Dactinomycin extravasation

Dactinomycin—vesicant-watch for extravasation Methotrexate Methotrexate 40 mg/M2 IM weekly... 

Dactinomycin -antitumor antibiotic inhibits transcription by complexing with DNA -bone marrow suppression -nausea and vomiting -erythema -hyperpigmentation -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -immunosuppression... 

Adverse effects The major dose-limiting toxicity is bone marrow depression, and the drug is immunosuppressive. Other adverse reactions include nausea, vomiting, diarrhea, stomatitis, and alopecia. Extravasation during injection produces serious problems. Dactinomycin sensitizes to radiation inflammation at sites of prior radiation therapy may occur. 

Dactinomycin inhibits rapidly proliferating cells of normal and neoplastic origin and, on a molar basis, is among the most potent antitumor agents known. The drug may produce alopecia and, when extravasated subcutaneously, causes marked local inflammation. Erythema, sometimes progressing to necrosis, has been noted in areas of the skin exposed to x-ray radiation before, during, or after administration of dactinomycin. 

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