Gallium Nitrate

A to Z Drug Facts

 Action Exerts hypocalcemic effect by inhibiting calcium resorption from bone, possibly by stabilizing bone matrix, thereby reducing increased bone turnover.

 Indications Treatment of symptomatic cancer-related hypercalcemia unresponsive to adequate hydration.

 Contraindications Severe renal impairment (serum creatinine > 2.5 mg/dl).

 Route/Dosage

ADULTS: IV 100 to 200 mg/m²/day for 5 consecutive days.

 Interactions

Nephrotoxic drugs (eg, aminoglycosides, amphotericin B): May increase risk for development of renal insufficiency.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Tachycardia; lower extremity edema; asymptomatic hypotension. EENT: Acute optic neuritis; visual impairment; tinnitus. GI: Nausea or vomiting; diarrhea; constipation. GU: Increased BUN and creatinine; acute renal failure. HEMA: Anemia; leukopenia. META: Hypocalcemia; mild to moderate transient hypophosphatemia; decreased serum bicarbonate concentrations. RESP: Shortness of breath; rales and rhonchi; pleural effusion; pulmonary infiltrates. OTHER: Lethargy; confusion; hypothermia; fever; paresthesia; skin rash.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Asymptomatic or mild to moderate hypocalcemia: Occurs frequently. Renal impairment: Hypercalcemia in cancer patients is commonly associated with impaired renal function. Visual and auditory disturbances: Have occurred in some patients treated with multiple high doses of gallium combined with investigational anticancer drugs.

 Administration/Storage

• Dilute medication with 1 L of either 0.9% Sodium Chloride for Injection or D5W.
• Administer diluted solution daily by IV infusion over 24 hr.
• Maintain adequate hydration of patient.
• If serum calcium concentrations are lowered into normal range in < 5 days, treatment may be discontinued early.
• Mixed solution is stable for 48 hr at room temperature and for 7 days if refrigerated. Discard unused portion.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note compromised renal or cardiovascular function.
• Carefully monitor infusion rate to maintain hydration while avoiding overhydration, especially in patients with compromised cardiovascular status.
• Assess baseline vital signs, BUN, CBC, serum creatinine, calcium, phosphate, and bicarbonate levels.
• Obtain baseline respiratory, neurological, visual, and auditory assessment.
• Take safety precautions with patient with increased neuromuscular irritability caused by hypocalcemia.
• Carefully evaluate patient with cancer-related hypercalcemia for renal insufficiency when there is concurrent use of gallium nitrate and other potentially nephrotoxic drugs (aminoglycosides, amphotericin B). If use of potentially nephrotoxic drug is indicated during therapy, discontinue gallium nitrate and continue hydration for several days after administering potentially nephrotoxic drug. Closely monitor serum creatinine and urine output during and after this period. Discontinue gallium nitrate therapy if serum creatinine level becomes > 2.5 mg/dl.
• Monitor serum creatinine, calcium and BUN continually during therapy. Monitor calcium and phosphorus levels daily and twice weekly, respectively.
• Evaluate patient for signs of hypocalcemia: Tingling and numbness of fingers and circumoral region, painful tonic muscle spasms, facial spasms, grimacing, fatigue, laryngospasm, positive Trousseau's and Chvostek's signs, convulsions, palpitations, and arrhythmias.
• Evaluate patient for signs of hypercalcemia: Anorexia, lethargy, fatigue, nausea, vomiting, constipation, dehydration, renal insufficiency, impaired mental status, coma, and cardiac arrest.

 Patient/Family Education

• Instruct patient and family members to report these symptoms to health care provider: Numbness or spasms noted in extremities or face, increased or irregular heart rate, edema, excessive pain not relieved by prescribed medication, excessive weakness, breathing difficulty, fever, bleeding and seizures, visual or auditory impairment, nausea, vomiting, diarrhea, constipation, abnormal skin sensations, skin rash, chills, pain at injection site.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts