Difference between revisions of "Vesicant & irritant chemotherapy"
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==Definitions== | ==Definitions== | ||
− | *Extravasation: | + | *Extravasation: Leakage of a medication into tissue around the infusion site. |
− | *Flare reaction: A skin reaction which | + | *Flare reaction: A skin reaction to a medication which is an allergic response. |
− | *Vesicants: | + | *Vesicants: Medications that may cause severe and/or irreversible tissue injury and necrosis. |
− | * | + | *Irritants: Medications that can cause local inflammatory reactions at the infusion site, which may include: swelling, pain, inflammation, or phlebitis. |
==Vesicant chemotherapy== | ==Vesicant chemotherapy== | ||
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==Suggested management of chemotherapy extravasation== | ==Suggested management of chemotherapy extravasation== | ||
+ | '''Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity.''' In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. | ||
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!Drug | !Drug |
Revision as of 04:03, 17 November 2011
Definitions
- Extravasation: Leakage of a medication into tissue around the infusion site.
- Flare reaction: A skin reaction to a medication which is an allergic response.
- Vesicants: Medications that may cause severe and/or irreversible tissue injury and necrosis.
- Irritants: Medications that can cause local inflammatory reactions at the infusion site, which may include: swelling, pain, inflammation, or phlebitis.
Vesicant chemotherapy
Some medications have vesicant properties in higher concentrations or large volumes.
- Amsacrine (Amsidine)
- Carmustine (BiCNU) (listed by some references as irritant)
- Cisplatin (Platinol) (concentration >=0.5 mg/mL)
- Dactinomycin (Cosmegen)
- Daunorubcin (Cerubidine)
- Docetaxel (Taxotere) (rare; also listed as an irritant)
- Doxorubicin (Adriamycin)
- Epirubicin (Ellence)
- Idarubicin (Idamycin)
- Mechlorethamine (Mustargen)
- Mitomycin (Mutamycin)
- Mitoxantrone (Novantrone) (rare; also listed as an irritant)
- Oxaliplatin (Eloxatin) (rare; also listed as an irritant)
- Paclitaxel (Taxol) (rare; also listed as an irritant)
- Streptozocin (Zanosar)
- Trabectedin (Yondelis)
- Vinblastine (Velban)
- Vincristine (Oncovin)
- Vindesine (Eldisine)
- Vinorelbine (Navelbine)
Irritant chemotherapy
- Arsenic Trioxide (Trisenox)
- Bleomycin (Blenoxane)
- Bortezomib (Velcade)
- Busulfan (Busulfex)
- Carboplatin (Paraplatin)
- Carmustine (BiCNU) (listed by some references as vesicant)
- Cisplatin (Platinol) (concentration <0.5mg/mL)
- Cladribine (Leustatin)
- Cytarabine liposomal (DepoCyt)
- Dacarbazine (DTIC)
- Daunorubicin liposomal (Daunoxome)
- Docetaxel (Taxotere) (also listed as a rare vesicant)
- Doxorubicin liposomal (Doxil)
- Etoposide (Vepesid)
- Fluorouracil (5-FU)
- Gemcitabine (Gemzar)
- Ifosfamide (Ifex)
- Irinotecan (Camptosar)
- Melphalan (Alkeran)
- Mitoxantrone (Novantrone) (also listed as a rare vesicant)
- Oxaliplatin (Eloxatin) (also listed as a rare vesicant)
- Paclitaxel (Taxol) (also listed as a rare vesicant)
- Paclitaxel, nanoparticle albumin-bound (Abraxane)
- Plicamycin (Mithracin)
- Teniposide (Vumon)
- Thiotepa (Thioplex)
- Topotecan (Hycamtin)
- Vincristine liposomal (Marqibo)
Suggested management of chemotherapy extravasation
Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain.
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 10 mL of 1/6 molar sodium thiosulfate). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into affected 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 gauge needle, changing needles between each injection, into affected area up to 250 units or until symptoms resolve. | |||
Cisplatin | Irritant (in concentrations of <0.5 mg/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 10 mL 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 10 mL 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. |
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)
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. |
Etoposide | Irritant | Heat - Apply warm compresses for 30 to 60 minutes, then alternate off/on every 15 minutes for 1 day | 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. |
Fluorouracil | Irritant | Cold | None | None |
Idarubicin | 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. |
Ifosfamide | Irritant | Cold - 60 minutes every 8 hours for 3 days. | 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. |
Irinotecan | Irritant | Cold | None | None |
Liposomal cytarabine | Irritant | Cold | None | None |
Liposomal daunorubicin | Irritant | Cold | None | None |
Liposomal doxorubicin | Irritant | Cold | None | None |
Liposomal vincristine | Irritant | Cold | None | None |
Mechlorethamine | Vesicant | Cold | 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 affected area in a pinwheel fashion. |
Melphalan | Irritant | Cold | None | None |
Mitomycin C | Vesicant | Cold | 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. |
Mitoxantrone | Irritant | Cold - Apply cold packs for 15-20 minutes 4 times per day for 1-2 days. | None | None |
Oxaliplatin | Vesicant | Heat - Apply warm compresses to extravasation site for 1 hour. Caution: excessive heat can cause tissue damage. | 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. |
Paclitaxel | Irritant | Cold - Apply ice to the area for 15-20 minutes each hour for 4 hours. Caution: excessive cold can cause tissue damage. | 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. |
Paclitaxel, nanoparticle albumin-bound | Irritant | Cold | None | None |
Plicamycin | Irritant | Cold | None | None |
Teniposide | 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. |
Thiotepa | Irritant | Cold | None | None |
Topotecan | Irritant | Cold | None | None |
Vinblastine | Vesicant | Heat | 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. |
Vincristine | Vesicant | Heat | 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. |
Vinorelbine | Vesicant | Heat | 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. |