In Canada—

Other commonly used names are acridinyl anisidide; m-AMSA.

• Antineoplastic

Amsacrine ( AM-sah-kreen) belongs to the general group of medicines known as antineoplastics. It is used to treat acute adult leukemia.

Amsacrine interferes with the growth of cancer cells, which are then eventually destroyed by the body. Since the growth of normal body cells may also be affected by amsacrine, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur until months or years after the medicine is used.

Before you begin treatment with amsacrine, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Amsacrine is to be administered only by or under the supervision of your doctor. It is available in the following dosage form:

Parenteral
• Injection (Canada)

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 amsacrine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to amsacrine.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals.

Before receiving amsacrine make sure your doctor knows if you are pregnant or if you may become pregnant. It is best to use some kind of birth control while you are receiving amsacrine. Tell your doctor right away if you think you have become pregnant while receiving amsacrine.

Breast-feeding— Amsacrine is not recommended during breast-feeding, because it may cause unwanted effects in nursing babies.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of amsacrine in children with use in other age groups.

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 amsacrine 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. When you are receiving amsacrine, it is especially important that your health care professional know if you are taking any of the following:

• Acyclovir (e.g., Zovirax) or
• Anticonvulsants (seizure medicine) or
• Antidiabetics, oral (diabetes medicine taken by mouth) or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Antipsychotics (medicine for mental illness) or
• Captopril (e.g., Capoten) or
• Enalapril (e.g., Vasotec) or
• Flecainide (e.g., Tambocor) or
• Gold salts (medicine for arthritis) or
• Imipenem or
• Inflammation or pain medicine, except narcotics or
• Lisinopril (e.g., Prinivil, Zestril) or
• Maprotiline (e.g., Ludiomil) or
• Penicillamine (e.g., Cuprimine) or
• Pimozide (e.g., Orap) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Ramipril (e.g., Altace) or
• Sulfasalazine (e.g., Azulfidine) or
• Tiopronin (e.g., Thiola) or
• Tocainide (e.g., Tonocard) or
• Tricyclic antidepressants (medicine for depression) or
• Trimeprazine (e.g., Temaril)—Concurrent use of these agents with amsacrine may cause blood disorders

• Alpha interferons (e.g., Intron A, Roferon-A) or
• Amphotericin B by injection (e.g., Fungizone) or
• Antineoplastics, other (cancer medicine) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Cyclophosphamide (e.g. Cytoxan) or
• Flucytosine (e.g. Ancoban) or
• Ganciclovir (e.g., Cytovene) or
• Zidovudine (e.g., AZT, Retrovir)—Concurrent use of these agents with amsacrine increases the risk of infection

• If you have ever been treated with radiation or cancer medicines—Amsacrine may increase the effects of these medicines or radiation therapy on the blood

• Bone marrow depression or
• Infection—There may be an increased risk of infections or worsening infections because of the body's reduced ability to fight them

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body
• Heart rhythm problems—Patients who have problems with heart rhythms may have increased problems while taking amsacrine
• Kidney disease or
• Liver disease—Effects of amsacrine may be increased because of its slower removal from the body

Amsacrine often causes nausea and vomiting. However, it is very important that you continue to receive the medication, even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

Dosing—

The dose of amsacrine will be different for different patients. The dose that is used may depend on a number of things, including what the medicine is being used for, the patient's body size, and whether or not other medicines are also being taken. If you are taking or receiving amsacrine at home, follow your doctor's orders or the directions on the label.If you have any questions about the proper dose of amsacrine, ask your doctor.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

While you are being treated with amsacrine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Amsacrine 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 oral polio vaccine, since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine within the last several months. 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.

Amsacrine can temporarily lower the number of white blood cells in your blood, 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 you can 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, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• 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.

If amsacrine accidentally leaks out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the place of injection.

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:

• More common
  • Accumulation of pus or swollen, red, tender area of infection around the rectum;  Black tarry stools;  blood in urine or stools;  cough or hoarseness ;  fever or chills;  lower back or side pain;  painful or difficult urination ;  pinpoint red spots on skin;  sores, ulcers, or white spots on lips, tongue, or inside mouth;  unusual bleeding or bruising;  unusual tiredness or weakness 
  
  

• Less common
  • Abdominal pain or tenderness;  blurred vision;  confusion;  dark urine;  diarrhea;  dizziness, faintness, or light-headedness ;  fast, pounding, or irregular heartbeat or pulse;  fever;  itching;  nausea;  palpitations;  convulsions (seizures);  vomiting or vomiting of blood or material that looks like coffee grounds;  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
  • Burning, crawling, numbness, prickling, “pins and needles”, or tingling feelings;  headache 
  
  

• Less common
  • Bleeding gums;  difficulty swallowing ;  hives;  loss of appetite ;  loss of strength or energy;  muscle or bone pain;  pain or redness at site of injection ;  rash;  redness and swelling of gums 
  
  

This medicine often causes a temporary loss of hair. After treatment with amsacrine has ended, normal hair growth should return.

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