- Brain tumors
- Non-Hodgkin's lymphoma
THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.
- Unopened vials of dry powder should be kept in fridge. Stable 36 days at room temperature. DO NOT use if powder has liquefied.
- Available as 100 mg vial. Reconstitute using 3 mL vial of absolute alcohol (supplied sterile diluent) . Shake well and allow to dissolve completely, then add 27 mL sterile water for injection and shake well.
- Final concentration is 3.3 mg/mL in 10% alcohol
- Reconstituted vial is stable for 24 hours in refrigerator
- Solution should be clear and colorless . Crystals that form during refrigeration can be redissolved by warming the vial to room temperature and shaking the vial.
- Further dilute with IV solution to a concentration of 0.2 - 2 mg/mL and dispense in non-PVC bag. Stable 48 hours in refrigerator or 8 hours at room temperature. Use bag within 4 hours of reconstitution.
- Protect from light
- Glass or non-PVC containers and non-PVC (polyethylene) tubing are recommended for administration
- Solutions Compatible: D5W, 0.9% NaCl
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: ondansetron, filgrastim, granisetron
Incompatible: sodium bicarbonate, allopurinol
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
|IV Intermittent Infusion||
- use non-PVC bag and tubing
|IV Continuous Infusion||NO, not stable in solution long enough at room temperature|
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- 200 - 250 mg/m2 once every 4-6 weeks
- 150 - 200 mg/m2 once every 6 weeks
- Non-Hodgkin's Lymphoma : 60 mg/m2 every 4 - 6 weeks.
Dose reduction in renal failure: creatinine clearance < 12 mL/min - 25-50% dosing
** dosage may differ according to protocol
Immediate (within a few minutes to hours):
- Burning at injection site or along vein - administer slowly according to patient's tolerance - local warm or cold compresses may lessen pain
- Intense facial flushing, hypotension (from too concentrated or rapid infusion)
- VESICANT: extravasation may cause tissue necrosis - refer to policy and procedure for administration of vesicant chemotherapy; also refer to protocol for treatment of extravasation of chemotherapy (Section H, Infusion Therapy Manual)
- Nausea and vomiting (moderate-severe) dose-dependent
- Ataxia, dizziness
- Metallic taste
- Hypotension with high dose therapy (due to alcohol content of diluent)
Early (days to weeks):
- Diarrhea, esophagitis, anorexia
- Skin discolouration along vein (hyperpigmentation)
Delayed (within a few weeks to months):
- Myelosuppression - nadir, 8 days, effect on bone marrow is delayed and cumulative and may last many weeks
- Hepatotoxicity (elevated liver enzymes, bilirubin, VOD [veno-occlusive disease] with very high doses)
- Transient increase in BUN
- Pulmonary fibrosis, clinical signs are; dyspnea, tachypnea and a dry hacking cough. Increased risk with increasing cumulative doses (> 1000 mg/m2) and mediastinal irradiation. Acute lung injury can occur 1-3 months after treatment. Pulmonary fibrosis may be delayed up to 3 years.
- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy
- Monitor hematological, liver, pulmonary and renal function
- Avoid contact with skin. Wash spills with copious amounts of water. Accidental skin contact may cause burning and brown discoloration of the skin.
- Bone marrow suppression is prolonged
- Drug interactions with cimetidine, digoxin (oral), phenytoin (oral), and phenobarbital; consult specialized references for details
- May discolour urine