Pharmacological Class
- Alkylating-like agent
- Hydrazine derivative
- Monofunctional alkylator (not a classic bifunctional alkylating agent)
Mechanism of Action
- Converted to active metabolites in the liver.
- Generates alkylating species + reactive oxygen radicals.
- Causes:
- Also has MAO-inhibitory activity → relevant for drug–food interactions.
Clinical Indications
- Component of the MOPP regimen (Mechlorethamine, Oncovin [vincristine], Procarbazine, Prednisone) for Hodgkin lymphoma.
- Sometimes used in brain tumors (gliomas, astrocytomas) as part of PCV regimen (Procarbazine, CCNU [lomustine], Vincristine).
Administration & Dosing
- Oral capsule.
- Adult: Typically 100 mg/m²/day (variable depending on protocol/regimen).
- Pediatric dosing: based on body surface area, adjusted for regimen.
- Always part of combination chemotherapy, not used alone.
Toxicities & Monitoring
- Myelosuppression → dose-limiting (monitor CBC).
- Nausea/vomiting → highly emetogenic.
- Neurotoxicity → drowsiness, mood changes, peripheral neuropathy.
- Secondary malignancies (AML, MDS risk).
- Drug–Food Interactions (because of MAOI activity):
- Avoid tyramine-rich foods (cheese, wine, fermented products) → hypertensive crisis risk.
- Avoid interacting drugs (sympathomimetics, SSRIs, TCAs, etc.).
Key Clinical Pearls (for Oncology Pharmacist)
- Rarely used today as frontline due to toxicity, but still important in some Hodgkin lymphoma salvage regimens and CNS tumors (PCV regimen).
- Counsel patients on diet restrictions (low-tyramine diet).
- Monitor for myelosuppression, CNS effects, and secondary malignancies.
- Be aware of drug–drug interactions (especially with antidepressants, decongestants, and alcohol).
In short:
Procarbazine is an oral hydrazine derivative, alkylating-like antineoplastic, used mainly in Hodgkin lymphoma (MOPP) and brain tumors (PCV). It inhibits DNA synthesis through alkylation and free radicals, with key toxicities of myelosuppression, neurotoxicity, high emetogenicity, and MAOI-like interactions.
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