Parenteral Manual

Pembrolizumab (NON-FORMULARY)

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): 
Keytruda
Classification: 
Antineoplastic agent - Monoclonal Antibody – PD-1 Immune Checkpoint Inhibitor
Original Date: 
August 2026
Indications: 
  • Adult and pediatric patients with refractory or relapsed classical Hodgkin Lymphoma (cHL), as monotherapy, who have failed autologous stem cell transplant (ASCT) or who are not candidates for multi-agent salvage chemotherapy and ASCT.
  • Adult and pediatric patients with refractory Primary Mediastinal B-cell Lymphoma (PMBCL) or who have relapsed after 2 or more lines of therapy, as monotherapy.
Reconstitution and Stability: 
  • Available as a 100 mg/4 mL (25 mg/mL) single-use vials of solution for infusion. Each 4 mL vial contains 0.25 mL of overfill.
  • Solution should be clear to slightly opalescent, colorless to slightly yellow solution. Translucent to white proteinaceous particles may be seen in diluted solutions.
  • Protect from light. Do NOT freeze. Do NOT shake.
  • Allow vial to reach room temperature before preparing diluted infusion. Vials are stable 24 hours at room temperature.
  • Dilute further in 50 mL 0.9% sodium chloride bag. Mix by gently inverting bag to avoid foaming.
  • Diluted solutions stable 48 hours at room temperature or 14 days refrigerated.
Administration: 

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

SC NO
IM NO
IV Push NO
IV Intermittent Infusion Yes - Over 30 minutes using sterile, non-pyrogenic, low-protein binding 0.2 - 5 micron in-line filter
IV Continuous Infusion NO
   

 

Dosage: 

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

Dosage may differ according to protocol

Pediatrics:

  • 2 mg/kg/dose IV every 3 weeks (usual max: 200 mg)

Adults:

  • 200 mg IV every 3 weeks OR 400 mg IV every 6 weeks
Potential hazards of parenteral administration: 
  • Common: Fatigue, diarrhea, rash/pruritus, nausea/vomiting and MSK pain
  • Occasional: Infusion related reactions (fever, chills, rigors, nausea, vomiting, headache, rash)
  • Rare: immune related adverse events (endocrinopathies, colitis, hepatitis, nephritis, pneumonitis).
Notes: 
  • Use of systemic corticosteroids or immunosuppressants should be avoided prior to starting pembrolizumab because of potential interference with efficacy; may be used during treatment with pembrolizumab for the management of immune-mediated adverse reactions.
  • Routine pre-medication is not recommended. May consider antipyretic or H1-receptor antagonist in patients who experience a grade 1-2 infusion reaction.
  • Administer pembrolizumab before chemotherapy, chemoradiotherapy, or radiation therapy if given on the same day.
References: 
  • Keytruda product monograph. Merck. November 2020.
  • Pembrolizumab Provider Monograph. Cancer Care Ontario. September 2025

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