1 What is Hexalen?

Brand: Hexalen

Generic: Altretamine

Hexalen refers to the group of drugs called Alkylating agents which are Cytotoxic drugs commonly used as anticancer drugs. The antineoplastic drugs exert their action either by killing cancer cells or modifying their growth. 

Altretamine does not require to form an active intermediate and it interferes with the uncontrolled growth of neoplastic cells, which are eventually destroyed. Thus, altretamine is used in ovarian and bladder cancer. It is also used in certain patients with lung cancer

Since the selectivity of altretamine is limited, the proliferation and maturation of normal cells may be affected. Some other effects will also occur which may become serious and warrant medical help immediately. 

Following oral administration, altretamine is well absorbed from the GI tract and undergoes rapid demethylation in the liver. This medicine is available in the market in capsule form. Before you start treatment with such medications, you should talk with your doctor about the risk-benefit ratio of using it.

2 What To Know Before Using

Before using Hexalen, you must know all about the risks and complications associated with it.

At present, six major types of alkylating agents are used in the chemotherapy of neoplastic diseases:

  • Nitrogen mustards 
  • Ethyleneimines 
  • Alkyl sulfonates 
  • Nitrosoureas 
  • The triazenes 
  • DNA-methylating drugs

Altretamine and majority of the cytotoxic drugs have more profound effect on rapidly multiplying cells, because the important target of action are the nucleic acids and their precursors, and rapid nucleic acid synthesis occurs during cell division. 

Large solid tumors have a lower growth fraction than normal bone marrow, epithelial linings, reticuloendothelial system and gonads. These tissues are particularly affected in a dose-dependent manner by majority of drugs; though, there are differences in susceptibility to individual members. 

In deciding to use this drug, the following should be considered: 

  • Always try to answer each question appropriately asked by the health professional. You should tell your doctor if you have had any unusual or allergic reaction to this medicine or any other medicines. 
  • If you are suffering from diabetes, heart diseases, metabolic disorders, hepatic or renal failure, you must mention these to your doctor. The presence of some diseases affects the use of altretamine.
  • You must tell your doctor if you have any of the following health problems, especially: chickenpox, shingles, CNS disorders, infection, renal and liver disease.
  • Studies in pregnant women have demonstrated a risk to the fetus. However, the potential benefits may warrant use of the drug in pregnant women despite potential risks.
  • There are no well-controlled studies in women for determining the risk to infants when this medication is used during breastfeeding. 
  • Certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some drugs for another health problem. Sometimes it is a must to avoid the particular medicines during a drug therapy in order to remain out of danger of serious drug reactions.

3 Proper Usage

To use Hexalen properly, you must follow all instructions given by your doctor.

Altretamine often may cause nausea, vomiting or other GI discomforts. It is recommended to not stop receiving the medicine even if you feel such problems. 

It is advised to take this medicine after meals that will lessen unwanted effects. You should ask your doctor for other ways in order to reduce these effects.

The usual dosage of Altretamine  as a single agent in ovarian cancer is 260 mg/m2/day in four divided doses, for 14 or 21 consecutive days out of a 28-day cycle, for up to 12 cycles.

The dosing of this medicine may vary from patient to patient. The dosage of the medicine that you are advised depends upon the disease condition and the strength of the drug as well. You should follow your doctor's directions as well as the advice in order to obtain maximum benefit. 

Always try to take your medicine according to your doctor’s prescription. You should store the medicine in a cool and dry place, away from heat, moisture, and direct light. 

Moreover, all types of drugs should be kept out of the reach of children. Outdated medicine should be destroyed in a proper way.

4 Precautions To Take

Before using Hexalen, there are some precautions you must take.

You should be careful in order to avoid the unwanted drug interactions and other toxicity that may arise because of concurrent use of altretamine with certain medicines and vaccines. 

If you need to take any other medicines for another health problem, it is safe to consult your doctor when you are taking this medicine. On the contrary, you should tell your healthcare professional if you are taking any of the medicines listed below. 

It will help your doctor in decision as using altretamine with any of the following medicines is not safe:

  • rotavirus vaccine (live)
  • adenovirus vaccine (live)
  • BCG vaccine (live)
  • measles vaccine (live)
  • mumps vaccine (live)
  • oral polio vaccine
  • clorgyline
  • furazolidone
  • iproniazid
  • isocarboxazid
  • lazabemide
  • linezolid
  • moclobemide
  • nialamide
  • pargyline
  • phenelzine
  • procarbazine etc.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Hexalen.

The main toxicities of altretamine are Myelosuppression and Neurotoxicity. Altretamine causes both peripheral and central neurotoxicity (ataxia, depression, confusion, drowsiness, hallucinations, dizziness, and vertigo). 

Neurological symptoms abate upon discontinuation of therapy. Peripheral blood counts and a neurological examination should be performed prior to the initiation of each course of therapy. 

Therapy should be interrupted for at least 14 days and subsequently restarted at a lower dosage of 200 mg/m2/day, if the white cell count falls to <2000 cells/mm3 or the platelet count falls to <75,000 cells/mm3 or if neurotoxic or intolerable GI symptoms occur. 

If neurological symptoms fail to stabilize on the reduced-dose schedule, altretamine should be discontinued. Nausea and vomiting also are common side effects and may be dose limiting. Renal dysfunction may necessitate discontinuing the drug. 

Other rare adverse effects include rashes, alopecia, and hepatic toxicity. Severe, life-threatening orthostatic hypotension may develop in patients who receive monoamine oxidase (MAO) inhibitors, amitriptyline, imipramine, or phenelzine concurrently with altretamine.