Procarbazine

MATULANE

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Pronunciation: proe-KAR-ba-zeen

Procarbazine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Procarbazine ballicule

What it isAlkylating agent generating methyl radicals; Hodgkin lymphoma and brain tumors.

Why this oneIt penetrates the CNS well, which is why it persists in brain tumor regimens.

What limits it⚑ It is a weak MAO inhibitor — tyramine and serotonergic interactions apply. Disulfiram-like reaction with alcohol; secondary leukemia.

Procarbazine molecular structure (skeletal formula) — Molecular structure: Procarbazine

Procarbazine prescription history

Animated chart of estimated U.S. prescriptions per year, Oral anticancer meds (1953–2026). Procarbazine enters in 1969 (estimated).

Principal riskMyelosuppression; disulfiram-like reaction with alcohol

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityMyelosuppression and agent-specific hepatic, cardiac, pulmonary, neurologic or reproductive toxicity require oncology monitoring.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Stage III or IV Hodgkin lymphoma (with other anticancer drugs)	Adult	100 mg/m² PO QD	100 mg/m² PO QD; individualize per regimen/response	100 mg/m² QD (MRHD per 8.1)
Stage III or IV Hodgkin lymphoma (with other anticancer drugs)	Pediatric	100 mg/m² PO QD	100 mg/m² PO QD; individualize per regimen/response	100 mg/m² QD (MRHD per 8.1)

Renal No dose adjustment stated; evaluate renal function before therapy, repeat BUN/urinalysis at least weekly, monitor for adverse reactions

Hepatic No dose adjustment stated; evaluate hepatic function before therapy, repeat transaminases/alk phos at least weekly, monitor for adverse reactions

Instructions

Dose on actual body weight; use estimated lean body mass if obese or edema/ascites/fluid retention
CBC before start; withhold or permanently discontinue for Grade 4 neutropenia/thrombocytopenia, infection, bleeding, CNS symptoms, stomatitis, diarrhea
Permanently discontinue for anaphylaxis/hypersensitivity
With or without food; hazardous drug — follow handling/disposal procedures
Avoid alcohol/propylene glycol, tyramine-rich foods, and MAO inhibitors (within two weeks before and during)

Available strengths

cap 50 mg

Cautions

Myelosuppression
Secondary malignancies
Use in renal or hepatic impairment
Disulfiram-like reaction with alcohol
Infertility
Embryo-fetal toxicity

Adverse reactions

Neutropenia
Anemia
Thrombocytopenia
Nausea
Vomiting

Pregnancy Can cause fetal harm (human case reports, animal data); verify pregnancy status and use effective contraception (females and males with female partners)

Lactation Advise not to breastfeed during treatment (potential tumorigenicity in breastfed child)

Cost

Procarbazine (MATULANE)

Strength		#/mo	generic $/unit	CostPlus
50 mg	cap	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Procarbazine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entryNo US generic

Serotonin and MAOI

Provisional washout figures

SRI significance0 / 4

MAO-A inhibition2 / 4

Serotonin release0 / 4

Elevating mechanismMAO-A inhibitor

Non-elevating actionNone recorded

Exposure dependenceTherapeutic exposure

Washout AFTER an MAOI14 days

Evidence confidenceHigh

InterpretationAntineoplastic with clinically relevant MAOI activity; manage as an MAOI for PD interaction screening.

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Self-check

Procarbazine: Why does it remain in brain-tumor regimens?
Good CNS penetration.
Procarbazine: Which enzyme inhibition creates tyramine interactions?
Weak MAO inhibition.