Procarbazine
Alkylating agents
Alkylating agentsHigh alert
An error with this medicine can cause serious harm: double checks and protocols are used.
Oral methylating drug for Hodgkin lymphoma and brain tumours. A weak MAO inhibitor with a disulfiram-like alcohol reaction, so food and drug rules apply.
Quick facts
- Group
- Alkylating agents
- Target
- DNA (methylated by activated procarbazine metabolites)
- Used for
- Hodgkin lymphoma · Some brain tumours
- Key effects
- Leukopenia and thrombocytopenia · Nausea · Drowsiness
- Monitor
- Blood counts · Blood pressure
- ATC
- L01XB01
No doses: the clinician sets them by the current guideline.
Mechanism of action
Procarbazine is a methylhydrazine that must be activated in the liver. Liver oxidation produces highly reactive species that methylate DNA and cause chromosome breaks. It is also a weak monoamine oxidase inhibitor and has disulfiram-like effects, which explain its food, alcohol and drug interactions.
- The liver activates procarbazine
- Its reactive metabolites methylate DNA
- Chromosome breaks lead to cell death
- It also weakly inhibits monoamine oxidase
Indications
- Hodgkin lymphoma, in combination regimens. Hodgkin lymphoma →
- Some brain tumours, in combination regimens.
Adverse effects
Common
- Leukopenia and thrombocytopenia
- Nausea, vomiting, diarrhoea, rash
- Drowsiness, confusion and other behavioural changes
- Numbness or tingling in hands and feet
Contraindications
- Hypersensitivity to procarbazine
Key interactions
- Alcohol
- Disulfiram-like reaction: flushing, vomiting, headache; avoided.
- Very tyramine-rich foods (certain cheeses, yogurt, bananas)
- Blood pressure can rise sharply because tyramine breakdown is blocked.
- Sympathomimetics and other drugs whose breakdown depends on monoamine oxidase
- Risk of hypertension.
- Sedatives and other CNS depressants
- Stronger sedation.
What is monitored
- Blood counts
- Blood pressure
- Mental state and neurological symptoms
Administration and safety
- Oral capsules taken exactly on the regimen's schedule; hazardous drug handled with gloves or clean hands.
- The patient receives a list of foods and medicines to avoid before starting.
- Any new medicine, including over-the-counter and herbal products, is checked with the team before use.
Pregnancy and breastfeeding
Can harm the fetus; pregnancy and breastfeeding are avoided during treatment.
Nursing care
- Review the patient's medicines, including decongestants and antidepressants, before each cycle.
- Teach the diet: avoid very high-tyramine foods and all alcohol.
- Check blood pressure and ask about headache, palpitations, confusion or tingling.
- Teaching: contraception; report fever or bleeding.
Pharmacokinetics
- Absorption
- Oral capsules.
- Metabolism
- Activated in the liver; its pharmacokinetics are not fully characterised.
Test yourself
Think of the answer, then tap the question to see it.
Why must patients on procarbazine avoid tyramine-rich foods?
Procarbazine weakly inhibits monoamine oxidase, so tyramine can cause a hypertensive reaction.
What happens if a patient on procarbazine drinks alcohol?
A disulfiram-like reaction (flushing, vomiting, headache).
Which lymphoma regimens classically include procarbazine?
Hodgkin lymphoma regimens.
Connections
← Back to the class: Alkylating agents
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Procarbazine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.