Name /bks_53161_deglins_md_disk/porfimer
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Contraindications/Precautions
Contraindicated in: History of porphyria or hypersensitivity to porphyrins;
porfimer (pore-fim-er)
Tracheobronchial or bronchoesophageal fistulas or tumors with potential to erode
into a major blood vessel or the trachea; Not suitable for acute treatment of patients
with severe respiratory distress due to obstructive endotrachial lesion; Tumors eroding into a major blood vessel; Esophageal or gastric varices, or esophageal ulcers ⬎1
cm in diameter; Should not be used within 4 wk of radiation therapy.
Use Cautiously in: Direct sunlight or bright indoor light (photosensitivity will occur); Hepatic or renal impairment (may require more than 90 days of precautionary
photosensitivity measures); OB, Lactation, Pedi: Pregnancy, lactation, or children
(contraception should be practiced; safety not established).
Photofrin
Classification
Therapeutic: antineoplastics
Pharmacologic: photosensitizers
Pregnancy Category C
Indications
Part of photodynamic therapy (PDT) for: Esophageal cancer that has completely or
partially obstructed the esophagus and cannot be treated with Nd:YAG laser therapy,
Reduction of obstruction and palliation of symptoms in patients with completely or
partially obstructive endobronchial non-small lung cancer, Microinvasive endobronchial non-small cell lung cancer when surgery or radiation are not options, High
grade dysplasia due to Barrett’s esophagus in patients who are unable to have esophagectomy.
Action
Porfimer is retained by the tumor, which is then treated with a laser light. When porfimer absorbs the light, a photochemical reaction occurs, causing cellular damage.
Thromboxane A is also produced, causing additional local tumor necrosis. Therapeutic Effects: Shrinkage of esophageal or endobronchial tumors.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability.
Distribution: Retained for a longer period by tumors, skin, and reticuloendothelial tissue.
Protein Binding: 90%.
Metabolism and Excretion: Unknown.
Half-life: 410 hr (first dose); 725 hr (2nd dose).
TIME/ACTION PROFILE (antitumor effect)
ROUTE
ONSET
PEAK
DURATION
IV
rapid†
unknown
unknown
†After laser light treatment
⫽ Canadian drug name.
⫽ Genetic Implication.
Adverse Reactions/Side Effects
CNS: insomnia, anxiety, confusion, weakness. Resp: RESPIRATORY INSUFFICIENCY,
dyspnea, mucositis reaction, pharyngitis, pleural effusion, pneumonia, cough, tracheoesophageal fistula. CV: HEART FAILURE, THROMBOEMBOLIC EVENTS, atrial fibrillation, chest pain, edema, hypertension, hypotension, tachycardia. GI: ESOPHAGEAL
RUPTURE, GI BLEEDING, abdominal pain, constipation, esophageal stricture, nausea,
vomiting, anorexia, diarrhea, dyspepsia, eructation, esophageal tumor bleeding.
Derm: photosensitivity. F and E: dehydration. Hemat: anemia. Misc: fever, pain,
moniliasis, urinary tract infection, weight loss.
Interactions
Drug-Drug: Photosensitizing effect may beqby concurrent use of tetracyclines,
sulfonamides, phenothiazines, sulfonylurea oral hypoglycemic agents, or
thiazide diuretics. The effects of photodynamic therapy may be altered by calcium
channel blockers, corticosteroids, ethanol, mannitol, dimethyl sulfoxide,
beta carotene, vasoconstrictors, or agents that affect clotting.
Route/Dosage
IV (Adults): 2 mg/kg followed 40– 50 hr later by laser light therapy. A second session of laser light therapy may be given 96– 120 hr after porfimer and may be preceded by gentle tumor débridement. Up to three treatments may be given, with a 30–
day minimum interval between treatments.
NURSING IMPLICATIONS
Assessment
● Assess patient for substernal chest pain after therapy. May result from an inflam-
matory response in the treatment area. May require opioid analgesics to relieve
symptoms.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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● Ultraviolet sunscreens offer no protection against a photosensitivity reaction be-
● Before each new course of therapy, the patient should be examined for
● Ocular sensitivity to sunlight, bright lights, or car headlights may occur. Patients
either bronchoesophageal or tracheoesophageal fistula.
● Lab Test Considerations: May causepin hemoglobin and hematocrit as a result of tumor bleeding induced by photodynamic therapy.
cause porfimer is activated by visible light.
Potential Nursing Diagnoses
should wear dark glasses that transmit ⬍4% of white light when outside for approximately 30 days after administration of porfimer.
● Advise patient to notify health care professional if ocular sensitivity, chest pain,
respiratory distress, or esophageal strictures occur.
Risk for injury (Adverse Reactions)
Evaluation/Desired Outcomes
Implementation
● Avoid contact with skin and eyes during preparation. Use of disposable gloves and
eye covering is recommended. If exposure occurs, follow directions for preventing a photosensitivity reaction (see Patient/Family Teaching).
● Porfimer spills may be wiped up with a damp cloth. Contaminated materials
should be disposed in a polyethylene bag, following regulations for handling hazardous waste.
● Shrinkage of esophageal tumors.
Why was this drug prescribed for your patient?
IV Administration
● Direct IV: Diluent: Dilute 75– mg vial with 31.8 mL of D5W or 0.9% NaCl. Pro-
tect reconstituted solution from bright light and use immediately. Concentration: 2.5 mg/mL. Rate: Administer over 3– 5 min. If solution extravasates, protect injection site from bright light for 30 days.
Patient/Family Teaching
● Instruct patient in precautions to prevent photosensitivity reactions. Precautions
should be used for 30 days (90 days if patient has liver impairment). Avoid exposure of skin and eyes to direct sunlight and bright indoor light (dental or operating
room lights, unshaded light bulbs at close proximity).
● Porfimer is slowly and safely inactivated by ambient indoor light. Patients should
avoid spending long periods in darkened rooms and should expose themselves to
ambient indoor light.
● Patients may test themselves for residual photosensitivity by exposing a small portion of skin to sunlight for 10 min. If erythema, blistering, or edema does not occur within 24 hr, patients may gradually increase their exposure to bright lights or
sunlight. If a photosensitivity reaction occurs, patient should avoid exposure for
an additional 2 wk, then retest skin. Do not use face for photosensitivity testing because skin around eyes may be more sensitive. Before traveling to geographic areas that have increased light, patients should retest their photosensitivity level.
䉷 2015 F.A. Davis Company
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