procarbazine

Procarbazine is a prodrug that undergoes hepatic activation, generating reactive intermediates that methylate DNA (alkylating-like) and produce free radicals causing strand breaks. It is part of the historical MOPP regimen (Mechlorethamine, Oncovin/vincristine, Procarbazine, Prednisone) for Hodgkin lymphoma and is used in the PCV regimen (procarbazine, CCNU/lomustine, vincristine) for anaplastic gliomas because it crosses the blood-brain barrier. Major boards toxicities: bone marrow suppression, infertility (azoospermia, ovarian failure), secondary AML/MDS, pulmonary toxicity, and notable drug interactions — disulfiram-like reaction with alcohol and hypertensive crisis with tyramine-containing foods or sympathomimetics due to weak MAO inhibition. Counsel patients to avoid alcohol and aged cheese/wine.