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)
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item 2
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row 2b
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Cladribine Irritant Cold None None
Dacarbazine Irritant Cold Manage Conservatively Manage conservatively with attention to protect exposed tissues from light following drug administration
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
DAUNOrubcin 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 guage 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.
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)
• 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.
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 guage 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)
• 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.
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 afftected 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 guage 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 guage 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 guage 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 guage 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 guage needle, changing needles between each injection, into affected area up to 250 units or until symptoms resolve.|}
- CISplatin is a vascular irritant when in concentrations of <0.5mg/mL
| Drug
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Vesicant or Irritant
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Apply Heat or Cold
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Known Antidote
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Treatment
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| Arsenic Trioxide
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Irritant
|
Cold
|
None
|
None
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| Bleomycin
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Irritant
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Cold
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None
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None
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| Bortezomib
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Irritant
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Cold
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None
|
None
|
| Busulfan
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Irritant
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Cold
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None
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None
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| Carboplatin
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Irritant
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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%
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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.
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| Carmustine
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Irritant
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Cold
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Manage conservatively
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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.
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| Hyaluronidase
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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.
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| Cisplatin
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Irritant (in concentrations of <0.5mg/mL)
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Cold – 60 minutes every 8 hours for 3 days
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Sodium Thiosulfate
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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%
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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.
|