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تعداد آیتم قابل مشاهده باقیمانده : -15 مورد

Dacarbazine: Drug information

Dacarbazine: Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Dacarbazine: Patient drug information" and "Dacarbazine: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Experienced physician:

It is recommended that dacarbazine be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.

In treatment of each patient, the physician must weigh carefully the possibility of achieving therapeutic benefit against the risk of toxicity.

Bone marrow suppression:

Hemopoietic depression is the most common toxicity with dacarbazine.

Hepatic effects:

Hepatic necrosis has been reported.

Carcinogenic/teratogenic:

Studies have demonstrated this agent to have a carcinogenic and teratogenic effect when used in animals.

Pharmacologic Category
  • Antineoplastic Agent, Alkylating Agent (Triazene)
Dosing: Adult

Dosage guidance:

Clinical considerations: Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref). Refer to the protocol or institutional guidance for additional details of off-label dosing.

Hodgkin lymphoma

Hodgkin lymphoma:

ABVD regimen: IV: 375 mg/m2 on days 1 and 15 every 4 weeks (in combination with doxorubicin, bleomycin, and vinblastine) for 2 to 4 cycles (Ref). The number of cycles required and follow-up treatment may be determined by PET scan after 2 cycles (Ref).

A-AVD regimen: IV: 375 mg/m2 on days 1 and 15 every 4 weeks (in combination with brentuximab vedotin, doxorubicin, and vinblastine) for up to 6 cycles (Ref). Administer primary prophylaxis with G-CSF (filgrastim) beginning with cycle 1.

Melanoma, metastatic malignant

Melanoma, metastatic malignant: IV: 250 mg/m2 over 30 minutes once daily on days 1 to 5 every 3 weeks for up to 12 cycles or until disease progression or unacceptable toxicity (Ref) or 850 to 1,000 mg/m2 once every 3 weeks until disease progression or unacceptable toxicity (Ref).

Pancreatic neuroendocrine tumors, advanced

Pancreatic neuroendocrine tumors, advanced (off-label use): IV: 850 mg/m2 over 60 to 90 minutes on day 1 every 4 weeks until disease progression or unacceptable toxicity (minimum of 2 cycles) (Ref).

Pheochromocytoma, malignant

Pheochromocytoma, malignant (off-label use): CVD regimen: IV: 600 mg/m2 once daily for 2 days every 3 or 4 weeks (in combination with cyclophosphamide and vincristine) until disease progression or unacceptable toxicity (Ref).

Soft tissue sarcoma, advanced

Soft tissue sarcoma, advanced (off-label use):

Single agent therapy: IV: 1,200 mg/m2 once every 3 weeks for up to 8 cycles (Ref).

Combination therapy:

AD regimen: IV: 250 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 1,000 mg/m2/cycle) (in combination with doxorubicin); patients received a median of 3 cycles (Ref) or 187.5 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 750 mg/m2/cycle) (in combination with doxorubicin) until disease progression or unacceptable toxicity (Ref).

MAID regimen: IV: 250 mg/m2/day as a continuous infusion for 4 days every 3 weeks (total of 1,000 mg/m2/cycle) (in combination with mesna, doxorubicin, and ifosfamide) (Ref). Continue until disease progression or unacceptable toxicity (Ref).

Gemcitabine/Dacarbazine regimen: IV: 500 mg/m2 once every 2 weeks (in combination with gemcitabine) for up to 12 cycles (Ref).

Thyroid carcinoma, medullary, advanced or metastatic

Thyroid carcinoma, medullary, advanced or metastatic (off-label use): IV: 200 mg/m2 once daily for 5 days every 8 weeks (in combination with fluorouracil and alternating with doxorubicin/streptozocin) until disease progression or unacceptable toxicity, or for a total of 6 cycles if tumor response or stabilization (Ref) or 200 mg/m2 once daily for 5 days every 6 weeks (in combination with fluorouracil and alternating with streptozocin/fluorouracil) until disease progression or unacceptable toxicity (Ref) or 600 mg/m2 once daily for 2 days every 3 or 4 weeks (in combination with cyclophosphamide and vincristine); patients received a median of 4 cycles (range: 2 to 17 cycles) (Ref) or 250 mg/m2 over 15 to 30 minutes once daily for 5 days every 4 weeks (in combination with fluorouracil) until disease progression or for a maximum of 6 cycles (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. The following adjustments have been recommended:

Kintzel 1995:

CrCl 46 to 60 mL/minute: Reduce dose to 80% of usual dose.

CrCl 31 to 45 mL/minute: Reduce dose to 75% of usual dose.

CrCl ≤30 mL/minute: Reduce dose to 70% of usual dose.

Krens 2019:

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: Consider reducing dose to 70% of usual dose.

Hemodialysis: Consider reducing dose to 70% of usual dose.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. May cause hepatotoxicity; monitor closely for signs of toxicity.

The following adjustments have been recommended (Ref):

Mild to moderate impairment: No dosage adjustment necessary.

Severe impairment: Use is not recommended.

Dosing: Obesity: Adult

American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2: Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref).

Dosing: Adjustment for Toxicity: Adult

Hematologic toxicity: May require temporary dacarbazine treatment interruption or discontinuation.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Dacarbazine: Pediatric drug information")

Dosage guidance:

Clinical considerations: For oncology uses, details concerning dosing in combination regimens should also be consulted. Dacarbazine in combination with doxorubicin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

Hodgkin lymphoma

Hodgkin lymphoma: Limited data available:

High risk:

ABVD regimen: Children and Adolescents: IV: 375 mg/m2 over 30 to 60 minutes on Days 1 and 15 of a 28-day treatment cycle for 2 to 6 cycles in combination with doxorubicin, vinblastine, and bleomycin (Ref).

CAPDac consolidation regimen: Children ≥6 years and Adolescents: IV: 250 mg/m2 on Days 1 to 3 of a 21-day treatment cycle for 4 cycles in combination with cyclophosphamide, brentuximab vedotin, and prednisone (Ref).

Intermediate or advanced stage:

Bv-AVD-R regimen: Children ≥4 years and Adolescents: IV: 375 mg/m2 on Days 1 and 15 of a 28-day treatment cycle for 4 to 6 cycles in combination with brentuximab vedotin, doxorubicin, vinblastine, and rituximab (Ref).

COPDac consolidation regimen: Children and Adolescents: IV: 250 mg/m2 on Days 1 to 3 of a 28-day treatment cycle for 2 to 4 cycles in combination with prednisone/prednisolone, vincristine, and cyclophosphamide (Ref).

Melanoma, high risk

Melanoma, high risk: Limited data available: Children ≥10 years and Adolescents: IV: 800 mg/m2 over 1 hour on Day 1 of a 21-day treatment cycle for 3 cycles; in combination with vinblastine, cisplatin, and interferon alfa-2b. Note: Administer dacarbazine after vinblastine on Day 1 (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; experience in adult patients suggests dose adjustment may be necessary; use with caution.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. May cause hepatotoxicity; monitor closely for signs of toxicity.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not always defined.

Central nervous system: Infusion-site pain

Dermatologic: Alopecia

Gastrointestinal: Nausea and vomiting (>90%), anorexia

Hematologic & oncologic: Bone marrow depression (onset: 5 to 7 days; nadir: 7 to 10 days; recovery: 21 to 28 days), leukopenia, thrombocytopenia

<1%, postmarketing, and/or case reports: Anaphylaxis, anemia, diarrhea, dysgeusia, eosinophilia, erythema, facial flushing, facial paresthesia, flu-like symptoms (fever, myalgia, malaise), hepatic necrosis, increased liver enzymes (transient), paresthesia, renal function test abnormality, skin photosensitivity, skin rash, urticaria, venous obstruction (hepatic vein)

Contraindications

Hypersensitivity to dacarbazine or any component of the formulation.

Canadian labeling: Additional contraindications (not in the US labeling): Prior severe myelosuppression.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: May occur following dacarbazine administration.

• Bone marrow suppression: Hematologic toxicity is the most common dacarbazine toxicity. Leukopenia and thrombocytopenia may be severe; anemia may also occur. The onset for leukopenia is ~14 days (range: 10 to 30 days) and the duration is ~1 to 3 weeks. The onset for thrombocytopenia is ~18 days (range: 12 to 30 days) and the duration is ~1 to 3 weeks.

• Extravasation: Dacarbazine is an irritant; local reactions may occur (ESMO/EONS [Pérez Fidalgo 2012]). According to the manufacturer, extravasation may result in tissue damage and severe pain.

• Hepatotoxicity: Hepatic necrosis has been reported with dacarbazine. Hepatotoxicity may be accompanied with hepatic vein thrombosis and hepatocellular necrosis; may be fatal. Hepatotoxicity usually occurs with combination chemotherapy, but may occur with dacarbazine alone.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Generic: 100 mg (1 ea); 200 mg (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Generic: 200 mg (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (reconstituted) (Dacarbazine Intravenous)

100 mg (per each): $14.87

200 mg (per each): $12.00 - $14.40

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Generic: 600 mg (1 ea)

Administration: Adult

Dacarbazine is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

IV: Infuse over 15 to 60 minutes; rapid infusion may cause severe venous irritation. Other infusion durations have been reported; refer to literature and/or regimen for infusion details (may vary by protocol).

Dacarbazine is an irritant; local reactions may occur (Ref). Monitor infusion site.

Administration: Pediatric

Note: Dacarbazine in combination with doxorubicin is associated with a high emetic potential; antiemetics are recommended to prevent nausea and vomiting (Ref).

Parenteral: Administer by IV infusion over 15 to 60 minutes; rapid infusion may cause severe venous irritation. Dacarbazine is an irritant; local reactions may occur (Ref). Monitor infusion site.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2024 [table 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).

Use: Labeled Indications

Hodgkin lymphoma: Treatment of Hodgkin lymphoma (in combination with other chemotherapy agents).

Melanoma, metastatic malignant: Treatment of metastatic malignant melanoma.

Use: Off-Label: Adult

Pancreatic neuroendocrine tumors, advanced; Pheochromocytoma, malignant; Soft-tissue sarcomas, advanced or metastatic; Thyroid carcinoma, medullary, advanced or metastatic

Medication Safety Issues
Sound-alike/look-alike issues:

Dacarbazine may be confused with dactinomycin, procarbazine

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).

Metabolism/Transport Effects

Substrate of CYP1A2 (Minor), CYP2E1 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor

Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid

BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of BCG Products. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor

Brivudine: May increase adverse/toxic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid

Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor

Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Cladribine. Risk X: Avoid

CloZAPine: Myelosuppressive Agents may increase adverse/toxic effects of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor

Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Cytotoxic Chemotherapy) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor

Deferiprone: Myelosuppressive Agents may increase neutropenic effects of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider Therapy Modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Denosumab: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider Therapy Modification

Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid

Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Fotemustine: May increase adverse/toxic effects of Dacarbazine. Specifically, the risk for pulmonary toxicity (adult acute respiratory distress syndrome) may be increased. Management: Do not administer fotemustine and dacarbazine simultaneously, particularly with high doses of dacarbazine. An interval of 1 week should be left between the last dose of fotemustine and the first dose of dacarbazine. Risk D: Consider Therapy Modification

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification

Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Lenograstim: Antineoplastic Agents may decrease therapeutic effects of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Lipegfilgrastim: Antineoplastic Agents may decrease therapeutic effects of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor

Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor

Palifermin: May increase adverse/toxic effects of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider Therapy Modification

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pidotimod. Risk C: Monitor

Pimecrolimus: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Piperacillin: May increase hypokalemic effects of Antineoplastic Agents. Risk C: Monitor

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification

Promazine: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification

Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid

Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider Therapy Modification

Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification

SORAfenib: May increase adverse/toxic effects of Dacarbazine. SORAfenib may increase active metabolite exposure of Dacarbazine. Risk C: Monitor

Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Tertomotide. Risk X: Avoid

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tofacitinib. Risk X: Avoid

Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid

Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may decrease therapeutic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting chemotherapy when possible. Patients vaccinated less than 14 days before or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification

Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Zoster Vaccine (Live/Attenuated): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid

Reproductive Considerations

Dacarbazine is a component of the ABVD regimen used for the treatment of Hodgkin lymphoma; there may be a low risk of amenorrhea and an intermediate risk of azoospermia associated with therapy. Fertility preservation can be discussed prior to therapy (ESMO [Lambertini 2020]; Traila 2018).

Pregnancy Considerations

Teratogenic effects were observed in animal reproduction studies. Outcome data following maternal use of dacarbazine primarily as part of a regimen for the treatment of Hodgkin lymphoma during pregnancy is available (Avilés 2018; Cotteret 2020; Evens 2013; NTP 2013; Pinnix 2016).

Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of dacarbazine may be altered (Kantrowitz-Gordon 2018).

The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). In general, if chemotherapy is indicated, it should be avoided during in the first trimester, there should be a 3-week time period between the last chemotherapy dose and anticipated delivery, and chemotherapy should not be administered beyond week 33 of gestation (ESMO [Peccatori 2013]). An international consensus panel has published guidelines for hematologic malignancies during pregnancy. Dacarbazine is a component of the ABVD regimen, which is used for the treatment of Hodgkin lymphoma. If treatment cannot be deferred until after delivery in patients with early stage Hodgkin lymphoma, ABVD may be administered safely and effectively in the latter phase of pregnancy (based on limited data); for patients with advanced-stage disease, ABVD can be administered in the second and third trimesters (Lishner 2016).

A long-term observational research study is collecting information about the diagnosis and treatment of cancer during pregnancy. For additional information about the pregnancy and cancer registry or to become a participant, contact Cooper Health (1-877-635-4499).

Breastfeeding Considerations

It is not known if dacarbazine is present in breast milk.

Due to the potential for serious adverse reactions in the breastfed infant, a decision should be made to discontinue dacarbazine or to discontinue breastfeeding, taking into account the benefits of treatment to the mother.

Monitoring Parameters

CBC with differential, liver function, renal function. Monitor closely for signs of toxicity in patients with hepatic or kidney dysfunction. Monitor infusion site.

The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Dacarbazine is an alkylating agent which is converted to the active alkylating metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide] via the cytochrome P450 system. The cytotoxic effects of MTIC are manifested through alkylation (methylation) of DNA at the O6, N7 guanine positions which lead to DNA double strand breaks and apoptosis. Dacarbazine is non-cell cycle specific (Marchesi 2007).

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Exceeds total body water; suggesting binding to some tissue (probably liver) (Perry 2012)

Metabolism: Extensively hepatic to the active metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide]

Half-life elimination: Biphasic: Initial: 19 minutes, 55 minutes (renal and hepatic dysfunction); Terminal: 5 hours, 7.2 hours (renal and hepatic dysfunction)

Excretion: Urine (~40%; as unchanged drug)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Dacarbazina Filaxis | Dacarbazina varifarma | Oncocarbil;
  • (AT) Austria: Dacarbazin lipomed | Dacarbazin Medac | Dtic-dome;
  • (AU) Australia: Dacarbazine Sandoz;
  • (BE) Belgium: Dtic;
  • (BG) Bulgaria: Dacarbazin | Dacarbazin lipomed;
  • (BR) Brazil: D.t.i. | Dacarb | Dacarbazina | Fauldacar;
  • (CL) Chile: Dacarbazina | Dacarbazina kampar | Deticene;
  • (CO) Colombia: Al quibazina | Carbaven | Dacarbazina | Dacarbazine medac | Daracina | Deticene | Tiferomed;
  • (CZ) Czech Republic: Dacarbazin | Dacarbazine medac | Dtic;
  • (DE) Germany: Dacarbazin lipomed | Detimedac | Dtic;
  • (EC) Ecuador: Dacarbazina | Deticene;
  • (EE) Estonia: Dacarbazin Medac | Dacmed | Deticene | Detimedac;
  • (ES) Spain: Dacarbazina almirall | Dacarbazina medac;
  • (ET) Ethiopia: Oncodac;
  • (FI) Finland: Dacarbazine lipomed | Dacarbazine medac | Dacatic;
  • (FR) France: Dacarbazine Dci | Dacarbazine lipomed | Dacarbazine medac | Deticene;
  • (GB) United Kingdom: Dacarbazine;
  • (GR) Greece: Dacarbazine medac | Dacarbazine/medac | Dacarbion | Deticene;
  • (HR) Croatia: Dacarbazine Pliva;
  • (HU) Hungary: Dacarbazine lipomed | Dacin lipomed | Dakarbazin | Dakarbazin medac | Deticene;
  • (ID) Indonesia: Dacarbazine medac;
  • (IN) India: Celdaz | Dabaz | Dacarzine | Dazine | Decarb | Zicarb;
  • (IT) Italy: Dacarbazina lipomed | Dacarbazina medac | Deticene;
  • (KR) Korea, Republic of: Deticene | Deticin | Detimedac | DTI | Dtic-dome;
  • (LT) Lithuania: Celdaz | Dacarbazin | Dacarbazine medac | Deticene | Detimedac | Dtic;
  • (LV) Latvia: Dacarbazin Medac | Deticene | Dtic;
  • (MX) Mexico: Acocarb | Dacarbazina | Deticeme | Detilem | Ifadac | Onecobax | Tiferomed;
  • (NL) Netherlands: Dacarbazin | Dacarbazine medac | Deticene;
  • (NO) Norway: Dacarbazine lipomed | Dacarbazine medac;
  • (PA) Panama: Dacarbazina;
  • (PE) Peru: Celdaz | Dacarbazina | Deticene | Oncocarbil;
  • (PH) Philippines: Arzi | Duticin;
  • (PK) Pakistan: Darbazine | Decarb;
  • (PL) Poland: Dacarbazin | Dacarbazine medac | Dacin | Deticene | Detimedac | Dtic;
  • (PR) Puerto Rico: Dacarbazine | Dtic-dome;
  • (PT) Portugal: Dacarbazina | Deticene | Detimedac | Fauldetic;
  • (PY) Paraguay: Dacarbazina cipla | Dacarbazina fusa | Dacarzin;
  • (RO) Romania: Dacarbazina lipomed | Dacarbazine medac | Daltrizen | Detimedac;
  • (RU) Russian Federation: Dacarbazin | Dacarbazine lens | Dacarbazine medac | Dacarbazine rus | Dakarbazin;
  • (SA) Saudi Arabia: Dacarbazine | Dacarbazine medac | Dacin | Deticene;
  • (SE) Sweden: Dacarbazine medac;
  • (SI) Slovenia: Dacarbazin | Dacarbazine App | Dacarbazine lipomed | Dacin | Detimedac | DTIC-Dome;
  • (SK) Slovakia: Dacarbazin | Dakarbazin medac;
  • (TH) Thailand: Dacarbazine medac | Dacmed;
  • (TN) Tunisia: Dacin | Deticene | Detimedac;
  • (TR) Turkey: Dakarbaz | Deticene;
  • (TW) Taiwan: Dtic-dome;
  • (UA) Ukraine: Dacarbazin | Dacarbazin Medac | Dacarbazine lens | Dacin;
  • (UY) Uruguay: Dacarbazina | Dacarbazina Filaxis | Dacarzin | Oncocarbil;
  • (ZA) South Africa: Dacin | Daraz | Dtic-dome;
  • (ZM) Zambia: Decarb;
  • (ZW) Zimbabwe: Arzi
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