Procarbazine

Procarbazine (Matulane (US), Natulan (Canada), Indicarb (India) is an antineoplastic chemotherapy drug for the treatment of Hodgkin's lymphoma and certain brain cancers (such as Glioblastoma multiforme). It is a member of a group of medicines called alkylating agents. It gained FDA Approved in July 1969. The drug is metabolized and activated in the liver. It also inhibits MAO thus increasing the effects of sympathomimetics, TCAs, and tyramine.

Pharmacology
Its mechanism of action is not fully understood. Metabolism yields azo-procarbazine and hydrogen peroxide which results in the breaking of DNA strands.

Indications
When used to treat Hodgkin's Lymphoma, it is often delivered as part of the MOPP regimen that includes Mechlorethamine, Vincristine (tradename Oncovin), Prednisone, and Procarbazine. Alternatively, when used to treat certain brain tumors (malignant gliomas), it is often dosed as PCV when combined with Lomustine (often called CCNU) and Vincristine.

Procarbazine is also part of the more modern BEACOPP regimen used for Hodgkin's lymphoma.

Side Effects/ Adverse Reactions
When combined with ethanol, procarbazine may cause a disulfiram-like reaction in some patients. It also inhibits the liver's CYP450 microsomal system, which leads to an increased effect of barbiturates, phenothiazenes, and narcotics normally metabolized by the CYP450 enzymes. Has monamine oxidase inhibition properties (MAOI), and should not be taken with most antidepressants and certain migraine medications.

Inhibits MAO in the gastrointestinal system thus can cause hypertensive crises if associated with the ingestion of tyramine-rich foods such as aged cheeses.

Dose
Adult: 2–4 mg/kg/day either in a single dose or divided, given for 7 days then increased to 4–6 mg/kg/day until response is obtained or mylosupression occurs. Dose should be adjusted for renal (kidney) disease or hepatic (liver) disease.

Dosage Form
50 mg capsules.