Parenteral Manual


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): 
Immunosuppressive agent - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
  • Prevention of rejection of organ transplants
  • Control of chronic graft vs. host disease post-bone marrow transplant
  • Adjunctive treatment of auto-immune diseases
Reconstitution and Stability: 

Reconstitute 100 mg vial with 10 mL sterile water (preservative free). Swirl until clear.

  • Reconstituted solution (10 mg/mL) stable 24 hours at room temperature
  • Stable for at least 8 days when diluted 2 mg/mL in D5W or normal saline at room temperature or in refrigerator

- Solutions Compatible: D5W, saline solutions

- DO NOT MIX with any other drug

- Incompatible: methyl and propylparabens and phenol preservatives


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

IV Direct


IV Intermittent Infusion YES
Usual dilution: 2-10 mg/mL
Infusion time: 30-60 minutes
IV Continuous Infusion NO

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


  • Initial dose: 2-5 mg/kg/day IV daily
  • Maintenance: 1-3 mg/kg/day IV daily

** dosage may differ according to protocol

- reduce dose in renal/ hepatic impairment
- bone marrow depressive effects are potentiated with allopurinol; reduce
azathioprine to 1/4 - 1/3 of usual dose

Potential hazards of parenteral administration: 
  • Bone marrow suppression (principial toxic effect)
  • Nausea and vomiting, diarrhea
  • Hepatotoxicity, veno-occlusive disease
  • Pancreatitis
  • Rarely: drug fever, skin rash, mucositis, arthralgia, renal toxicity

- Treatment for unusual side effects available through the study chair identified on the front page of the protocol and/or pharmacy

  • Monitor hematologic status, bilirubin, liver function tests, creatinine, BUN
  • Caution: cytotoxic, use chemotherapy precautions when handling
  • Toxic potential of azathioprine is increased when concomitant immunosuppressive therapy is given

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