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Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.

A - Drug Name



B - Mechanism of Action and Pharmacokinetics

Dacarbazine is an imidazole carboxamide derivative with structural similarity to certain purines; however, its primary mode of action appears to be alkylation of nucleic acids. Inhibition of DNA synthesis, by acting as a purine analogue and interacting with sulfhydryl groups, is also possible. Dacarbazine is cell cycle non-specific.


Liver. Pharmacokinetics may be more than dose-dependent at high doses (>1200 mg/m2) due to decreased renal clearance; metabolism may also be saturated at this level.

Cross blood brain barrier? < 15 %
PPB < 5 %

Metabolized by hepatic microsomal enzyme oxidation system.

Active metabolites Yes
Inactive metabolites

Yes, including amino imidazole carboxamide (AIC; major)


Excreted in urine via renal tubular secretion.


20-50% unchanged, 12-24% as AIC


Terminal t½:  0.5 to 3.5 hours

C - Indications and Status
Health Canada Approvals:

  • Palliative therapy of metastatic malignant melanoma

Other Uses:

  • Adrenal cancer (pheochromocytoma)
  • Hodgkin lymphoma
  • Neuroendocrine tumours
D - Adverse Effects

Emetogenic Potential:  


Extravasation Potential:   Irritant

The incidences for the adverse effects are based on product monographs where available. Incidences marked with "^" are based on the dacarbazine arm in other metastatic melanoma clinical trials.

Cardiovascular ECG changes D
Flushing (facial; rare) I
Hypotension (high doses > 850mg/m2) I
Dermatological Alopecia (rare) E
Photosensitivity (rare, more common with large single doses) I
Rash (rare) I
Gastrointestinal Anorexia (>90%) E
Constipation (23%) ^ E
Diarrhea (12%) ^ I
Mucositis (11%) ^ E
Nausea, vomiting (>90%) I
General Fatigue (31%) ^ E
Flu-like symptoms (<10%) E
Hematological Immunosuppression E
Myelosuppression (11%) ^ (neutropenia); may be severe E
Hepatobiliary Hepatic necrosis (rare) E
↑ LFTs (rare) E
Veno-occlusive disease (rare) E
Hypersensitivity Hypersensitivity (rarely severe) I
Injection site Injection site reaction (pain / irritation) I
Phlebitis (chemical) I
Nervous System Confusion (rare) I
Headache (rare) E
Paresthesia (facial; rare) E
Seizure (rare) I
Ophthalmic Blurred vision (rare) E
Renal Creatinine increased (impaired renal function; rare) E

* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days)     E = early (days to weeks)
D = delayed (weeks to months)      L = late (months to years)

Anorexia, nausea and vomiting appear to be induced via a CNS mechanism.  The use of prophylactic antiemetics is recommended.  Nausea and vomiting may last 1-12h but tend to subside after the first few days of treatment.  In rare cases, this may require drug discontinuation.

A flu-like syndrome consisting of fever, myalgia and malaise may occur, especially after large, single doses. These symptoms occur in less than 10% of patients, starting 2-7 days after treatment and lasting for 7-21 days. This syndrome may recur on subsequent treatments.

Hepatotoxicity, including fatal cases, has occurred during dacarbazine treatment. It was usually seen during the second cycle; some cases have been preceded by mild, transient hepatic toxicity after the first cycle.

E - Dosing

Refer to protocol by which patient is being treated.  Numerous dosing schedules exist and depend on disease, response and concomitant therapy.  Guidelines for dosing also include consideration of white blood cell count. Dosage may be reduced and/or delayed in patients with bone marrow depression due to cytotoxic/radiation therapy. 


Intravenous: 200-250 mg/m² daily for 5 days Every 3-4 weeks

Intravenous: 2 to 4.5 mg/kg daily for 10 days Every 3 weeks

Intravenous: 375 mg/m² IV on days 1 and 15 (as in ABVD); every 4 weeks

Dosage with Toxicity:

Dosage in myelosuppression:

Modify according to protocol by which patient is being treated.  If significant hematological toxicity occurs, consider hold or discontinuation of therapy.

Dosage with Toxicity:




Grade 3 (with fever or systemic infection) or Grade 4 hematological toxicity


↓ 25%

Grade 3 non-hematological


↓ 25%; discontinue if recurs after 2 dose reductions

Grade 4 non-hematological


Not applicable


1Before retreatment, major organ toxicities should recover to ≤ Grade 2, platelets ≥ 100 x 109/L, and ANC ≥ 1.5 x 109/L. 

Dosage with Hepatic Impairment:

Adjustment required, no details found

Dosage with Renal Impairment:

Creatinine Clearance (mL/min)



100% of dose


75% of dose


50% or discontinue



* modified from Kintzel et al 1995

Dosage in the elderly:

Safety and efficacy not established.


Safety and efficacy not established.

F - Administration Guidelines

  • Administration of concentrated dacarbazine solutions may cause severe perivenous pain; therefore, it is recommended to give dacarbazine as a diluted IV infusion.
  • Extreme care should be taken to avoid extravasation as this may result in tissue damage and severe pain.
  • May be mixed in normal saline or D5W bag (250 to 1000 mL), depending on the regimen.  
  • Infuse over 30 to 120 minutes; refer to the institutional guidelines for infusion duration.
  • Keep dacarbazine vials refrigerated (2 to 8ºC); protect the undiluted drug, infusion bags and tubing from light.

G - Special Precautions

  • patients with known hypersensitivity to dacarbazine and any component of its formulation
  • patients who have previously had severe myelosuppression.

Other Warnings/Precautions:

  • Dacarbazine is a moderate immunosuppressive agent. Avoid the use of live vaccines during treatment and for at least 3 months after the last dose. Response to inactivated vaccines may be decreased.

Other Drug Properties:

  • Carcinogenicity: Yes

Pregnancy and Lactation:
  • Mutagenicity: Yes
  • Teratogenicity: Yes

    Dacarbazine is not recommended for use in pregnancy. Adequate contraception should be used by both sexes during therapy and for at least 6 months after treatment cessation.

  • Breastfeeding:

    Breast feeding is not recommended due to the potential secretion into breast milk.

  • Fertility effects: Probable
H - Interactions

Dacarbazine is metabolized by CYP1A1, CYP1A2 and CYP2E1.

Interleukin-2 ↑ dacarbazine clearance Unknown Clinical significance is uncertain; increased dose of dacarbazine may be required.
Fotemustine Fatal Acute Respiratory Distress Syndrome Unknown Caution
levodopa ↓ response to levodopa Unknown Caution in patients stabilized on levodopa; dosage adjustments of levodopa may be required
Phenytoin, phenobarbital and other drugs inducing hepatic oxidase enzymes. ↑ metabolism of dacarbazine Induction of hepatic microsomal enzyme oxidation system Caution; monitor carefully
CYP1A2 inhibitors (e.g., atazanavir, ciprofloxacin, fluvoxamine) ↓ metabolism of dacarbazine Inhibition of CYP1A2 enzymes Caution; monitor carefully and consider therapy modification.
CYP2E1 inhibitors (e.g., ritonavir, fluoxetine) ↓ metabolism of dacarbazine Inhibition of CYP2E1 enzymes Caution; monitor carefully and consider therapy modification.
Mercaptopurine allopurinol, azathioprine ↑ activity of these drugs Dacarbazine inhibits xanthine oxidase Theoretical risk; monitor carefully
I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

Monitor Type Monitor Frequency


Baseline and before each cycle

Liver function tests

Baseline and as clinically indicated

Renal function tests

Baseline and as clinically indicated

Clinical toxicity assessment including GI, infection, bleeding, hypersensitivity, skin, injection site reactions, flu-like symptoms

At each visit

Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

K - References

Bedikian AY, Millward M, Pehamberge H, et al. Bcl-2 Antisense (oblimersen sodium) plus dacarbazine in patients with advanced melanoma: the oblimersen melanoma study group. J Clin Oncol 2006; 24(29): 4738-45.

Cancer Drug Manual (the Manual), 1994, British Columbia Cancer Agency (BCCA)

Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 2011;364:2507-16.

Kintzel PE and Dorr RT. Anticancer Drug Renal Toxicity and Elimination: Dosing Guidelines for Altered Renal Function. Cancer Treat Rev 1995; 21(1): 33-64.

McEvoy GK, editor. AHFS Drug Information 2009. Bethesda: American Society of Health-System Pharmacists, p. 1020-2.

Middleton MR, Grob JJ, Aaronson N, et al. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol 2000; 18(1): 158-166.

Product Monograph: Dacarbazine for injection. Pfizer Canada, January 25, 2019.

Robert C, Dummer R, Gutzmer R, et al. Selumetinib plus dacarbazine versus placebo plus dacarbazine as first-line treatment for BRAF-mutant metastatic melanoma: a phase 2 double-blind randomised study. Lancet Oncol 2013 Jul;14(8):733-40.

Summary of Product Characteristics: Dacarbazine. medac GmbH, March 2017.

April 2020 Updated pharmacokinetics, indications, adverse effects, administration guidelines, special precautions, and monitoring sections

L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.

The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.

Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.

While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.

CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.