Also called mithramycin
Plicamycin
An old chemotherapy medicine, now obsolete, once used for cancer and for very high calcium levels.
What is Plicamycin?
Plicamycin, also called mithramycin, is an old chemotherapy medicine given by injection. As well as treating some cancers, it was used to bring down severely high blood calcium (hypercalcaemia). Its dominant and serious risks are a tendency to bleeding, toxicity to the liver and kidneys, and bone-marrow suppression, which is why it needs very careful monitoring. It is now largely obsolete and replaced by safer treatments, so it is essentially of historical or highly specialist interest in the UK.
Education and reference only. This is a plain-language guide to Plicamycin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Plicamycin, also known as mithramycin, is a chemotherapy medicine of the antitumour-antibiotic type, given by injection into a vein. It was used to treat certain cancers and, separately, to lower dangerously high levels of calcium in the blood (hypercalcaemia), often when this was caused by cancer. It is a powerful medicine with serious potential side effects. It is now largely obsolete, having been replaced by safer and more effective treatments — for example, modern medicines for high calcium — so today it is essentially of historical or highly specialist interest.
How it works
Plicamycin binds to the genetic material (DNA) inside cells and interferes with the processes cells use to grow and divide, which is how it acts against cancer. Its effect on high calcium comes from a separate action: it reduces the activity of the cells that break down bone (osteoclasts), and because bone breakdown releases calcium into the blood, slowing this lowers blood calcium. These powerful actions also affect healthy tissues, which is why it can damage the liver and kidneys, suppress the bone marrow and, importantly, interfere with blood clotting, leading to a bleeding tendency.
Company & origin
Originated / developed by: Generic (obsolete).
An old chemotherapy medicine, no longer in routine use, given by injection and once also used to bring down dangerously high calcium levels.
Practical use
How to take Plicamycin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as an injection into a vein by specialist staff, never self-administered.
- Very close monitoring of blood counts, clotting, and liver and kidney function is essential.
- Report any unusual bruising, bleeding, nosebleeds or blood in the urine or stools straight away.
- Report signs of infection, such as fever, promptly, as it can lower blood cells.
- Use only under close specialist supervision; it is now largely obsolete and replaced by safer treatments.
Weighing it up
Advantages & disadvantages of Plicamycin
Advantages
- Could lower dangerously high blood calcium and treat certain cancers when it was in use.
- Acted through bone, offering a way to reduce high calcium before modern medicines existed.
- Part of the historical group of cancer medicines that informed later, safer treatments.
Disadvantages
- Can cause a serious bleeding tendency by interfering with blood clotting.
- Toxic to the liver and kidneys and suppresses the bone marrow.
- Now largely obsolete and replaced by safer, more effective treatments.
Practical use
Good to know
The dominant message with plicamycin is that it is a powerful and potentially toxic medicine that demands very careful monitoring. Its most serious risks are a bleeding tendency — it can interfere with the body's ability to clot, leading to bruising, nosebleeds and more serious bleeding — together with toxicity to the liver and kidneys and suppression of the bone marrow, which lowers blood cells and raises the risk of infection. Because of these dangers it is given only by specialists with close monitoring of blood counts, clotting, and liver and kidney function. It is now largely obsolete, having been replaced by safer treatments, including better options for lowering high calcium, so you would not expect to be offered it today; it is described here for completeness.
Who should not take it / use with caution
- People who have had a serious allergic reaction to it should not be given it.
- It is unsuitable for people with bleeding or clotting problems, or significant bone-marrow suppression.
- It is avoided in people with significant liver or kidney problems, and in pregnancy.
Monitoring
- Very close monitoring of blood counts and clotting tests for bleeding risk.
- Regular checks of liver and kidney function.
- Checking calcium levels when it is being used to treat high calcium.
Side effects
- A bleeding tendency, with bruising, nosebleeds or more serious bleeding, from effects on clotting.
- Liver and kidney toxicity, picked up on blood tests.
- Bone-marrow suppression, lowering blood cells and raising the risk of infection.
- Nausea, vomiting and other stomach upset.
Key interactions
- It adds to the bleeding risk of blood-thinning medicines and antiplatelets.
- It can add to the bone-marrow-lowering effect of other chemotherapy or radiotherapy.
- Tell the specialist team about all medicines, including those affecting the liver, kidneys or clotting.
Available as: A solution given by injection into a vein (historical).
Answers
Plicamycin: frequently asked questions
What was plicamycin used for?
It was an old chemotherapy given by injection, used to treat certain cancers and to bring down severely high blood calcium (hypercalcaemia). It is now largely obsolete.
Is it the same as mithramycin?
Yes, plicamycin is also called mithramycin; they are two names for the same medicine.
Why is bleeding a major concern?
Plicamycin can interfere with the body's ability to clot, leading to bruising, nosebleeds and more serious bleeding, which is why very close monitoring is essential.
What other serious risks does it have?
Besides bleeding, it is toxic to the liver and kidneys and suppresses the bone marrow, lowering blood cells and raising the risk of infection.
Is it still used?
No. It is now largely obsolete, having been replaced by safer and more effective treatments, including better options for lowering high calcium.
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.