Alkylating agent (triazene, specialist) Pregnancy: Contraindicated during pregnancy (mutagenic, teratogenic and carcinogenic in animals; increased risk of teratogenic effects assumed in humans) and during breast-feeding. Women of childbearing potential must use effective contraception during and for 6 months after treatment; men during and for 3 months after treatment.

Dacarbazine

Brand names: DTIC-Dome (specialist)

Dacarbazine is an alkylating-type cytotoxic agent used in the treatment of metastatic melanoma, Hodgkin lymphoma (as part of combination regimens) and soft-tissue sarcoma.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Malignant melanoma (single agent): 200 to 250 mg/m2 body surface area/day as an IV injection for 5 days, every 3 weeks

Route: Intravenous (bolus injection or short-term infusion over 15-30 minutes)

Frequency: Daily for 5 days, repeated every 3 weeks (regimen-dependent)

Max: Not stated as a single fixed cap (BSA/regimen-based)

Use confined to physicians experienced in oncology/haematology. Malignant melanoma alternative: 850 mg/m2 on day 1, then once every 3 weeks as IV infusion. Hodgkin's disease: 375 mg/m2/day IV every 15 days in combination with doxorubicin, bleomycin and vinblastine (ABVD regimen); usual recommendation 6 cycles of ABVD in advanced disease. Adult soft-tissue sarcoma: 250 mg/m2/day IV (days 1-5) in combination with doxorubicin every 3 weeks (ADIC regimen). Doses up to 200 mg/m2 may be given as slow IV injection; larger doses (200-850 mg/m2) as IV infusion over 15-30 minutes. Dacarbazine is light-sensitive; protect solutions from light. Monitor blood counts and hepatic/renal function frequently; antiemetic/supportive measures advisable.

Dose adjustments

Renal

Mild to moderate renal or hepatic insufficiency alone: dose reduction not usually required. Combined renal and hepatic impairment prolongs elimination; no validated dose-reduction recommendations can currently be given. Contraindicated in severe kidney disease.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or any excipient
Pregnancy or breastfeeding
Leukopenia and/or thrombocytopenia
Severe liver or kidney diseases

Side effects

Anorexia, nausea, vomiting (common; most commonly reported)
Anaemia, leukopenia, thrombocytopenia (common; dose-dependent, delayed, nadirs at 3-4 weeks)
Alopecia, hyperpigmentation, photosensitivity (uncommon)
Flu-like symptoms (uncommon)
Hepatic necrosis due to veno-occlusive disease of the liver / Budd-Chiari syndrome (rare, potentially fatal)

Interactions

Phenytoin: avoid concomitant use (reduced GI absorption of phenytoin may predispose to convulsions)
Fotemustine: should not be used concomitantly with dacarbazine
Live vaccines: avoid during therapy (risk of serious/fatal infection); vaccinate no sooner than 3 months after completion of chemotherapy
Hepatotoxic medicinal products and alcohol: should be avoided during chemotherapy

Clinical monograph

How it works

It is metabolised in the liver to an active methylating species that alkylates DNA, causing methylation of guanine and disrupting DNA synthesis and cell division.

Prescribing in practice

It is a potent vesicant that causes severe tissue damage on extravasation, and is markedly emetogenic, requiring careful intravenous administration and antiemetic cover.
Causes bone marrow suppression and is photosensitising; rare hepatic vein thrombosis/hepatotoxicity has been reported.
A specialist cytotoxic administered only under oncology supervision in line with the SPC.

Monitoring

Monitor full blood count and liver function, and observe the infusion site closely for extravasation during administration.

Counselling the patient

Tell staff immediately of any pain, stinging or swelling at the drip site.
Nausea is common and anti-sickness medicines will be provided; use sun protection during treatment.
Effective contraception is required as the drug can harm a pregnancy.

Evidence & guidelines

Dacarbazine is a long-established agent in melanoma and Hodgkin lymphoma regimens, supported by trial evidence and the SPC.

Reference: BSH lymphoma; ESMO; UKONS extravasation; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways