Parenteral Manual

Thiotepa (SPECIAL ACCESS PROGRAM)

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): 
TESPA, TSPA
Classification: 
Alkylating agent, antineoplastic - CYTOTOXIC
Original Date: 
June 2009
Revised Date: 
June 2015
Indications: 
  • Multiply relapsed or refractory leukemia, high-dose conditoning regimens with autologous bone marrow transplantation, and lymphomas or sarcomas

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.

Reconstitution and Stability: 
  • Store vial in refrigerator
  • Protect from light
  • Supplied as 15 mg vial of powder for reconstitution
  • Reconstitute 15 mg vial with 1.5 mL Sterile Water for Injection  to give a 10 mg/mL solution
  • Filter through a 0.22 micron filter
  • Further dilute to a concentration of 0.5 to 5 mg/mL in NS
  • Reconstituted solution is stable for 8 hours in refrigerator
  • Diluted solution of 0.5 mg/mL in NS is stable for 8 hours at room temperature
  • Diluted solution of 1 mg/mL in NS is stable for 24 hours at room temperature
  • Unstable at concentrations less than 0.5 mg/mL
Compatibility: 

- Solutions Compatible: D5W or NS

- Y-site Compatible: dexamethasone, diphenhydramine, fluconazole, gentamicin, granisetron, hydromorphone, lorazepam, metoclopramide, morphine, ondansetron, piperacillin, piperacillin-tazobactam, potassium chloride (up to 100 mEq/L), ranitidine, vancomycin

Administration: 

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

SC No
IM No
IV Direct Yes, over 1-5 minutes
IV Intermittent Infusion

Yes - Infuse over 10 to 60 minutes

(4 hours for TVTG treatment in Sloan-Kettering Memorial protocol)

IV Continuous Infusion No

 

 

Dosage: 

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

Children:

  • Sarcomas: 25-65 mg/m2 IV as a single dose every 3-4 weeks
  • High dose conditioning for BMT: 300 mg/m2/dose over 3 hours daily for 3 doses
  • TVTG treatment in Sloan Kettering Memorial Protocol for relapsed leukemia: 15 mg/m2  as a single dose on Day 2 of cycle

 

 

Adults:

  • 0.3 - 0.4 mg/kg IV as a single dose at 1 - 4 week intervals
  • 0.2 mg/kg or 6 - 8 mg/m2 IV once daily for 4 - 5 days, repeating at 2 - 4 week intervals
Potential hazards of parenteral administration: 

Common: nausea and vomiting (low emetic potential), anorexia, myelosuppresion (anemia, leukopenia, thrombocytopenia), fatigue, injection site pain

 

Occasional: allergic reactions, rash, pruritis, urticaria, fever, alopecia, hyperuricemia, weakness, dizziness, conjunctivitis, headache, urinary retention, amenorrhea

 

Rare: hemorrhage, septicemia, blurred vision, abdominal pain, dysuria, myelodysplastic syndrome hyperpigmentation of the skin

 

-At higher doses used in conditioning regimens for BMT: mucositis, esophagitis, confusion, inappropriate behaviour, somnolence, increased liver enzymes, hyperbilirubinemia, hyperpigmentation of the skin

- Non-vesicant    

Notes: 
  • Monitor: CBC with differential, urinalysis, hypersensitivity reactions, renal and hepatic function tests
  • Thiotepa is a major cytochrome p450 isoenzyme CYP2B6 inhibitor -phenytoin can increase rate of thiotepa conversion to TEPA; succinylcholine and pancuronium can cause prolonged apnea
  • To minimize skin toxicities, on days of Thiotepa and for 24 hours after dose; encourage bathing 3 times a day, discontinue use of tapes, skin adhesives, creams and ointments, no constrictive clothing or jewellery and encourage large loose clothing that exposes most of skin to air

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