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P A R T 3
Drugs acting on the immune system
When synthetic interleukins are administered, there
are increases in the numbers of natural killer cells and
lymphocytes, in cytokine activity and in the number of
circulating platelets. See Table 17.1 for usual indications.
Pharmacokinetics
The interleukins are rapidly distributed after injection.
Aldesleukin, given IV, reaches peak levels in 13 minutes
and has a half-life of 85 minutes. This drug is primarily
cleared from the body by the kidneys.
Contraindications and cautions
Interleukins are contraindicated in the presence of any
allergy to an interleukin or
E. coli
–produced product.
They were shown to be embryocidal and teratogenic
in animal studies and should not be used during preg-
nancy. Use of barrier contraceptives is recommended
for women of childbearing age who require one of these
drugs. It is not clear whether the drugs cross into breast
milk, but it is recommended that they not be used during
breastfeeding; if they must be used, another method of
feeding the baby must be chosen because of the potential
for adverse effects in the baby. Caution should be used
with renal, liver or cardiovascular impairment
because
of the adverse effects of the drugs.
Interleukins are also
contraindicated in individuals with evidence of active
infection requiring antibiotic therapy.
Adverse effects
The adverse effects associated with the interleukins
can be attributed to their effect on the body during
inflammation (flu-like effects: lethargy, myalgia, arthral-
gia, fatigue, fever). Respiratory difficulties, CNS changes
and cardiac arrhythmias have also been reported, and
the person should be monitored for these effects and the
drug stopped if they do occur.
Clinical Important drug–drug interactions
There are no reported drug–drug interactions with
interleukins.
Prototype summary: Aldesleukin
(not available in Australia)
Indications:
Metastatic renal cell carcinoma in
adults; treatment of metastatic melanomas (orphan
drug use).
Actions:
Activates human cellular immunity and
inhibits tumour growth through increases in
lymphocytes, platelets and cytokines.
Pharmacokinetics:
Route Onset
Peak
Duration
IV 5 mins
13 mins
3–4 hours
T
1/2
:
85 minutes; metabolised in the kidney and
excreted in the urine.
Adverse effects:
Mental status changes, dizziness,
hypotension, sinus tachycardia, arrhythmias,
pruritus, nausea, vomiting, diarrhoea, anorexia,
gastrointestinal (GI) bleed, bone marrow
suppression, respiratory difficulties, fever, chills,
pain.
Care considerations for
people receiving immune stimulants
Assessment: History and examination
■
■
Assess for contraindications and cautions: known
allergies to any of these drugs or their components
to prevent hypersensitivity reactions
; current
status related to pregnancy or breastfeeding
to
avoid serious adverse effects on the fetus or baby
;
history of hepatic, renal or cardiac disease, bone
marrow depression and CNS disorders, including
seizures,
all of which could be exacerbated by the
effects of these drugs
.
■
■
Perform a physical assessment
to determine
baseline status before beginning therapy and
for any potential adverse effects
; inspect for
the presence of any skin lesions
to detect early
dermatological effects
; obtain weight
to monitor
for fluid retention
; monitor temperature
to detect
any infection
; check heart rate and rhythm and
blood pressure
to monitor for any cardiac effects
of the drug
; assess level of orientation and reflexes
to evaluate CNS effects of the drug
.
■
■
Obtain a baseline electrocardiogram (ECG)
to
evaluate cardiac function and monitor adverse
effects of the drugs
.
■
■
Assess the person’s renal and liver function,
including renal and liver function tests,
to
determine the appropriateness of therapy
and
to determine the need for possible dose adjustment
and toxic drug effects
.
■
■
Monitor the results of laboratory tests such as full
blood count (FBC)
to identify changes in bone
marrow function
.
Implementation with rationale
■
■
Arrange for laboratory tests before and periodically
during therapy, including FBC and differential,
to monitor for drug effects and adverse effects
.
■
■
Administer drug as indicated; instruct the person
and a significant other if injections are required
to ensure that the drug will be given even if the
person is not able to administer it
.
