WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Procarbazine is a chemotherapy agent used as part of combination
chemotherapy regimens. It is classified as an alkylating agent — it works by
damaging DNA in cancer cells, preventing them from copying and dividing.
It is most commonly used as part of the BEACOPP or MOPP regimens for
Hodgkin lymphoma (a cancer of the lymphatic system), and in the PCV regimen
(procarbazine, lomustine/CCNU, and vincristine) for certain brain tumours —
particularly low-grade gliomas and anaplastic oligodendrogliomas.
Procarbazine also has weak monoamine oxidase inhibitor (MAOI) activity,
which has important dietary and drug interaction consequences.
3. HOW TO TAKE THIS MEDICINE
Procarbazine is always taken as part of a multi-drug chemotherapy
protocol. The dose and schedule are prescribed by your oncologist or
haematologist and vary depending on the specific regimen.
A common dose is 100mg/m² per day by mouth for 14 days of a 28-day cycle
(e.g. in BEACOPP or MOPP regimens). Take capsules with or without food. Swallow
whole with water. Do not open capsules. Follow your oncologist's exact schedule
— the days you take procarbazine will be specified within your cycle.
Because of procarbazine's MAOI activity, strict dietary restrictions
apply during treatment and for at least 2 weeks after stopping. Avoid
tyramine-rich foods — these include mature cheeses, cured or fermented meats
(salami, chorizo, pepperoni), fermented soy products (soy sauce, miso, tofu),
pickled or fermented vegetables, broad beans, beer, wine, and other alcoholic
drinks. Eating tyramine-rich foods while taking procarbazine can cause a
dangerous, sudden hypertensive crisis — a life-threatening spike in blood
pressure.
⚠ PATIENT TIP: The dietary restrictions with
procarbazine are not optional or minor — they are essential for your safety. A
hypertensive crisis (dangerously high blood pressure) caused by eating
tyramine-rich food while on procarbazine can be life-threatening. Ask your
oncology nurse for the full MAOI dietary restriction list before starting
treatment, and follow it closely. The restrictions continue for 2 weeks after
your last dose.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Very Common |
Nausea and vomiting
(often severe — anti-sickness medicines are routinely prescribed alongside),
low white blood cell count (neutropenia), low platelets (thrombocytopenia),
anaemia, fatigue, loss of appetite |
|
Common |
Mouth sores,
peripheral neuropathy (tingling, numbness, or weakness in hands and feet),
skin rash, muscle and joint pain, flu-like symptoms |
|
Serious — Seek Urgent
Medical Help |
Hypertensive crisis
(from tyramine interaction or with prohibited medicines — sudden severe
headache, visual disturbances, chest pain, nausea): seek emergency care
immediately. Febrile neutropenia (fever above 38°C with low blood counts): go
to hospital immediately. Severe lung toxicity (interstitial pneumonitis —
cough, breathlessness). Second malignancies (leukaemia) with long-term use —
discussed by oncologist. Severe allergic reaction. |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Procarbazine must not be combined with the dietary sources of tyramine
listed above. It must not be used alongside other MAOIs, tricyclic
antidepressants, SSRIs/SNRIs, meperidine (pethidine), sympathomimetics, or many
other medicines (see interactions). It must not be given to patients with
severely impaired liver or kidney function. It is not safe during pregnancy —
highly teratogenic. Effective contraception is essential during and for at
least 6 months after treatment.
⚠ MAOI DIETARY AND DRUG RESTRICTIONS —
LIFE-THREATENING HYPERTENSIVE CRISIS: Procarbazine has MAOI activity. Consuming
tyramine-rich foods or taking prohibited medicines (SSRIs, tricyclics,
pethidine, sympathomimetics, alcohol) can trigger a hypertensive crisis — a
sudden, dangerous spike in blood pressure that can cause stroke, heart attack,
or death. This is a medical emergency. Follow the restricted diet strictly and
tell every healthcare provider about procarbazine before any new medicine is
prescribed.
⚠ FERTILITY: Procarbazine is highly gonadotoxic
— it causes significant damage to sperm production and fertility, which may be
permanent, particularly in males. Sperm banking before starting treatment is
strongly recommended for males of reproductive age. Female fertility can also
be affected.
⚠ SECOND MALIGNANCIES: Long-term use of
alkylating agents including procarbazine is associated with a small but real
increased risk of developing a secondary cancer (particularly leukaemia) in
later years. This risk is taken into account by the oncology team when
selecting treatment regimens.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
This is one of the most interaction-prone chemotherapy medicines.
Absolute contraindications: other MAOIs, tricyclic antidepressants
(amitriptyline, nortriptyline), SSRIs (fluoxetine, sertraline, citalopram),
SNRIs (venlafaxine, duloxetine), meperidine/pethidine (can cause fatal
serotonin syndrome or hyperpyrexia).
Significant risks: alcohol (nausea, flushing, disulfiram-like reaction
and additive CNS depression — avoid completely), sympathomimetics (adrenaline,
decongestants such as pseudoephedrine), certain antihistamines.
All antidepressants, psychiatric medicines, and most centrally-acting
drugs must be checked with the oncology team before use. Warfarin effect may be
enhanced — INR monitoring required.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Keep in original packaging. Protect from moisture. Keep
out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (oncology or haematology) prescription required;
hospital administration and dispensing only |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Take procarbazine exactly as your oncologist prescribes — it is part of a
complex chemotherapy regimen. Follow the MAOI dietary restrictions strictly
throughout treatment and for 2 weeks after your last dose — your oncology team
will give you a detailed list of foods and drinks to avoid.
Alcohol must be completely avoided. Tell every doctor, pharmacist, and
nurse that you are taking procarbazine before any new medicine is prescribed —
many common medicines are dangerous with this chemotherapy.
Go to hospital immediately if you develop a sudden severe headache,
visual changes, or chest pain (possible hypertensive crisis) or a fever above
38°C (neutropenic sepsis). Attend all blood test appointments. If you are male
and wish to preserve fertility, speak to your oncologist about sperm banking
before starting.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Procarbazine has MAOI
activity — comprehensive drug interaction screening is mandatory before any
new medicine is co-prescribed. Absolute contraindications: all
antidepressants (SSRIs, SNRIs, MAOIs, TCAs), meperidine, sympathomimetics,
alcohol. Dietary restriction counselling is essential — provide full MAOI
dietary restriction list: tyramine-rich foods (aged cheeses, cured meats,
fermented products, beer, wine, other alcohol) must be avoided during
treatment and for 2 weeks post-completion. Febrile neutropenia emergency plan
(FBC monitoring before each cycle; fever >38°C = immediate hospital
attendance). Gonadotoxicity counselling — sperm banking referral for male
patients. Embryo-fetal toxicity — highly teratogenic; effective contraception
required during and 6 months post-treatment. Warfarin INR monitoring. Second
malignancy risk — document in patient record. Pethidine/meperidine is
absolutely contraindicated (fatal interaction risk). |
11. FREQUENTLY ASKED QUESTIONS
Q: Why do I have to follow a special diet on this medicine?
Procarbazine inhibits an enzyme called monoamine oxidase (MAO), which
normally breaks down tyramine — a natural compound found in many aged,
fermented, and cured foods. When tyramine builds up in the body, it can cause a
sudden and dangerous spike in blood pressure (hypertensive crisis). Strict
avoidance of tyramine-rich foods and alcohol is essential for your safety
during treatment and for 2 weeks after.
Q: Can I have any alcohol at all?
No alcohol must be completely avoided during procarbazine treatment. As
well as containing tyramine and triggering a hypertensive crisis risk, alcohol
with procarbazine also causes a disulfiram-like reaction (flushing, nausea,
palpitations) and adds to central nervous system depression.
Q: How long do the dietary restrictions last?
Throughout all the days you take procarbazine, and for 2 full weeks after
your last dose. The MAOI effect of procarbazine takes this long to fully clear
from the body.
Q: What painkillers can I take while on procarbazine?
Paracetamol (acetaminophen) is generally safe. Avoid codeine (which
converts to morphine) and especially pethidine/meperidine — the combination
with an MAOI can cause a life-threatening reaction. Ask your oncologist or
pharmacist before taking any painkiller.
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