Purpose/objectives: To review the drug profile and nursing implications of amifostine, a new cytoprotective agent.
Data sources: Published articles, abstracts, professional communications, drug manufacturer, and personal experience with amifostine clinical studies.
Data synthesis: Amifostine increases the selectivity of specific anticancer agents for neoplastic cells by protecting normal tissue. It is indicated for reduction of the cumulative renal toxicity associated with repeated administration of cisplatin, in radiation therapy, and in several types of chemotherapies in patients with a variety of malignancies. Studies of amifostine used as a radioprotective and cytotoxic chemoprotective agent have demonstrated results against nephrotoxicity, neurotoxicity, hematotoxicity (granulocytopenia, leukopenia, and thrombocytopenia), and ototoxicity without adversely affecting tumor response or patient survival. The most common side effects are hypotension, nausea and vomiting (which may be severe), and a decrease in serum calcium concentrations.
Conclusions: Amifostine is a new cytoprotectant, the first such agent with pancytoprotection. With appropriate management and premedication, amifostine is generally well-tolerated. Side effects are reversible following treatment discontinuation.
Implications for nursing practice: Nurses need to be knowledgeable about cytoprotectants, a new class of drugs, in order to teach patients and their families about the need for cytoprotection so they can comply with and participate in treatment plans and to identify the need for and management of amifostine administration. Patient-care concerns include the risk of decreased systolic blood pressure that requires fluid infusion and postural management and potentially severe nausea and vomiting.