Procarbazine

MATULANE

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Pronunciation: proe-KAR-ba-zeen

Procarbazine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Procarbazine ballicule

What it isAlkylating agent generating methyl radicals; Hodgkin lymphoma and brain tumors.

Why this oneIt penetrates the CNS well, which is why it persists in brain tumor regimens.

What limits it⚑ It is a weak MAO inhibitor — tyramine and serotonergic interactions apply. Disulfiram-like reaction with alcohol; secondary leukemia.

Procarbazine molecular structure (skeletal formula) — Molecular structure: Procarbazine

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Administer only by or under supervision of a physician experienced with potent antineoplastic drugs; adequate clinical and laboratory facilities must be available.

FDA dosing	Population	Start	Target	Max
Hodgkin lymphoma (single agent)	Adult	2-4 mg/kg/day x1 week	4-6 mg/kg/day until response	maintenance 1-2 mg/kg/day
Hodgkin lymphoma (single agent)	Pediatric	50 mg/m²/day x1 week	100 mg/m²/day until response	maintenance 50 mg/m²/day

Renal Undefined

Hepatic Undefined

Instructions

Base dose on actual weight (use lean body mass if obese/edematous)
Discontinue if WBC <4000/cmm or platelets <100,000/cmm, then resume at 1-2 mg/kg/day after recovery
In MOPP combination, dose is 100 mg/m²/day x14 days
Avoid tyramine-rich foods, alcohol, and sympathomimetics (MAOI activity)

Available strengths

cap 50 mg

Contraindications

Inadequate bone marrow reserve (by bone marrow aspiration)

Cautions

Myelosuppression (leukopenia, thrombopenia, anemia)
MAOI activity — hypertensive reactions with tyramine/sympathomimetics; disulfiram-like reaction with alcohol
CNS toxicity (tremors, coma, convulsions)
Secondary malignancies and azoospermia
Hepatic dysfunction

Adverse reactions

Leukopenia, anemia, thrombocytopenia, pancytopenia
Nausea and vomiting
Neurologic: coma, convulsions, neuropathy, ataxia, paresthesia
Hepatic dysfunction, jaundice
Dermatologic: dermatitis, alopecia, hyperpigmentation

Pregnancy Can cause fetal harm; teratogenic; advise women of childbearing potential to avoid pregnancy

Lactation Undefined

Cost

Procarbazine (MATULANE)

Strength		#/mo	generic $/unit	CostPlus
50 mg	cap	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Procarbazine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entryNo US generic

⚠ BOXED WARNING

Administer under supervision of an experienced physician

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityMyelosuppression and agent-specific hepatic, cardiac, pulmonary, neurologic or reproductive toxicity require oncology monitoring.

Serotonin and MAOI

Provisional washout figures

SRI significance0 / 4

MAO-A inhibition2 / 4

Serotonin release0 / 4

Elevating mechanismMAO-A inhibitor

Non-elevating actionNone recorded

Exposure dependenceTherapeutic exposure

Washout AFTER an MAOI14 days

Evidence confidenceHigh

InterpretationAntineoplastic with clinically relevant MAOI activity; manage as an MAOI for PD interaction screening.

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