Natulan - instructions for use, analogs, reviews and release forms (capsules or tablets 50 mg) of the drug for the treatment of lymphogranulomatosis, non-Hodgkin's lymphomas, brain cancer in adults, children and pregnancy. Composition, side effects

In this article, you can read the instructions for using the drug Natulan. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Natulan in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Natulan in the presence of existing structural analogs.Use for the treatment of lymphogranulomatosis, non-Hodgkin's lymphomas, brain cancer in adults, children, as well as during pregnancy and lactation. Side effects and composition of the drug.

Natulan - antitumor preparation, alkylating compound from the group of methylhydrazines. The mechanism of action of procarbazine (active ingredient Natulan) with accuracy has not been studied. The drug inhibits the synthesis of proteins, deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), disrupting the processes of transmethylation - the transfer of methyl radicals from methionine to transport RNA. The lack of a normally functioning transport RNA causes a disruption in the synthesis of DNA, RNA and proteins (refers to the esophase-specific drugs). An important component in the mechanism of action is the formation of hydrogen peroxide as a result of autooxygenation. Hydrogen peroxide, interacting with sulfhydryl groups of tissue proteins, promotes more dense spiralization of the DNA molecule and hinders transcription processes.

It blocks the activity of monoamine oxidase (MAO), which causes the accumulation of tyramine and, as a consequence,an increase in the content of noradrenaline in the endings of the sympathetic nervous system and an increase in blood pressure (BP).

Composition

Procarbazine + auxiliary substances.

Pharmacokinetics

After ingestion, quickly and completely absorbed from the gastrointestinal tract (GIT). The maximum concentration of the drug in the blood is reached within 30-60 minutes. Penetrates through the blood-brain barrier (BBB). Metabolised in the liver and kidneys with the formation of active metabolites. It is excreted primarily by the kidneys (70% excreted in the urine in 24 hours, mainly in the form of en-isopropylterephthalic acid, less than 5% in unchanged form) and lungs in the form of methane and carbon dioxide.

Indications

• Hodgkin's disease (lymphogranulomatosis);
• non-Hodgkin's lymphomas, including follicular non-Hodgkin's lymphoma, diffuse non-Hodgkin's lymphoma;
• reticulosarcoma;
• chronic lymphocytic leukemia;
• Brill-Simmers disease;
• Malignant brain tumors (neuroblastoma and medulloblastoma).

Forms of release

Capsules 50 mg (sometimes mistakenly called pills).

Instructions for use and dosing regimen

Assign inside, after eating.When choosing the dose and the scheme of application of the drug in each individual case, you should refer to the special literature.

In monotherapy, the initial dose of Natulan is 50 mg, followed by a daily increase of 50 mg to a daily dose of 250-300 mg. The frequency of admission - 1-3 times a day, every day for 15-20 days or until the development of leukopenia and thrombocytopenia. When the therapeutic effect develops, the dose is gradually reduced to a maintenance dose, usually up to 150-50 mg per day. The total dose for the course of treatment, as a rule, is 4-7 g.

In combination with other antitumor drugs, Natulan is prescribed at a dose of 100 mg per 1 m2 of the body surface daily for 10-14 days.

Side effect

• leukopenia, thrombocytopenia, eosinophilia, hemolytic anemia;
• bleeding and hemorrhage;
• nausea, vomiting;
• anorexia (eating disorder);
• dysphagia (difficulty swallowing);
• dry mouth;
• diarrhea, constipation;
• abdominal pain;
• stomatitis (damage to the oral mucosa);
• abnormal liver function;
• Cholestatic (due to difficulty of outflow of bile) jaundice;
• headache, dizziness;
• paresthesia (a feeling of numbness, crawling crawling on the skin);
• peripheral neuropathy (peripheral nerve damage);
• increased excitability;
• hypomanic and manic states;
• convulsions;
• hallucinations;
• depression, nightmares;
• increased fatigue, weakness;
• confusion, coma;
• diplopia (double vision);
• nystagmus (involuntary rapid rhythmic movements of the eyeballs);
• photophobia;
• edema of the optic nerve;
• intraocular hemorrhage;
• hearing impairment;
• lowering blood pressure, tachycardia;
• syncope (short-term loss of consciousness);
• pneumonitis (inflammation of the alveoli in the lungs);
• pleurisy (inflammation of the pleura);
• cough;
• impaired renal function;
• hematuria (blood in the urine);
• amenorrhea (absence of menstruation);
• azoospermia (absence of spermatozoa in the sperm);
• dermatitis, itching, rash, hives;
• alopecia (baldness);
• Hyperpigmentation (pigment spots on the skin);
• sensation of hot flashes or redness of the face;
• arthralgia (pain in the joints);
• Myalgia (pain in the muscles);
• tremor (trembling of limbs or body parts);
• accession of infections;
• temperature increase;
• risk of developing secondary malignant tumors;
• allergic reactions.

Contraindications

• hypoplasia (hypoplasia) of the bone marrow;
• marked impairment of renal and / or liver function;
• pheochromocytoma (adrenal tumor);
• pregnancy;
• lactation period;
• hypersensitivity to the components of the drug.

Application in pregnancy and lactation

The drug Natulan is contraindicated for use in pregnancy and lactation (breastfeeding).

Use in children

Contraindicated in childhood.

Application in elderly patients

With caution should be used in elderly patients.

special instructions

Natulan treatment is performed under the supervision of a doctor who has experience in the use of antitumor drugs.

During therapy with procarbazine, careful monitoring of hematologic parameters (before treatment, then once every 3-4 days) and biochemical (before treatment, then once a week) blood values ​​is necessary.

When there are disorders of the nervous system (paresthesia, peripheral neuropathy, confusion), leukopenia (less than 4,000 in 1 μl), thrombocytopenia (less than 100,000 in 1 μl), allergic reactions, stomatitis, diarrhea, increased bleeding or bleeding Natulan treatment should immediately stop.

During the treatment period, the use of alcohol, hypnotics (barbiturates, benzodiazepines) and sympathomimetic agents is contraindicated. From the diet should exclude foods with increased content of tyramine (aged cheeses, wine, beer, yeast / protein extracts, yogurt, bananas).

With caution should be used in patients with arrhythmias and other cardiovascular diseases, diabetes, hyperthyroidism, cerebral vascular diseases, paranoid schizophrenia and other conditions, accompanied by increased excitability, epilepsy, alcoholism, parkinsonism, chicken pox, herpes zoster, other systemic infections, chronic viral diseases, previous cytotoxic or radiotherapy, sympathectomy in history, in elderly patients.

Men and women of childbearing age during treatment with Natulan and at least 3 months afterwards should use reliable methods of contraception.

Impact on the ability to drive vehicles and manage mechanisms

During Natulan's treatment, care must be taken when driving a car and engaging in other potentially hazardous activities,requiring increased concentration of attention and speed of psychomotor reactions.

Drug Interactions

With the simultaneous use of other myelotoxic drugs and radiotherapy, additive inhibition of bone marrow function is possible.

Natulan increases the activity of sympathomimetics, barbiturates, antihistamines, narcotic, hypotensive drugs, tricyclic antidepressants and phenothiazine.

With the simultaneous application Natulan potentiates the action of hypoglycemic agents and anticonvulsant drugs.

When used simultaneously with non-steroidal anti-inflammatory drugs (NSAIDs), the risk of bleeding increases.

Natulan is incompatible with ethyl alcohol (alcohol), since it is possible to develop a disulfiram-like reaction.

Analogues of Natulan

Natulan does not have structural analogues for the active substance.

Analogues for the pharmacological group (alkylating agents):

• Alkeran;
• Aranosa;
• Astroglyph;
• BikNU;
• Blastocarb;
• Blastol;
• Vero-Ifosfamide;
• Dacarbazine;
• Displanor;
• Ifosfamide;
• Carboplatin;
• Carbothers;
• Kemokarb;
• Кемоплат;
• Ledoxine;
• Leukeran;
• Lysomustine;
• Lomustine;
• Myelosan;
• Mileran;
• Moustophoran;
• Nidran;
• Oxaliplatin;
• Oxter;
• Oxiplates;
• Oxitane;
• Oncoplatinum;
• Paract;
• Paraplatin;
• Plaksat;
• Platidiam;
• Platycad;
• Platimit;
• Platinum;
• Prospidin;
• Ribomustine;
• Sarcolysin;
• CINU;
• Spirobromin;
• Thesal;
• Temodal;
• Temozolomide;
• Temomide;
• Temtical;
• Tepadine;
• Thiotepa-Thioplex;
• Thiophosphamide;
• Chlorobutin;
• Holoksan;
• Cycloplatin;
• Cyclophosphamide;
• Cyclophosphane;
• Cisanplat;
• Cisoter;
• Cisplatin;
• Cytoxan;
• Cytoplatin;
• The Exorcise;
• Eloxatin;
• Endoxane.

Response of a therapist

I have no personal experience of using Natulan, as this is a very specific drug. But I have a young man with a lymphogranulomatosis on the site among the patients. He periodically undergoes routine treatment in the hematological unit of the hospital, where he is prescribed Natulan in combination with other drugs. According to the patient, he tolerates the treatment very hard. He has pain in the muscles and joints, dry mouth, headaches. During the last hospitalization, he developed severe stomatitis and twice he noticed hallucinations.

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