In the U.S.—

Another commonly used name is mithramycin.

• Antihypercalcemic
• Antihypercalciuric
• Antineoplastic
• Bone resorption inhibitor

Plicamycin ( plye-ka-MYE-sin) belongs to the group of medicines known as antineoplastics. It may be used to treat certain types of cancer. It is also used to treat hypercalcemia or hypercalciuria (too much calcium in the blood or urine) that may occur with some types of cancer.

Plicamycin may also be used for other conditions as determined by your doctor.

Plicamycin is to be administered by or under the immediate care of your doctor. It is available only with a prescription, in the following dosage form:

Parenteral
• Injection (U.S.)

Plicamycin is a very strong medicine. In addition to its helpful effects in treating your medical problem, it has side effects that could be very serious. Before you receive this medicine, be sure that you have discussed its use with your doctor.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For plicamycin, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to plicamycin. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Plicamycin is not recommended for use during pregnancy. There is a possibility that it may be harmful to the fetus.

Breast-feeding—It is not known whether plicamycin passes into the breast milk.

Children—Studies on this medicine have not been done in children; however, plicamycin can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of plicamycin in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other medicines or are having x-ray treatments.

• Bleeding problems—Use of plicamycin may increase the risk of bleeding

• Blood disease or
• Kidney disease or
• Liver disease—Use of plicamycin may make these conditions worse

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Use of plicamycin may make your reaction to either of these conditions worse

Plicamycin sometimes causes nausea, vomiting, and loss of appetite. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. If you have any questions about this, check with your doctor.

Dosing—

The dose of plicamycin will be different for different patients. The dose is based on body weight and will be determined by your doctor. Follow your doctor's orders. The following information includes only the average doses of plicamycin.

• For injection dosage form:
  • To treat cancer:
    • Adults and children—The dose that is used may depend on a number of things, including what the medicine is being used for, the patient's weight, and whether or not other medicines are also being taken. If you are receiving plicamycin at home, follow your doctor's orders or the directions on the label. If you have any questions about the proper dose of plicamycin, ask your doctor.
  • To treat hypercalcemia or hypercalciuria (too much calcium in the blood or urine):
    • Adults—The dose is based on body weight and must be determined by your doctor. At first, the usual dose is 15 to 25 micrograms (mcg) per kg (6.8 to 11.4 mcg per pound) of body weight a day, injected slowly into a vein. The dose is given over a period of four to six hours once a day for three to four days. Your doctor may repeat the treatment if needed.
    • Children—Dose must be determined by your doctor.

It is very important that your doctor check your progress daily while you are receiving plicamycin to make sure that this medicine does not cause unwanted effects.

Your doctor may want you to follow a low-calcium, low–vitamin D diet. If you have any questions about this, check with your doctor.

Do not take aspirin or large amounts of any other preparations containing aspirin, other salicylates, or acetaminophen without first checking with your doctor. These medicines may increase the effects of plicamycin.

While you are being treated with plicamycin, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Plicamycin may lower your body's resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take or have recently taken oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid other persons who have taken oral polio vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Plicamycin can lower the number of white blood cells in your blood temporarily, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions your doctor may ask you to take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills.
• Check with your doctor immediately if you notice any unusual bleeding or bruising.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

• Less common
  • Muscle and abdominal cramps 
  
  

• Symptoms of overdose
  • Bloody or black, tarry stools;  flushing or redness or swelling of face;  nosebleed;  skin rash or small red spots on skin;  sore throat and fever;  unusual bleeding or bruising ;  vomiting of blood;  yellow eyes or skin 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Diarrhea;  irritation or soreness of mouth;  loss of appetite;  nausea or vomiting—may occur 1 to 2 hours after the injection is started and continue for 12 to 24 hours 
  
  

• Less common
  • Drowsiness;  fever;  headache;  mental depression;  pain, redness, soreness, or swelling at place of injection;  unusual tiredness or weakness 
  
  

After you stop using plicamycin, it may still produce some side effects that need attention. During this period of time check with your doctor if you notice any of the following side effects:

• Bloody or black, tarry stools;  nosebleed ;  sore throat and fever;  unusual bleeding or bruising;  vomiting of blood 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, plicamycin is used in certain patients with the following medical condition:

• Paget's disease of the bone

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.