Arsenic trioxide: Difference between revisions

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{{Chembox new
{{DrugProjectFormSinglePage
|   Name = Arsenic trioxide
|authorTag=
|   ImageFile = Arsenic trioxide.jpg
 
<!-- | ImageSize = 160px -->
 
|   ImageName = Arsenic trioxide
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|   ImageFile1 = Arsenic-trioxide-3D-balls.png
 
<!-- | ImageSize1 = 120px  -->
|genericName=
|   ImageName1 = Ball-and-stick model of the As4O6 molecule
 
|   OtherNames = Arsenic(III) oxide,<br />Arsenic [[sesquioxide]],<br />Arsenicum album,<br />Arseneous oxide,<br />Arseneous anhydride
 
| Section1 = {{Chembox Identifiers
 
|   CASNo = 1327-53-3
|aOrAn=
|  EINECS = 215-481-4
 
|   PubChem = 518740
a
  }}
 
| Section2 = {{Chembox Properties
|drugClass=
|   Formula = As<sub>2</sub>O<sub>3</sub>
 
|  MolarMass = 197.841 g/mol
 
|  Appearance = White solid
 
|   Density = 3.86 g/cm³, solid.
|indication=
|   Solubility = 2 g/100 ml (25°C)<br />'''see text'''
 
|   MeltingPt = 274°C
 
|   BoilingPt = 460°C
 
|   pKa = 9.2
|hasBlackBoxWarning=
|   pKb =  
 
  }}
Yes
| Section3 = {{Chembox Structure
 
|   MolShape = '''See Text'''
|adverseReactions=
|   CrystalStruct = [[Cubic crystal system|cubic]] (α)<180°C<br />[[monoclinic]] (β) >180°C
 
|   Dipole = Zero
 
  }}
 
| Section4 = {{Chembox Thermochemistry
<!--Black Box Warning-->
|   DeltaHf = &minus;657.4 kJ/mol
 
|   Entropy = ? J.K<sup>–1</sup>.mol<sup>–1</sup>
|blackBoxWarningTitle=
  }}
Title
| Section7 = {{Chembox Hazards
 
|  ExternalMSDS =
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|  EUClass = Very toxic ('''T+''')<br />Carc. Cat. 1<br />Dangerous for the<br />environment ('''N''')
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<!--Adult Indications and Dosage-->
|   SPhrases = {{S53}}, {{S45}}, {{S60}},<br />{{S61}}
 
  }}
<!--FDA-Labeled Indications and Dosage (Adult)-->
| Section8 = {{Chembox Related
 
|  OtherAnions = [[Arsenic trisulfide]]
|fdaLIADAdult=
|  OtherCations = [[Phosphorus trioxide]]<br />[[Antimony trioxide]]
 
|   OtherCpds = [[Arsenic pentoxide]]<br />[[Arsenous acid]]
=====Condition1=====
  }}
 
}}
* Dosing Information
 
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=====Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
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<!--Non–Guideline-Supported Use (Adult)-->
 
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=====Condition1=====
 
* Dosing Information
 
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<!--FDA-Labeled Indications and Dosage (Pediatric)-->
 
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<!--Off-Label Use and Dosage (Pediatric)-->
 
<!--Guideline-Supported Use (Pediatric)-->
 
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=====Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
 
|offLabelPedNoGuideSupport=
 
=====Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Contraindications-->
 
|contraindications=
 
* Condition1
 
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|warnings=
 
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=====Body as a Whole=====
 
 
 
 
=====Cardiovascular=====
 
 
 
 
=====Digestive=====
 
 
 
 
=====Endocrine=====
 
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
 
=====Metabolic and Nutritional=====
 
 
 
 
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|postmarketing=
 
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=====Body as a Whole=====
 
 
 
=====Cardiovascular=====
 
 
 
=====Digestive=====
 
 
 
=====Endocrine=====
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
=====Metabolic and Nutritional=====
 
 
 
=====Musculoskeletal=====
 
 
 
=====Neurologic=====
 
 
 
=====Respiratory=====
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
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|useInPregnancyAUS=
* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
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|useInNursing=
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|useInPed=
There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
 
|useInGeri=
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|useInGender=
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|useInRace=
There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
 
|useInRenalImpair=
There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
 
|useInHepaticImpair=
There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
 
|useInReproPotential=
There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
 
|useInImmunocomp=
There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
<!--Administration and Monitoring-->
 
|administration=
 
* Oral
 
* Intravenous
 
|monitoring=
 
There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
 
* Description
 
<!--IV Compatibility-->
 
|IVCompat=
 
There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
 
<!--Overdosage-->
 
|overdose=
 
===Acute Overdose===
 
====Signs and Symptoms====
 
* Description
 
====Management====
 
* Description
 
===Chronic Overdose===
 
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
 
<!--Pharmacology-->
 
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: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
 
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<!--Pharmacokinetics-->
 
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There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
 
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There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
 
<!--Clinical Studies-->
 
|clinicalStudies=
 
There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
 
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|howSupplied=


{{drugbox
*
| IUPAC_name = 2,4,5-trioxa-1,3-diarsabicyclo[1.1.1]pentane
| image = Arsenic trioxide.png
| CAS_number = 1327-53-3
| ATC_prefix = L01
| ATC_suffix = XX27
| ATC_supplemental =


| DrugBank = APRD00171
<!--Patient Counseling Information-->
| As=2 | O=3
| molecular_weight = 197.841 g/mol
| bioavailability =
| protein_bound = 75% bound
| metabolism =
| elimination_half-life =
| excretion =
| pregnancy_AU =<!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_US =<!-- A / B / C / D / X -->
| pregnancy_category =
| legal_AU =<!-- Unscheduled / S2 / S4 / S8 -->
| legal_UK =<!-- GSL / P / POM / CD -->
| legal_US =<!-- OTC / Rx-only -->
| legal_status =
| routes_of_administration =
}}
{{SI}}


|fdaPatientInfo=


==Overview==
There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
'''Arsenic trioxide''' is the most important commercial compound of [[arsenic]], and the main starting material for arsenic chemistry. It is the highly toxic byproduct of certain kinds of ore processing, for example gold mining.<ref>{{cite web |url=http://nwt-tno.inac-ainc.gc.ca/giant/atg_e.html |title=Giant Mine - Northwest Territories Region - Indian and Northern Affairs Canada |accessdate=2007-08-28 |format= |work=
  }}</ref>


==Preparation==
<!--Precautions with Alcohol-->
* Burning [[arsenic]] in [[air]].
* [[Hydrolysis]] of [[arsenic trichloride]].
* Roasting of [[arsenide]] minerals. (Main industrial route)


==Chemical properties==
|alcohol=
Arsenic trioxide is an [[amphoteric]] oxide which shows a marked preponderance for its [[Acidic oxide|acidic]] properties. It dissolves readily in alkaline solutions to give [[arsenite]]s. It is much less soluble in acids, but will dissolve in [[hydrochloric acid]] to give [[arsenic trichloride]] or related species. It reacts with [[oxidizing agent]]s such as [[ozone]], [[hydrogen peroxide]] and [[nitric acid]] to give [[arsenic pentoxide]], As<sub>2</sub>O<sub>5</sub>: the reaction with [[hydrogen peroxide]] can be explosive. It is also readily reduced to [[arsenic]], and [[arsine]] (AsH<sub>3</sub>) may also be formed.


==Molecular structure==
* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Tetrahedral molecules, As<sub>4</sub>O<sub>6</sub>, in α-form and in liquid and gas phases.


==Uses==
<!--Brand Names-->
* Starting point for the manufacture of arsenic-based pesticides .([[sodium arsenite]], [[sodium arsenate]], [[sodium cacodylate]]).
* Starting point for the manufacture of certain arsenic-based pharamaceuticals ([[Neosalvarsan]]) and veterinary products.
* Decolorizing agent for glasses and enamels.
* Preservative for wood.
* Hydrogen recombination poison for metallurgical studies.
* Starting point for the preparation of elemental [[arsenic]], arsenic alloys and [[arsenide]] [[semiconductors]].
* Use as a [[cytostatic]] in the treatment of refractory promyelocytic (M3) subtype of acute myeloid [[leukemia]]. The drug is available as Trisenox® ampules; each containing 10mg to be diluted for i.v. infusion.
* Arsenic trioxide is also used to treat leukemia in patients who have not responded to other medications.


==Medical applications==
|brandNames=
Arsenic trioxide under the trade name Trisenox (manufacturer: Cephalon) is a chemotheraputic agent of [[idiopathic]] function used to treat [[leukemia]] that is unresponsive to first line agents. It is suspected that arsenic trisulfide induces cancer cells to undergo [[apoptosis]].  Due to the toxic nature of arsenic, this drug carries significant risks.


The enzyme [[thioredoxin reductase]] has recently been identified as a target for arsenic trioxide.<ref name="pmid17640917">{{cite journal |author=Lu J, Chew EH, Holmgren A |title=Targeting thioredoxin reductase is a basis for cancer therapy by arsenic trioxide |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=104 |issue=30 |pages=12288-93 |year=2007 |pmid=17640917 |doi=10.1073/pnas.0701549104}}</ref>
* ®<ref>{{Cite web | title = | url = }}</ref>


==Toxicology==
<!--Look-Alike Drug Names-->
:''See also: [[arsenicosis]].''
Arsenic trioxide is readily absorbed by the digestive system: toxic effects are also well known after inhalation of the dust or fumes and after skin contact. Elimination is rapid at first (half-life of 1&ndash;2 days), by methylation to [[cacodylic acid]] and excretion in the urine, but a certain amount (30&ndash;40% in the case of repeated exposure) is incorporated into the bones, muscles, skin, hair and nails (all tissues rich in [[keratin]]) and eliminated over a period of weeks or months.


The first symptoms of acute [[arsenic]] poisoning by ingestion are digestive problems: vomiting, abdominal pains, diarrhea often accompanied by bleeding. Sub-lethal doses can lead to convulsions, cardiovascular problems, inflammation of the [[liver]] and [[kidneys]] and abnormalities in the coagulation of the blood. These are followed by the appearance of characteristic white lines (Mees stripes) on the nails and by hair loss. Lower doses lead to liver and kidney problems and to changes in the pigmentation of the skin.
|lookAlike=


Cases of acute arsenic poisoning are known after inhalation and after skin contact with arsenic trioxide. The first signs
* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>
are severe irritation, either of the respiratory tract or of the exposed skin, followed by longer term neurological problems.
Even dilute solutions of arsenic trioxide are dangerous on contact with the eyes.


Chronic [[arsenic]] poisoning is known as [[arsenicosis]]: it is found after professional exposure (for example, in metal
<!--Drug Shortage Status-->
smelters), in populations whose drinking [[water]] contains high levels of arsenic (0.3&ndash;0.4&nbsp;ppm) and in patients
treated for long periods with arsenic-based pharmaceuticals.


Arsenic trioxide has been shown to be a human [[carcinogen]]. Studies on workers exposed in [[copper]] foundries in the U.S.,
|drugShortage=
Japan and Sweden indicate a risk of lung cancer 6&ndash;10 times higher for the most exposed workers compared with the
}}
general population. Long-term ingestion of arsenic trioxide either in drinking water or as a medical treatment can lead
to skin cancer. Reproductive problems (high incidence of miscarriage, low birth weight, congenital deformations) have also
been indicated in one study of women exposed to arsenic trioxide dust as employees or neighbours of a copper foundry.


==Bibliography==
<!--Pill Image-->
* Institut national de recherche et de sécurité (INRS), ''Fiche toxicologique nº 89&nbsp;: Trioxyde de diarsenic'', 1989.
* AFHS Database on use as a cytostatic


==References==
{{PillImage
<references/>
|fileName=No image.jpg|This image is provided by the National Library of Medicine.
|drugName=
|NDC=
|drugAuthor=
|ingredients=
|pillImprint=
|dosageValue=
|dosageUnit=
|pillColor=
|pillShape=
|pillSize=
|pillScore=
}}


==External links==
<!--Label Display Image-->
* [http://www.atsdr.cdc.gov/HEC/CSEM/arsenic/ Case Studies in Environmental Medicine: Arsenic Toxicity]
* [http://www-cie.iarc.fr/htdocs/monographs/suppl7/arsenic.html IARC Monograph &ndash; Arsenic and Arsenic Compounds]
* [http://www.ilo.org/public/english/protection/safework/cis/products/icsc/dtasht/_icsc03/icsc0378.htm International Chemical Safety Card 0378]
* [http://www.cdc.gov/niosh/npg/npgd0038.html NIOSH Pocket Guide to Chemical Hazards]
* [http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s015arse.pdf NTP Report on Carcinogens &ndash; Inorganic Arsenic Compounds]
* [http://www.multiplemyeloma.org/treatments/3.08.07.html Use of Arsenic Trioxide in Multiple Myeloma Treatment]
* [http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500241.html The use of Arsenic trioxide in medicine].
* {{inrs|title=Trioxyde d'arsenic|number=89|year=1989}}


{{Chemotherapeutic agents}}
{{LabelImage
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
}}
 
{{LabelImage
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
}}


[[Category:Arsenic compounds]]
<!--Category-->
[[Category:Oxides]]
[[Category:IARC Group 1 carcinogens]]
[[Category:Alchemical substances]]


[[cs:Oxid arsenitý]]
[[Category:Drug]]
[[de:Arsen(III)-oxid]]
[[eo:Arseniko]]
[[it:Claudetite]]
[[hu:Arzenolit]]
[[nl:Arsenoliet]]
[[ja:三酸化二ヒ素]]
[[no:Arsenikk]]
[[nn:Arsenikk]]
[[pl:Tlenek arsenu(III)]]
[[sl:Arzenov trioksid]]
[[sr:Арсенолит]]
[[fi:Arseenitrioksidi]]
[[sv:Arseniktrioxid]]
[[vi:Ôxít asen]]
[[uk:Клодетит]]
[[zh:三氧化二砷]]
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Revision as of 15:45, 20 January 2015

Arsenic trioxide
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

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Black Box Warning

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Arsenic trioxide is a that is FDA approved for the {{{indicationType}}} of . There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Arsenic trioxide in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Arsenic trioxide in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Arsenic trioxide in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Arsenic trioxide in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Arsenic trioxide in pediatric patients.

Contraindications

  • Condition1

Warnings

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Arsenic trioxide in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Arsenic trioxide in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Arsenic trioxide in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Arsenic trioxide during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Arsenic trioxide with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Arsenic trioxide with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Arsenic trioxide with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Arsenic trioxide with respect to specific gender populations.

Race

There is no FDA guidance on the use of Arsenic trioxide with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Arsenic trioxide in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Arsenic trioxide in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Arsenic trioxide in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Arsenic trioxide in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Arsenic trioxide in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Arsenic trioxide in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Arsenic trioxide in the drug label.

Pharmacology

There is limited information regarding Arsenic trioxide Pharmacology in the drug label.

Mechanism of Action

Structure

File:Arsenic trioxide01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Arsenic trioxide in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Arsenic trioxide in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Arsenic trioxide in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Arsenic trioxide in the drug label.

How Supplied

Storage

There is limited information regarding Arsenic trioxide Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Arsenic trioxide |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Arsenic trioxide |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Arsenic trioxide in the drug label.

Precautions with Alcohol

  • Alcohol-Arsenic trioxide interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)


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