Medical uses of ATGAM Injection

ATGAM is introduced to manage the allograft rejection in the recipients of renal transplant; when used along with conventional therapy at the moment of rejection this agent increases the frequency of the resolution of the acute rejection episode. 

ATGAM is approved to treat moderate/severe aplastic anemia in recipients unsuitable for the bone marrow transplantation.

The usefulness of atgam injection has not been shown in recipients with aplastic anemia who are suitable candidates for bone marrow transplantation or in recipients with aplastic anemia secondary to neoplastic disease, Fanconi's syndrome, storage disease, myelofibrosis, or in patients known to have been exposed to radiation or myelotoxic agents.

Approval: The ATGAM injection is approved in the US (United States):

• In order to manage moderate/severe aplastic anemia (a blood disorder that damages stem cells).

• In order to prevent the body from rejecting a kidney transplant.

Dosage Form: ATGAM comes in the form of injection. It is intended for intravenous use only with concomitant immunosuppressants. While repeat courses of ATGAM, observe the recipients for signs of allergic reactions. 

The recommended dose of ATG injection for Renal Allograft Recipients is 10 to 15 mg per kg daily administered intravenously for 2 weeks. The supplementary alternate day therapy up to a total of 21 doses can be administered.

The recommended dose for Aplastic Anemia (Moderate to Severe) is 10 to 20 mg per kg daily administered intravenously for 8 to 14 days. The supplementary alternate day therapy up to a total of twenty one doses can be given. Because thrombocytopenia can be related with the use of ATGAM, patients with this therapy for their aplastic anemia may require prophylactic platelet transfusions in order to maintain the count of platelets at the clinically acceptable levels.

Side Effects: Side effects of ATGAM are usually mild and not life threatening. The most commonly reported side effects include chills, fever, nausea, vomiting, diarrhea, dizziness, hives and headache. These side effects due to ATGAM usually go away following treatment.

Cost: The atgam injection price in India may vary depending on the wholesaler or pharmacy and of course the brand you choose. The cost of atgam injection usually depends on the branded to non-branded drugs and certain other factors. 

Medical uses of Octreotide Injection

Octreotide acetate is used for reducing blood levels of growth hormone and IGF-I (somatomedin C) in acromegaly patients who haven't had adequate response to or cannot be treated with surgical resection, pituitary irradiation, and bromocriptine mesylate at maximally tolerated doses.

The octreotide injection is also used for the symptomatic treatment of patients with metastatic carcinoid tumors where this agent is believed to suppress or block the severe diarrhea and flushing episodes associated with the disease.

Octreotide acetate is used in order to treat the profuse watery diarrhea associated with the VIP-secreting tumors. 

Approval: As an octapeptide, the medication octreotide mimics the natural somatostatin pharmacologically, though it is an absolutely potent inhibitor of growth hormone, glucagon, and insulin in comparison to the natural hormone. 

In 1979 Octreotide was initially synthesized by Wilfried Bauer, and binds predominantly to the somatostatin receptors SSTR2 & SSTR5. In 1988 Octreotide was approved for use in the United States.

Dosage Form: Octreotide comes in the form of injection generically and under the brand name Sandostatin. Always use octreotide 100 mcg as per words by a healthcare professional. Depending on the complication being treated, Octreotide is administered by subcutaneous (under the skin) injection or intravenous (into a vein) infusion. In case patients have liver cirrhosis (chronic liver disease), their doctor may need to adjust their maintenance dose. A doctor will explain to a patient how to inject Octreotide injection under the skin, but infusion into a vein must always be performed by a healthcare practitioner.

Side Effects: Side effects of octreotide are usually mild and not life threatening. The commonly reported side effects may include vomiting, headache, hypothyroidism, cardiac conduction changes, diarrhoea, constipation, gallstones, reduction of insulin release, slow heart rate, nausea, injection site reactions, skin reactions and cramps. 

Cost: The octreotide injection price in India may vary depending on the wholesaler or pharmacy and of course the brand you choose. The cost of octreotide 0.05 mg is around Rs. 380 for a supply of vial of 1 injection. 

Medical uses of Artesunate

Artesunate injection is an antimalarial agent introduced as an initial treatment of severe malaria in adult/pediatric patients. Treatment of severe malaria with artesunate 60 mg injection must always be followed by a full treatment course of an apt oral antimalarial regimen.

Artesunate injection basically does not treat the hypnozoite liver stage forms of Plasmodium and is therefore unable to prevent the relapses of malaria because of the Plasmodium vivax or Plasmodium ovale.

The concomitant therapy and an antimalarial medication such as an 8-aminoquinoline are important in treating severe malaria due to P. vivax or P. ovale.

Approval: Artesunate specifically falls under the artemisinin class of medication. In 1977, it was developed by Liu Xu. It is on the WHO's List of Essential Medicines. In May 2020, it was approved for medical use in the United States.

Dosage Form: Artesunate comes in the form of injection generically and under the brand name Falcigo. The standard dose of artesunate injection is 2.4 mg per kg given intravenously at 0 hours, 12 hours, and 24 hours, and thereafter, administered once in a day until the patient is capable of tolerating the oral antimalarial therapy.

Side Effects: Side effects of artesunate are usually mild and not life threatening. The commonly reported side effects may include kidney failure requiring dialysis, jaundice, and hemoglobinuria (the presence of hemoglobin in urine).

Cost: The artesunate 60 mg price in India may vary depending on the wholesaler or pharmacy and of course the brand you choose. The cost of artesunate is around Rs. 224 for a supply of vial of 1 injection. 

Medical uses of Cisplatin Injection

Cisplatin is a well-known chemotherapeutic agent. It is used for treatment of numerous human cancers including lung, bladder, head and neck, ovarian, and testicular cancers. The cisplatin injection is effective against several types of cancers, including lymphomas, carcinomas, germ cell tumors, and sarcomas. Its mode of action has been associated with its ability in order to crosslink with the purine bases on the DNA; interfering with the DNA repair mechanisms, causing the DNA damage, and subsequently inducing the apoptosis in the cancerous cells.

The combination therapies of cisplatin with certain other medications have been highly considered in order to overcome the drug resistance and reduce the toxicity. 

Approval: Cisplatin falls under the platinum based antineoplastic family of drugs, which works in part in order to bind to the DNA and inhibits its replication.

In the year of 1845, this agent was discovered and licensed for medical use in 1978 & 1979.

Dosage Form: Cisplatin comes in the form of injection generically and under the brand name Platinol. The recommended dose of cisplatin for injection should be administered intravenously. 

The recommended dose of cisplatin for advanced testicular cancer is 20 mg/m2 daily for 5 days per cycle. 

The recommended dose of cisplatin for advanced ovarian cancer: 75 mg/m2 to 100 mg/m2 per cycle once every 3-4 weeks. 

The recommended dose for advanced bladder cancer is cisplatin 50 mg/m2 to 70 mg/m2 intravenously per cycle once every 3-4 weeks. 

Side Effects: Side effects of cisplatin are usually not life threatening. The commonly reported side effects include nephrotoxicity, myelosuppression, peripheral neuropathy, nausea, vomiting, and ototoxicity. 

Cost: The cisplatin price in India may vary depending on the wholesaler/pharmacy and of course the brand you choose. The cost of cisplatin starts from around 278 INR to 590 INR for a supply of a single vial of injection. 

Lenalidomide History

Lenalidomide, which is sold under the name of revlimid, is used for the treatment of MM (Multiple Myeloma) and myelodysplastic syndromes (is a group of cancers in which immature blood cells in the bone marrow do not mature, so do not become healthy blood cells).

Before knowing history, one needs to know that thalidomide, a pioneer to lenalidomide, was not developed for the treatment of multiple myeloma. It is said that the history of lenalidomide is one of the most interesting stories in medical science. In the late 50s when thalidomide developed it was known as sleeping pills because people feel sleepy after taking that. And when it was developed no one knew about the exact mechanism of medication.

In the early 60s when pregnant women inhaled thalidomide for morning sickness it was observed that they gave birth to babies with malformations. After that, it was felt that the drug is for some other mechanism too.

In 1971, the concept discovered called anti-angiogenesis which involves blocking the formation of new blood vessels important for a tumor to survive. Then only this showed progress by preventing the growth of new blood vessels. Then when thalidomide and then lenalidomide came into the spotlight.

Approval history

On December 27, 2005, lenalidomide was first approved by the US Food and Drug Administration for the treatment of multiple myeloma who received at least one prior therapy.

Dosage and usage 

After knowing about the history of lenalidomide, it is important to know about the drugs how and when to consume them. First of all, it is recommended to consult the doctor, and is not advisable to consume any drug dose without the doctor's prescription.

The lenalidomide is in a form of a capsule and strength of 2.5mg, 5mg, 10mg, 15mg, 20mg, and 25mg. Lenalidomide is suggested to be taken daily once orally at the same time. Lenalidomide should be swallowed fully with water and not break, crush or split.

Usage of medication in Multiple Myeloma (MM) as starting dose is 25mg once daily from Day 1 to day 21 repeated 28 days cycle.

Later we all see this part called pricing. Lenalidomide price in India is different and depends on different trade such as 

• Lenalid cost approximately Rs. 4386 – Rs. 9297
• Lenmid cost approximately Rs795 –Rs 2797
• Lenid cost approximately Rs 1500 – Rs 2900

Carfilzomib along with immunomodulatory drugs, and dexamethasone for Relapsed/Refractory Multiple Myeloma

The triplet carfilzomib, immunomodulatory drugs, and dexamethasone has shown effective outcomes for the treatment of relapsed/refractory (R/R) multiple myeloma.

Apart from this, for numerous authorities, this combination has a little bit of a high cost. On behalf of new data, this triplet (carfilzomib, thalidomide, and dexamethasone) could be a safe as well as a cost-effective alternative.

The carried out study enrolled patients with relapsed/refractory MM who had between 1 to 3 prior lines of treatment. Total 83 of the patients had a median age of about 66 years. Patients were taken 12 cycles, each lasting one month, of this triplet.

The main result that is measured at the end of a study in order to see if a given treatment worked was PFS (Progression-Free Survival). Secondary endpoints were ORR (Overall Response Rate), OS (Overall Survival), SE (side effects), and QoL (Quality of Life).

The median progression-free survival was noted as 20 months. The progression free survival rate at 6.5 months was noted as 76.2%. Median OS has not been achieved in the carried out study. The combination achieved an overall response rate of 86.4%.

Maximum side effects noted in the study population were grade 2 or lower. The most commonly reported side effects were peripheral neuropathy, with 16% of patients reporting, followed by upper respiratory tract infections in 12% of patients. Those most recent data indicates that 41% of patients have completed 18 cycles of treatment.

An interview was held in between Targeted Oncology and Hang Quach, MD, a consultant clinical and laboratory haematologist at St. Vincent’s Hospital, in which Hang Quach discussed the phase-II Australasian Leukaemia and Lymphoma Group multiple myeloma 018/ Asian Myeloma Network 002 study and how it can be responsible for impacting the treatment of relapsed/refractory MM in the future.

Reference:

https://www.targetedonc.com/view/expert-reviews-results-of-carfilzomib-combination-in-r-r-multiple-myeloma

Zoledronic Acid: A Bisphosphonate Therapy

Zoledronic acid injection, also addressed as zoledronate, specifically is a drug prescribed for the treatment of bone diseases including high blood calcium due to cancer, bone breakdown due to cancer, osteoporosis, and Paget’s disease of bone. 

Mechanism of Action: Zoledronic acid falls under a class of substances named Bisphosphonates. It binds specifically to bone and it does not stay in your blood. The zoledronic acid injection helps in order to slow down the bone resorption (caused by osteoclasts) which enables the bone-forming cells (osteoblasts) time in order to rebuild the normal bone.

Dosage & Administration: The zoledronic acid injection is administered as an infusion into a vein for 15 minutes by your healthcare practitioner. 

Your healthcare practitioner will recommend you to consume at least 2 glasses of water (500 mL or 2 cups) prior to and following the treatment.

In order to prevent Osteoporosis, 5 mg should be given as a single dose.

In order to prevent Paget’s disease, 5 mg should be given as a single dose.

The zoledronic injection may work for over 1 year, and your healthcare professionals will inform you in case you need to be treated again. 

It is crucial to take calcium as well as vitamin D supplements as directed by your healthcare practitioner in order to reduce the probability of having reduced blood calcium levels, to prevent the loss of bone and to help rebuild the bone.

Possible Side Effects: Like all drugs, zoledronic acid injection may also be responsible for causing some unwanted adverse reactions in addition to its beneficial effects.

The most common zoledronic acid side effects include:

• Fever
• Fatigue
• Chills
• Headache
• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Back pain
• Pain in extremity
• Influenza-like illness
• Weakness
• Pain
• Shortness of breath
• Dizziness
• Excessive sweating
• Tiredness
• Disturbed digestion
• Decreased appetite
• Non-cardiac chest pain
• Malaise (unwell feeling)
• Bone, joint or muscle pain or stiffness

Other side effects: There's possibility that some other side effects due to zoledronic acid infusion may also occur, which are listed as follows:

• Numbness
• Tingling sensations
• Allergic reactions
• Urinary tract infection
• Constipation
• High blood cholesterol levels
• Pain in jaw
• Pain in neck
• Joint sprain
• Post-traumatic pain
• Cough
• Seasonal allergy
• Vaginal dryness
• Congestion of the nose
• Pharyngolaryngeal pain 
• Increased or irregular heartbeat
• Rheumatoid arthritis/arthritis (inflammation of the joints)

Warning & Precautions:

• Administration of zoledronic acid injection is not recommended for patients aged under 18 years.
• Prior to taking zoledronate infusion talk to your doctor if you're unable to take daily calcium/vitamin D supplements. 
• Ensure that you have talked about zoledronic acid injection treatment with your healthcare practitioner. 
• In case you're taking treatment with another intravenous form of zoledronic acid 4mg, you're not allowed to be treated with the zoledronic acid injection.
• In case you're being treated with this injection, treatment should be avoided with other bisphosphonates (such as risedronate, alendronate, clodronate, etidronate, pamidronate and ibandronate) at the same time.
• Use of zoledronate is not recommended in case you are pregnant or plan to become pregnant or are breast-feeding.
• Talk to your healthcare practitioner in case you've any pain in your hip, groin, or thigh. This injection may be responsible for causing the unusual fractures in the thigh bone.
• Inform your doctor if you've a sudden headache, numbness in your limbs, confusion, trouble talking, vision problems, and trouble walking.
• Tell your healthcare team if you have kidney problems. Cases of worsening of kidney function, including kidney failure may happen when you take the zoledronic acid 4mg injection.

Drug Interactions: You need to inform your healthcare team in case you're taking or have recently taken any other drugs, including any kind of drug you have bought without a prescription. It is specifically crucial for your healthcare team to know if you are taking :

• any drugs known to be harmful to your kidneys (such as Non-Steroidal Anti-inflammatory Drugs).
• water pill (diuretics)
• aminoglycoside antibiotics (a type of drug used to treat severe infections).

Drug Overdose: In case you have received or taken too much zoledronic acid dose, contact your healthcare practitioner, hospital emergency department as soon as you can, even if there are no signs and symptoms.

Storage Guidelines: Store these injections at the room-temperature between 15°C-30°C. Original packaging should be kept unchanged as well as sealed until a healthcare practitioner administers the inj zoledronic acid. Don't forget to keep the injection and all drugs safely away from the children.

Cost: The zoledronic acid price may vary from branded (innovator) to non-branded (generic) drugs. The price for a bottle of Aclasta 5mg/100ml Infusion (Trade Name) is around 20492 INR. 

Frequently Asked Questions:

From which class of drug Zoledronic acid belongs? 

Zoledronic acid specifically belongs to a class of drugs named bisphosphonates that helps in order to prevent the abnormal breakdown of bones.

What is Zoledronic acid? What is it used for?

Zoledronic acid is used in order to prevent and treat osteoporosis and fractures in patients with metastatic cancer (a cancer which spreads to newer areas of the body). This drug can also be used in order to treat hypercalcemia (elevated blood calcium levels).

How should Zoledronic acid be given? 

Zoledronic acid is given by injection into a vein.

How does Zoledronic acid act? 

Zoledronic acid acs in order to block the activity of osteoclast cells and thus reduces the bone breakdown. 

How long should I take Zoledronic acid?

This medication should be taken in the dose as well as duration recommended by healthcare professionals. Zoledronic takes around 6-month in order to show its maximum benefits on bones. Although, in certain cases, the healthcare practitioner may suggest this medication for a longer period of time. The appropriate duration will depend on the condition you're currently being treated for.

What are the commonly reported side effects of Zoledronic acid? 

Commonly reported side effects of Zoledronic acid include joint pain, high blood pressure, fever, diarrhea, and feeling tired.

What are the severe side effects of Zoledronic acid? 

Severe side effects of Zoledronic acid may include low blood calcium, osteonecrosis of the jaw and kidney problems. 

What if Zoledronic acid is used during pregnancy? 

Use of zoledronic acid during pregnancy may be responsible for harm to the baby.

NOTE: The information provided about zoledronic acid injection in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.