Difference between revisions of "Vesicant & irritant chemotherapy"
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==Vesicant chemotherapy== | ==Vesicant chemotherapy== | ||
− | *[[Cisplatin (Platinol)]] [in concentrations =0.5 mg/mL) | + | *[[Cisplatin (Platinol)]] [in concentrations >=0.5 mg/mL) |
*DACTINomycin (Actinomycin-D, Cosmegen) | *DACTINomycin (Actinomycin-D, Cosmegen) | ||
*DAUNOrubcin (daunomycin, Cerubidine) | *DAUNOrubcin (daunomycin, Cerubidine) | ||
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|OR Sodium Thiosulfate | |OR Sodium Thiosulfate | ||
− | |Mix 4 mL of 10% sodium thiosulfate with 6 mL sterile water (yields 10mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into afftected area in a pinwheel fashion. | + | |Mix 4 mL of 10% sodium thiosulfate with 6 mL sterile water (yields 10mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into afftected area in a pinwheel fashion. '''NOTE:''' Sodium thiosulfate is recommended only when '''concentrated dacarbazine''' is extravasated. There are no clinical reports of the use of sodium thiosulfate following dacarbazine extravasation. Its use for dacarbazine extravasation is based on evidence that it has worked as an antidote for dacarbazine-induced skin toxicity. |
− | + | |- | |
+ | |Dactinomycin | ||
+ | |Vesicant | ||
+ | |Cold | ||
+ | |None | ||
+ | |None | ||
+ | |- | ||
+ | |Daunorubicin | ||
+ | |Vesicant | ||
+ | |Cold | ||
+ | |Dexrazoxane | ||
+ | |Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. Recommended dose: (Maximum daily dose) | ||
+ | *Day one: 1000 mg/m² (2000 mg) | ||
+ | *Day two: 1000 mg/m² (2000 mg) | ||
+ | *Day three: 500 mg/m² (1000 mg) | ||
+ | If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Infuse in an extremity or area other than the one affected by the extravasation. Reduce dose by 50% for patients with creatinine clearance <40 mL/min. | ||
+ | |- | ||
+ | |Docetaxel | ||
+ | |Irritant | ||
+ | |Cold | ||
+ | |Hyaluronidase | ||
+ | |Inject a total of 1 mL (200 units) divided into 5-10 subcutaneous injections of 0.1-0.2 mL in a pinwheel fashion using a 25 gauge needle, changing needles between each injection, into affected area up to 250 units or until symptoms resolve. | ||
+ | |- | ||
+ | |Doxorubicin | ||
+ | |Vesicant | ||
+ | |Cold - Apply intermittently for 15 minutes, 4 times daily for 3 days | ||
+ | |Dexrazoxane | ||
+ | |Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. Recommended dose: (Maximum daily dose) | ||
+ | *Day one: 1000 mg/m² (2000 mg) | ||
+ | *Day two: 1000 mg/m² (2000 mg) | ||
+ | *Day three: 500 mg/m² (1000 mg) | ||
+ | If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Infuse in an extremity or area other than the one affected by the extravasation. Reduce dose by 50% for patients with creatinine clearance <40 mL/min. | ||
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Epirubicin Vesicant Cold Dexrazoxane Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. | Epirubicin Vesicant Cold Dexrazoxane Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. | ||
Recommended dose: (Maximum daily dose) | Recommended dose: (Maximum daily dose) |
Revision as of 06:50, 12 November 2011
Adapted from the Beth Israel Deaconess Medical Center: Administration and Extravasation Management of Vesicant Chemotherapy Agents, revised 11/2010. Authors: Holly Dowling, RN, BSN, OCN; unit based educator Ambulatory Hematology/Oncology; Zaven Norigian, Pharm.D., BCOP; Clinical Pharmacy Coordinator - Oncology; Meggie Galligan, RN, BSN; unit based educator Inpatient Hematology/BMT; Erin Tardanico, RN, BSN; OCN, unit based educator Inpatient Oncology
Vesicant chemotherapy
- Cisplatin (Platinol) [in concentrations >=0.5 mg/mL)
- DACTINomycin (Actinomycin-D, Cosmegen)
- DAUNOrubcin (daunomycin, Cerubidine)
- DOXOrubicin (Adriamycin)
- Epirubicin (Ellence)
- IDArubicin (Idamycin)
- Mechlorethamine (Mustargen)
- Mitomycin C (Mutamycin)
- Oxaliplatin (Eloxatin)
- VinBLAStine (Velban)
- VinCRIStine (Oncovin)
- Vinorelbine (Navelbine)
Vascular irritant chemotherapy
- Arsenic Trioxide (Trisenox)
- Bleomycin (Blenoxane)
- Bortezomib (Velcade)
- Busulfan (Busulfex)
- CARBOplatin (Paraplatin)
- Carmustine (BiCNU)
- CISplatin (Platinol) [concentration <0.5mg/mL)
- Cladribine (Leustatin)
- Dacarbazine (DTIC-Dome)
- DOCEtaxel (Taxotere)
- Etoposide (VePsid)
- Etoposide Phosphate (Etopophos)
- Fluorouracil
- Gemcitabine (Gemzar)
- Ifosfamide (Ifex)
- Irinotecan (Camptosar)
- Liposomal Cytarabine (DepoCYT)
- Liposomal DAUNOrubicin (Daunoome)
- Liposomal DOXOrubicin (Doxil)
- Liposomal VinCRIStine (Marqibo)
- Melphalan (Alkeran)
- Mitoxantrone (Novantrone)
- PACLItaxel (Taxol)
- PACLItaxel, nanoparticle albumin-bound (Abraxane)
- Plicamycin (Mithracin)
- Teniposide (Vumon)
- Thiotepa
- Topotecan (Hycamtin)
item 1 | item 2 |
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row2a | row 2b |
- CISplatin is a vascular irritant when in concentrations of <0.5mg/mL
- DMSO = Dimethylsulfoxide
Drug | Vesicant or Irritant | Apply Heat or Cold | Known Antidote | Treatment |
---|---|---|---|---|
Arsenic Trioxide | Irritant | Cold | None | None |
Bleomycin | Irritant | Cold | None | None |
Bortezomib | Irritant | Cold | None | None |
Busulfan | Irritant | Cold | None | None |
Carboplatin | Irritant | Cold – every 8 hours for 3 days | Sodium Thiosulfate | Mix 4 mL of 10% sodium thiosulfate with 6 mL sterile water (yields 10mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into afftected area in a pinwheel fashion. |
OR DMSO (Dimethylsulfoxide) 99% | 4 drops per 10 square centimeters of skin surface applied topically over area twice the size affected every 8 hours for 7 days. Allow to air dry. | |||
Carmustine | Irritant | Cold | Manage conservatively | Manage conservatively as first line option with supportive non-pharmacologic care measures. Hyaluronidase maybe used in extreme cases such as large volume extravasation, severe irritation, etc. |
Hyaluronidase | Inject a total of 1 mL (200 units) divided into 5-10 subcutaneous injections of 0.1-0.2 mL in a pinwheel fashion using a 25 guage needle, changing needles between each injection, into affected area up to 250 units or until symptoms resolve. | |||
Cisplatin | Irritant (in concentrations of <0.5mg/mL) | Cold – 60 minutes every 8 hours for 3 days | Sodium Thiosulfate | Mix 4 mL of 10% sodium thiosulfate with 6 mL sterile water (yields 10mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into afftected area in a pinwheel fashion. |
OR DMSO (Dimethylsulfoxide) 99% | 4 drops per 10 square centimeters of skin surface applied topically over area twice the size affected every 8 hours for 7 days. Allow to air dry. | |||
Cladribine | Irritant | Cold | None | None |
Dacarbazine | Irritant | Cold | Manage Conservatively | Manage conservatively with attention to protect exposed tissues from light following drug administration |
OR Sodium Thiosulfate | Mix 4 mL of 10% sodium thiosulfate with 6 mL sterile water (yields 10mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into afftected area in a pinwheel fashion. NOTE: Sodium thiosulfate is recommended only when concentrated dacarbazine is extravasated. There are no clinical reports of the use of sodium thiosulfate following dacarbazine extravasation. Its use for dacarbazine extravasation is based on evidence that it has worked as an antidote for dacarbazine-induced skin toxicity. | |||
Dactinomycin | Vesicant | Cold | None | None |
Daunorubicin | Vesicant | Cold | Dexrazoxane | Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. Recommended dose: (Maximum daily dose)
If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Infuse in an extremity or area other than the one affected by the extravasation. Reduce dose by 50% for patients with creatinine clearance <40 mL/min. |
Docetaxel | Irritant | Cold | Hyaluronidase | Inject a total of 1 mL (200 units) divided into 5-10 subcutaneous injections of 0.1-0.2 mL in a pinwheel fashion using a 25 gauge needle, changing needles between each injection, into affected area up to 250 units or until symptoms resolve. |
Doxorubicin | Vesicant | Cold - Apply intermittently for 15 minutes, 4 times daily for 3 days | Dexrazoxane | Dexrazoxane once daily for 3 consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation. Recommended dose: (Maximum daily dose)
If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Infuse in an extremity or area other than the one affected by the extravasation. Reduce dose by 50% for patients with creatinine clearance <40 mL/min. |