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INTRODUCTION

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HIGH ALERT

altretamine (al-tret-a-meen)

Hexalen, Image not available.Hexastat

Other Names:

hexamethylmelamine

Classification

Therapeutic: antineoplastics

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Indications
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Management of ovarian cancer unresponsive to treatment with other agents.

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Action
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Mechanism unknown, but may disrupt DNA and RNA synthesis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, fatigue. GI: nausea, vomiting, anorexia, hepatic toxicity. GU: renal toxicity. Derm: alopecia, pruritus, skin rash. Endo: gonadal suppression. Hemat: anemia, leukopenia, thrombocytopenia. Neuro: peripheral neuropathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • Assess signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

  • Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

  • Monitor signs of renal toxicity, including blood or pus in urine, decreased urine output, weight gain from fluid retention, and fatigue. Report these signs to the physician or nursing staff.

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Interventions
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  • For patients who are medically able to begin exercise, implement appropriate resistive exercises, and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy, or to help restore function after chemotherapy.

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and avoid crowds and contact with persons with contagious diseases.

  • Advise patient about the likelihood of GI reactions (nausea, vomiting, loss of appetite). Instruct patient or family and caregivers to report severe or unexpected GI reactions, and also to report signs of hepatotoxicity, including abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising.

  • Advise patient that rash and other skin reactions (itching, hair loss) are likely. Report severe or unexpected skin reactions to the physician.

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Pharmacokinetics
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Absorption: Well absorbed following oral administration. Requires metabolism for conversion to antineoplastic compounds.

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Distribution: Reaches high concentrations in liver, kidney, and small intestine. Poor penetration into brain.

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Metabolism and Excretion: Mostly metabolized by the liver to compounds with antineoplastic activity.

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Half-life: 4.7–10.2 hr.

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TIME/ACTION PROFILE (effects on blood counts)

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ROUTE ONSET PEAK DURATION
PO unknown 3–4 wk 6 wk

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