Talc is sometimes used as an adulterant to illegal heroin, to expand volume and weight and thereby increase its street value. With intravenous use, it may lead to pulmonary talcosis, a granulomatous inflammation in the lungs. Sterile talc powder
Sterile talc powder (NDC 63256-200-05) is a sclerosing agent used in the procedure of pleurodesis. This can be helpful as a cancer treatment to prevent pleural effusions (an abnormal collection of fluid in the space between the lungs and the thoracic wall). It is inserted into the space via a chest tube, causing it to close up, so fluid cannot collect there. The product can be sterilized by dry heat, ethylene oxide, or gamma irradiation. Safety
Suspicions have been raised that talc use contributes to certain types of disease, mainly cancers of the ovaries and lungs. According to the IARC, talc containing asbestos is classified as a group 1 agent (carcinogenic to humans), talc use in the perineum is classified as group 2B (possibly carcinogenic to humans), and talc not containing asbestos is classified as group 3 (unclassifiable as to carcinogenicity in humans). Reviews by Cancer Research UK and the American Cancer Society conclude that some studies have found a link, but other studies have not.The studies discuss pulmonary issues, lung cancer, and ovarian cancer.
Patients on dalbavancin also had post-baseline alanine aminotransferase (ALT) levels that were 3 times the upper normal limit, some even having elevations 10 times the upper normal limit; however, eight of the twelve dalbavancin-treated patients had comorbid conditions that could affect their ALT, compared to only one patient in the comparator group. There is no evidence of ototoxicity associated with dalbavancin. Drug interactions
Clinical drug-drug interactions with dalbavancin have not been studied, and dalbavancin does not appear to interact with cytochrome P450 substrates, inhibitors, or inducers. It was found to have an in vitro synergistic interaction with the antimicrobial oxacillin, but the clinical significance of this interaction has yet to be established. Pregnancy and lactation
Use of dalbavancin in pregnant women has not been studied sufficiently and should only occur when the potential benefit outweighs the potential risk to the fetus. Animal studies did not show embryo or fetal toxicity at doses that were 1.2 and 0.7 times the human dose. However, delayed fetal maturation was observed at a dose that was 3.5 times the human dose. While dalbavancin is excreted in rat milk, it is unknown if it is excreted in human milk. It should be used in nursing mothers only when the potential benefit exceeds the potential risk. There is no evidence in animals of teratogenicity. Production and composition
Dalbavancin is manufactured by fermentation of a selected Nonomuraea strain to generate the natural glycopeptide complex A-40926.