- Experimentally in resistant leukemia, lymphoma, sarcoma
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.
- Available as a 2 mg/mL solution which is red in color
- Refrigerate
- Diluted solutions stable 24 hours at room temperature and 48 hours refrigerated
- 2 mg/mL solution is stable in syringe for 7 days refrigerated
- Protect from light
- Solutions Compatible: D5W, NS
- Very limited compatibility information available
- Incompatible: heparin, fluorouracil, mesna
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Push |
YES, doses <30 mg/m2 ONLY
Usual dilution: into running IV Infusion time: > 5 minutes Flush: > 20 mL of IV fluid to clear line |
| IV Intermittent Infusion | YES Usual dilution: dilute in 50-100 mL D5W or NS Infusion time: 30-60 minutes |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- 75 - 90 mg/m2 q 3 weeks
- 25 - 30 mg/m2 x 2-3 days, q 3 weeks
Use ideal body weight for dosage calculations ( ie if patient is obese or has ascites). Total cumulative lifetime dose should generally not exceed 650 mg/m2, or 450 mg/m2 with concomitant use of radiation to the mediastinum. Children < 0.5 mg/m2 or <2 years of age should be doses on a mg/kg basis. (To obtain mg/kg dose, divide mg/m2 dose by 30.)
** Dosage may differ according to protocol
Dosage adjustment in hepatic impairment:
|
Serum Bilirubin |
Dose |
|
25-50 micromol/L |
50% of usual dose |
|
51-85 micromol/L |
25% of usual dose |
|
>85 micromol/L |
Contraindicated |
Immediate (within minutes to hours):
- Nausea and vomiting (moderately low to moderately high emetogenic potential; dose dependent)
- Erythematous streaking along vein (likely a flare reaction, not extravasation; may respond to antihistamines or slowing of infusion rate).
- Transient arrhythmias, hypotension.
- VESICANT: will cause severe pain and tissue necrosis. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
Delayed (within days to months):
- Alopecia
- Mucositis, diarrhea
- Myocardial toxicity (cumulative, additive with other cardiotoxic drugs), congestive heart failure, cardiomyopathy
- Myelosuppression; nadir 10 - 14 days
- Red discoloration of urine for 1-2 days after dose (this is not hematuria)
- Treatment for unusual side effects are available through he study chair identified on the front page of the protocol and/or pharmacy
- Monitor cardiac function (eg: ECG, echocardiogram) at onset of therapy, and prior to each dose (particularly after cumulative doses of 650 mg/m2 have been reached)
- Monitor hematologic status
- Serious irreversible myocardial toxicity can occur as total cumulative dose approaches 1000 mg/m2
- Cardiotoxicity is enhanced by mediastinal irradiation, and previous anthracycline therapy
- Anthracycline equivalent is 0.6 for cardiotoxicity