Parenteral Manual

Amifostine (INVESTIGATIONAL)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ETHYOL
Classification: 
Cytoprotective agent
Original Date: 
August 2005
Indications: 
  • Protective agent against cumulative renal toxicity from cisplatin
Reconstitution and Stability: 
  • Reconstitute 500 mg vial with 9.7 mL of normal saline to give a total volume of 10 mL and a concentration of 50 mg/mL
  • Stable for up to 5 hours at room temperature and 24 hours in the refrigerator when prepared in PVC bags at a concentration of 5-40 mg/mL in normal saline
Compatibility: 
  • Solutions Compatible: 0.9% NaCl ONLY
  • Additives/ Above Cassette Compatible: no information
  • Y-site Compatible: dexamethasone, ondansetron, lorazepam

Incompatible: flush line with NS, stop all other medications for the duration of the infusion, and run amifostine in a dedicated line.  Infusion time is short (15 minutes)

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES  Blood Pressure Monitoring
Usual Dilution: 5-40 mg/mL       
Infusion time: 15 minutes (infusion > 15 minute associated with increased side effects

- Start chemotherapy within 30 min of start of amifostine

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Usual dosage is 740-910 mg/m2 IV prior to each dose of cisplatin
Potential hazards of parenteral administration: 
  • Hypotension; interruption of infusion may be necessary if systolic BP is significantly decreased (see guidelines below).
  • Hypotension has been reported to be associated with dyspnea, apnea, hypoxia, and rarely seizures, unconsciousness, respiratory arrest, and renal failure
  • Nausea and vomiting (immediate); give dexamethasone, and 5HT3 antagonist (i.e. ondansetron) prior to amifostine.
  • Hypocalcemia (clinical significance is rare)
Notes: 
  • BLOOD PRESSURE MUST BE MONITORED EVERY 3-5 MINUTES DURING INFUSION.
  • Maintain patient in supine (sitting) position during infusion
  • Hypotension may still occur during or shortly after completion of amifostine infusion, despite adequate hydration and positioning
  • Patient should be well hydrated prior to amifostine. Patients who are dehydrated or hypotensive should NOT receive amifostine. Antihypertensives should be held for 24 hours prior to amifostine. If patient cannot tolerate this, do not give amifostine.
  • Monitor fluid balance carefully
  • Infusion should be interrupted if a clinically significant decline in blood pressure occurs, ie

Systolic BP Decrease from Baseline

Baseline Systolic Pressure (mmHg)

20 mmHg <100

25 mmHg

100-119

20 mmHg

120-139

40 mmHg

140-179

50 mmHg

>180

  • If hypotension requiring interruption of the amifostine infusion occurs, the patient should be placed in Trendelenburg position and an IV infusion of normal saline initiated. If blood pressure normalizes in 5 minutes and the patient is asymptomatic, amifostine may be resumed.

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