat extracts, or meat or fish (including dried fish, sausage, bologna, pepperoni, and salami) that is fermented, spoiled, kept un-refrigerated, pickled, prepared with tenderizers, or smoked.
• Fruits and Vegetables: Raspberries, figs (either canned or overripe), bananas, dried fruit such as raisins and prunes, avocados. Stay away from miso soup (soybean soup), soy sauce and sauerkraut. 
• Herbs: Do not take any before consulting your healthcare provider; especially ginseng.
• Do not take any over-the-counter medications, including cold remedies, and herbals, before consulting with your healthcare provider. Most of the over-the-counter medicines and herbs may cause extremely high blood pressure in combination with Procarbazine. 
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking Procarbazine.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category D Procarbazine 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 Procarbazine. 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 Procarbazine.

Self-Care Tips:

• Procarbazine may cause you to be drowsy or dizzy. Do not attempt to operate heavy machinery, unless you know how you will react to the medication. Try to avoid taking with other medications that may make you sleepy, such as sedatives, antihistamines, or sleeping pills. You should discuss this with your healthcare provider. 
• In general, drinking all types of alcoholic beverages should be avoided.  You could experience severe nausea and vomiting, as drinking alcohol may interact with this medicine. 
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by Procarbazine. 
• Drink 2 to 3 quarts of fluid every 24 hours, unless you were told to restrict your fluid intake, and maintain good nutrition. This will decrease your chances of being constipated, and prevent dehydration.
• For flu-like symptoms, keep warm with blankets and drink plenty of liquids.
• Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains.  However, be sure to talk with your doctor before taking it.
• You may be at risk of infection so try to avoid crowds or people with colds or not feeling well and report fever or any other signs of infection immediately to your healthcare provider. 
• Wash your hands often.
• Use an electric razor and soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• Avoid sun exposure.  Wear SPF 15 (or higher) sun block and protective clothing, as you will be very susceptible to sun burns.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• 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.
• 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.
• Do not share your pills with anyone.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking Procarbazine, 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 Procarbazine 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:

Procarbazine is classified as an alkylating agent.  Alkylating agents are most active in the resting phase of the cell.  These drugs are cell-cycle non-specific.  There are several types of alkylating agents.

• Mustard gas derivatives:  Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan, and Ifosfamide. 
• Ethylenimines:  Thiotepa and Hexamethylmelamine.
• Alkylsulfonates:  Busulfan.
• Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine and Temozolomide. 
• Nitrosureas:  Carmustine, Lomustine and Streptozocin.  Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain barrier.  They can be useful in treating brain tumors.
• Metal salts:  Carboplatin, Cisplatin, and Oxaliplatin.

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.

Chemocare.com 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 www.4thangel.org