Gallium NitrateU.S. Brand Names: Ganite™
Synonyms: NSC-15200
Generic Available: No
Use: Treatment of hypercalcemia
Pregnancy Risk Factor: C
Pregnancy Implications: Reproduction studies have not been conducted.
Lactation: Excretion in breast milk unknown/not recommended
Contraindications: Hypersensitivity to gallium nitrate or any component of the formulation; severe renal dysfunction (creatinine >2.5 mg/dL)
Warnings/Precautions: Use caution with renal impairment or when administering other nephrotoxic drugs (eg, aminoglycosides, amphotericin B); consider discontinuing gallium nitrate during treatment with nephrotoxic drugs. Maintain adequate hydration. Use intended for the treatment of symptomatic cancer-related hypercalcemia not responding to hydration. Safety and efficacy in pediatric patients have not been established.
Adverse Reactions: Not all frequencies defined. Cardiovascular: Hypotension, tachycardia, edema of lower extremities Central nervous system: Lethargy, confusion, dreams, hallucinations, hypothermia, fever Dermatologic: Rash Endocrine & metabolic: Hypophosphatemia (>50%, usually asymptomatic); hypocalcemia; mild respiratory alkalosis with hyperchloremia Hematologic: Anemia, leukopenia Gastrointestinal: Nausea (14%, generally mild), vomiting, diarrhea, constipation Neuromuscular & skeletal: Paresthesia Renal: Nephrotoxicity (>10%, generally reversible and reported to be minimized with adequate hydration and urine output) Respiratory: Dyspnea, rales, rhonchi, pleural effusion, pulmonary infiltrates Note: Toxicities reported with doses higher than those used to treat hypercalcemia (ie, in trials evaluating anticancer effect): Optic neuritis, tinnitus, hearing acuity decreased, metallic taste, hypomagnesemia, encephalopathy
Overdosage/Toxicology: Symptoms of overdose include nausea, vomiting, and increased risk of nephrotoxicity.
Drug Interactions: Cyclophosphamide: Concurrent use of low dose gallium nitrate has been associated with dyspnea, stomatitis, asthenia, and rarely interstitial pneumonitis. Nephrotoxic drugs (eg, aminoglycosides, amphotericin B): Concurrent use with gallium nitrate may increase nephrotoxic effects.
Stability: Store unopened vials (25 mg/mL) at room temperature of 15°C to 30°C (59°F to 86°F); not light sensitive. Solutions in 0.9% NaCl or D5W are stable for 48 hours at room temperature or for 7 days under refrigeration at 2°C to 8°C (36°F to 46°F).
Compatibility: Compatible: Stable in NS, D5W
Mechanism of Action: Inhibits bone resorption by inhibiting osteoclast function
Pharmacodynamics/Kinetics: Onset of calcium lowering: Seen within 24-48 hours of beginning therapy, with normocalcemia achieved within 4-7 days of beginning therapy Bioavailability: Oral: 5% Distribution: Tissue concentrations were determined postmortem in one patient and concentrations were higher in liver and kidney than in lung, skin, muscle, heart, and cervix tumor; in dogs, tissue gallium concentrations were higher in renal cortex, bone, bone marrow, small intestine, and liver than in skeletal muscle and brain Half-life elimination: Alpha: 1.25 hours; Beta: ~24 hours Elimination half-life varies with method of administration (72-115 hours with prolonged intravenous infusion versus 24 hours with bolus administration); long elimination half-life may be related to slow release from tissue such as bone Excretion: Primarily renal with no prior metabolism in the liver or kidney
Dosage: I.V.: Adults: 200 mg/m 2/day for 5 days; duration may be shortened during a course if normocalcemia is achieved. If hypercalcemia is mild and with very few symptoms, 100 mg/m 2/day may be used. Dosage adjustment in renal impairment: Serum creatinine >2.5 mg/dL: Contraindicated Serum creatinine 2 to <2.5 mg/dL: No guidelines exist; frequent monitoring is recommended
Administration: Continuous I.V. infusion; daily dose is administered in 1000 mL of 0.9% NaCl or D5W
Monitoring Parameters: Renal function, serum calcium (daily), serum phosphorus (twice weekly)
Dental Health: Effects on Dental Treatment: No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions: No information available to require special precautions
Mental Health: Effects on Mental Status: None reported
Mental Health: Effects on Psychiatric Treatment: Nausea is common; risk may be increased with concomitant SSRI use
Oncology: Emetic Potential: Moderate (reported in 14% in one comparative trial, but reported as mild)
Oncology: Vesicant: Administered SubQ in human trials, but approved regimen for hypercalcemia is via I.V. infusion; no reports in the literature detailing extravasation or its consequences
Dosage Forms: Injection, solution [preservative free]: 25 mg/mL (20 mL)
| 
Email to a Friend 
(GAL ee um NYE trate)
