III. Contraindications

  1. Active Varicella Zoster Virus (Chicken Pox)
  2. Active Shingles (Herpes Zoster)
  3. Age <6 months

IV. Mechanism

  1. See Antibiotic Chemotherapy
  2. Dactinomycin is a chromopeptide Antineoplastic Antibiotic extracted from the bacterium Streptomyces parvulus
  3. Dactinomycin inserts between adjacent guanine-cytosine base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  4. Dactinomycin also induces single stranded DNA breaks by several postulated mechanisms
    1. Free-radical intermediate
    2. Topoisomerase 2 interaction

V. Medications

  1. Dactinomycin injection powder for solution in 0.5 mg vials

VI. Dosing

  1. See other references for disease specific dosing protocols
  2. Caution that dosing units may be written in either mg or mcg

VII. Adverse Effects

  1. Alopecia
  2. Myelosuppression
  3. Severe skin and soft tissue necrosis on extravasation
    1. Dactinomycin is a strong Vesicant (causes Blistering)

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception

IX. Resources

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