MARSHALL HEMATOLOGY ONCOLOGY QUICK REFERENCE FOR CHEMOTHERAPY PREPARATIONS^ MEDICATION AMIFOSTINE (Ethyol) AzaCITIDine (Vidaza) VIAL CONC.

AND STABILITY add 9.7 ml NS to 500 mg SDV to make 50 mg/ml; 5 h stability @RT, 24h in refrig. Reconstitute 100 mg vial with 10 ml of SW to make 10 mg/ml. Stability 60 min 5 mg/ml w/SW. Stable for 30 min (transfer dose to 500 ml NS within 30 min period)
EXPIRATION OF
EMETIC

TYPICAL SOLUTION FINAL PRODUCT 50 ml NS (final conc: 5-40 mg/ml) 5h @RT, 24h refrig.

INFUSION RATE

VESICANT POTENTIAL

15 min

NO

HIGH

RN NOTES Check BP q5min during infusion. May require premeds

MISC. NOTES SDV = SINGLE DOSE VIAL

50-100 ml NS 500 ml NS, final conc = 0.2-0.6 mg/ml

60 min

over 10-40 min (complete infusion within 1h) IRRITANT over 30 min for treatment of CLL; over 60 min for treatment of NHL IRRITANT *90min (1st infusion); may shorten to 60min (2nd infusion & 30min (3rd & subsequent infusions) NO

MODERATE

May pre-med for Check PI for N/V dilution if given SQ May require premed for previous Avoid extravasation rxns.

BENDAMUSTINE (Treanda)

3h @RT, 24h refrig.

MODERATE

BEVACIZUMAB (Avastin) BLEOMYCIN (Intrapleural)

Available as 25 mg/ml solution. Refrig; do not shake; DO NOT SHAKE. 100 ml NS (DO NOT Protect from light MIX IN D5W) w/NS in 60 ml syringe Reconstitution FOR I.V. USE: reconstitute 15 unit vial w/5 ml NS; the 30 unit vial w/10 ml NS. = 3 UNIT/ML 1 mg/ml (reconstitute w/NS). Use within 8h is recommended. Protect from light 1 mg/ml in syringe Reconstitute each 3.5 mg vial with 1.4 ml NS 2.5 mg/ml in a syringe dilute in 250 ml D5W or NS nonPVC container within 30 min of reconstitution. Final conc < 0.26 mg/ml

8h refrig. 96h @RT or refrig.

VERY LOW VERY LOW

Monitor for infusion rxn; shorten infusion only if tolerating

Usually given after the other chemotherapy meds in the regimen. May add lidocaine. Use catheter-tip syringe

NO

BLEOMYCIN (Blenoxane) BORTEZOMIB (Velcade) BORTEZOMIB (Velcade) SUBCUTANEOUS

96h @RT or refrig.

less 1 unit/min (3060 min) IRRITANT

VERY LOW (<10%)

TEST DOSE (lymphoma); dose adjust renal

LOW (10% TO 3 day @RT; 5 Rapid IVP over 3-5 days refrig. seconds. IRRITANT 30%) Give SUBCUTANEOUSLY ONLY Pre-med with antihistamine, steroid, and an H2 antag. 30 min prior touse Do not infusion infusion sets/needles that contain aluminum, it will precipitate. Use 0.22 micron filter. Dosing precautions in renal and hepatic impairment Dose adjust for renal (AUC Calc). Calculate CrCl using ABW

CABAZITAXEL (Jevtana)

10 mg/ml (2-step process, consult PI)

8h @RT, 24h refrig.

over 60 min

NO

LOW

CARBOplatin (Paraplatin)

10 mg/ml. Dilute further within 8h

dilute in D5W or NS 4 days to final conc >/= @RT/refrig (8h 0.5 mg/ml for NS)

30-60 min

IRRITANT

MODERATE

^Use in conjunction with published references, MFG package inserts (PI)

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MARSHALL HEMATOLOGY ONCOLOGY QUICK REFERENCE FOR CHEMOTHERAPY PREPARATIONS^ MEDICATION VIAL CONC. AND STABILITY
EXPIRATION OF
EMETIC

TYPICAL SOLUTION FINAL PRODUCT

INFUSION RATE

VESICANT POTENTIAL

RN NOTES

MISC. NOTES DO NOT SHAKE. Dose dispensed in glass evac-bottle or DHEP plasticized PVC bag. Administer via lowsorb (non-PVC) tubing and 0.22 micron low proteinbinding inline filter. Prime tubing w/NS.

2 mg/ml. Refrigerate. 1 mg/ml RTU vial; stable 28 days when protected from light or 7 day under NS, D5NS 250 mlfluorescent light. DO 1000 ml (conc: 0.05- 72h @RT or CISplatin (Platinol) NOT REFRIGERATE. 2 mg/ml) refrig.

CETUXIMAB (Erbitux)

IV Infusion: loading dose over 2h, weekly maint. Dose over 1h. DO NOT ADMINISTER AS ivp OR BOLUS. Max infusion rate is 10 mg/min. Use No further dilution 12h refrig.; 8h NS to flush line at necessary @RT completion

NO VESICANT (> 0.5 Rate depends on dose/protocol mg/ml), (typically over 6-8 IRRITANT hrs). Check (< 0.5 literature. mg/ml)

LOW

HIGH

Requires adequate hydration

Dose adjust for renal. No aluminum needles

Reconstitute to a conc CYCLOPHOSPHAMIDE of 20 mg/ml; 24h @RT D5W or NS 100-250 24h @RT or 6 (Cytoxan) or 6 days refrig. ml days refrig.

30-120 min.

Moderate (<750 mg/m); High (>750 IRRITANT mg/m) Hydration

Dose adjust for renal

Available as powder or 20 mg/ml and 100 mg/ml solution. Stable D5W or NS 250for 8 days @RT; CYTARABINE (ARA-C) 1000 ml ml 8 days @RT Protect from light. Reconstitute with SW to conc 10 mg/ml; 8h @RT (mfg); 3 days D5W or NS 250-500 8h @RT or 24h DACARBAZINE (DTIC) refrig. ml refrig. NS or D5W 50-250 ml. Final conc = 0.11 mg/ml D5W or NS; final 10 mg/ml; reconstitute conc: 1.3-5 mg/ml. Mix in NS 1L for with 0.167 M. sodium lactate. Stable 6h extravasation purposes @RT/refrig. reconstitute w/10 ml SW to a conc of 5 mg/ml 15 min (7h if done with cold infusion fluids)

High dose: 1-3 hours

NO

>1000 mg/m (Modera te 30%90%), 100-200 mg/m (Low 10%-

Use preservativefree (PF) solution for high dose or Prophylactic steroid eye drops intrathecal recommended therapy. Hepatic dose adjust may be with high dose required. therapy

HIGH (> 30-120 min. 1-3 hours (rate depends on regimen used) IRRITANT
90%)

Discard if solution Protect from light turns pink/red precautions in renal and hepatic impairment dose adjust for renal. *Consult extravasation guidelines if using as antidote Dose adjust for hepatic. Give taxanes prior to platinum cpds to reduce toxicity

DECITABINE (Dacogen)

VERY Pre-med with LOW (< antiemetic (per IRRITANT 10%) LexiComp)

DEXRAZOXANE (Zinecard)

Variable depending on dose/indication. 6h @RT/refrig Consult literature.

NO

VERY LOW Chemo (<10%) precautions

DOCEtaxel (Taxotere)

D5W OR NS glass bottle or non-DHEP 10 mg/ml; 28 d refrig. bag. Final conc: 0.3DO NOT SHAKE 0.74 mg/ml 4h @RT/refrig

60 min

IRRITANT

LOW (10%30%)

Pre-med w/steroid (1d prior) to decr hypersensitivity rxns. Use lowsorb tubing. DO NOT FILTER.

^Use in conjunction with published references, MFG package inserts (PI)

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MARSHALL HEMATOLOGY ONCOLOGY QUICK REFERENCE FOR CHEMOTHERAPY PREPARATIONS^ MEDICATION VIAL CONC. AND STABILITY 2 mg/ml, refrig RTU vial. Reconstituted soln is stable 7 days @RT or 15 days refrig.
EXPIRATION OF
EMETIC

TYPICAL SOLUTION FINAL PRODUCT

INFUSION RATE

VESICANT POTENTIAL
Very High (> 60 mg, 90%), Moderate (< 60 mg, 30%90%)

RN NOTES

DOXOrubicin (Adriamycin

IN A SYRINGE

48h @RT. PROTECT FROM LIGHT

Slow IVP over 3-5 min through a running IV

YES

DOXOrubicin Liposomal (Doxil) EPIRUBICIN (Ellence) ETOPOSIDE (VP-16, Toposar)

</= 90 mg in D5W 250 ml; > 90 mg in 60 min; initial rate 2 mg/ml 24h @RT/refrig @ 1 mg/min IRRITANT D5W 500 ml 24h refrig. 2 mg/ml RTU solution; Slow IVP over 3-20 PROTECT refrig IN A SYRINGE YES FROM LIGHT min via running IV D5W or NS 250 ml. 0.2 mg/ml = 20 mg/ml; 24h @RT or Final conc: 0.2-0.4 96h; 0.4 mg/ml mg/ml = 24h 6 days refrig. 60 min IRRITANT 10-25 mg/ml; reconstituted vial stable for 16 days @RT/refrig. 30 min; continuous infusion D5W or NS 100-125 48h ml @RT/refrig. occasionally used NO 72h @RT. DO IVP, IVPB, cont. syringe, IVPB. D5W NOT infusion i.e. CADD MAY BE or NS REGRIGERATE pump IRRITANT 50-500 ml NS, typically 100 ml. 24h @RT per Final conc > 0.1 MFG PI. Do MAY BE not refrig. 30 min IRRITANT mg/ml slow IVP over 1015 min through in syringe (IVPB only acceptable via 3 days @RT or running IV D5W or central line) 7 days refrig. NS YES Further dilution in as slow IV infusion 50-1000 ml D5W or over 30 min to NS; to final conc: 7 days @RT or several hrs or CIV MAY BE 0.6-20 mg/ml over 5 days 3 weeks refrig. IRRITANT 250 ml to 500 ml D5W; conc = 0.122.8 mg/ml

LOW (10%30%)

Major vesicant potential DO NOT infuse via in-line filter. Monitor for infusion rxn. Flush IV line pre- and Dose adjust for post-infusion hepatic w/D5W impairment

MISC. NOTES May mix in IVPB ONLY if infusing via central line. Lifetime dose NTE 550 mg/m

MODERATE

Dose adjust hepatic impairment Use 0.22 micron filter Dose adjust for renal and hepatic

LOW

FLUDARABINE (Fludara) FLUOROURACIL (5FU) (Adrucil) GEMCITABINE (Gemzar) IDArubicin (Idamycin)

VERY LOW VERY LOW

Dose adjust for renal store @RT, protect from light Infusion rates > 60 min increases toxicity Avoid extravasation patient hydration. Give w/MESNA (Bladder protectant) monitor infusion site for inflammation; avoid extravasation Dose adjust renal and consider hepatic Dose adjust renal and consider hepatic Diarrhea can be severe (notify physician)

50 mg/ml

38 mg/ml 1 mg/ml (use PF diluent); stable for 3 day refrig.

LOW

MODERATE

IFOSFAMIDE (Ifex)

50 mg/ml; 24h @RT

HIGH TO MODERATE

IRINOTECAN (Camptosar)

20 mg/ml

24h @RT; 48h refrig.

90 min

MAY BE IRRITANT

MODERATE

METHOTREXATE MitoMYcin (Mutamycin0 MitoXANthrone (Novantrone)

VARIABLE dilute to conc = 0.5 mg/ml

D5W or NS up to 500 ml (dependent 24h (if preservon dose and route) free) syringe 50 to 100 ml D5W or NS 12h in NS

VARIABLE Slow IVP via free flowing IV

NO YES

LOW (< 250 mg/m); MOD (> 250 mg/m) LOW Avoid extravasation

2 mg/ml

7 days @RT or over 5-15 min, do Refrig. not infuse < 3 min. VESICANT

LOW

Dose adjust renal and hepatic. Use leucovorin as rescue as req. Dose adjust renal and hepatic Consider dose adjust in hepatic impairment

^Use in conjunction with published references, MFG package inserts (PI)

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MARSHALL HEMATOLOGY ONCOLOGY QUICK REFERENCE FOR CHEMOTHERAPY PREPARATIONS^ MEDICATION VIAL CONC. AND STABILITY 5 mg/ml; reconstitute with SW [10 ml in 50 mg vial, 20 ml in 100 mg vial]
EXPIRATION OF
EMETIC

TYPICAL SOLUTION FINAL PRODUCT

INFUSION RATE

OXALIPLATIN (Eloxatin)

250-500 ml D5W

6h @RT, 24h refrig.

over 2-6 hrs

MISC. NOTES Not compatible w/NS. Renal dose Flush IV line with adjust guidelines MODERATE TO HIGH (30- D5W pre and post not FDA 90%) established IRRITANT infusion
VESICANT POTENTIAL

RN NOTES

6 mg/ml 5 mg/ml, reconst. w/NS; swirl or invert for at least 2 min. No further dilution PACLitaxol [Protein avoid foaming. Stable necessary; final bound] (Abraxane) conc = 5 mg/ml 8h refrig.

PACLitaxel (Taxol)

250 to 1000 ml D5W or NS (final conc = 0.3-1.2 mg/ml) in GLASS or NON-PVC.

up to 3 day @RT

1-96 hrs (~3 hours)

IRRITANT (POSSIBLE VESICANT)

LOW (10%30%)

8h @RT

30 min

POSSIBLE IRRITANT

LOW (10%30%)

PEMEtrexed (Alimta) PRALAtrexate (Folotyn) RiTUXimab (Rituxan) TOPOTECAN (Hycamtin)

Reconstitute w/PF NS 4.2 ml to 100 mg vial, 20 ml to 500 mg vial. Resulting conc: 25 mg/ml. Stable 24h 100 ml NS (Preserv@RT/refrig. free) 20 mg/ml 1 ml, 2 ml. In solution. 10 mg/ml. Gently invert to mix, do not shake

24h @RT/refrig.

10 min IVP over 3-5 minutes

NO

LOW (10%30%) LOW (10%30%)

Infuse via 0.22 micron non-DEHP Pre-treat for in-line filter & nonhypersensitivity DEHP tubing. DO rxns. Give taxanes NOT use chemo prior to dispensing pins. carbo/cisplat ro Protect from light reduce toxicity when storing. Use of non-DEHP Give taxanes free containers or prior to platinum infusion set not cpds. to avoid required. DO NOT toxicity FILTER prophylaxis with folic acid and Vit B-12 required prior to 1st dose. Steroids may be Dose adjust for hepatic started one day prior to infusion impairment. Avoid to decr cutaneous use with CrCl < 45 ml/min rxns. IVP in a freeflowing normal saline iV Pre-treat for infusion related rxns.

no further dilution DISCARD AFTER necessary USE 250 ml to 500 ml NS or D5W; final conc = 1-4 mg/ml

TRASTUZUMAB (Herceptin)

1 mg/ml reconstitute 440 mg vial w/ 20 ml SW or Bacteriostatic SW. for conc: 21 mg/ml. Gently swirl

TITRATE rate from 24h @RT, a starting rate of refrig. 50 mg/hr (see PI) 24h @RT, (MFG PI), 7 days 50 to 100 ml D5W refrig or NS (Lexicomp) 30 min Loading doses over 90 min; maintenance doses over 30 min.

NO

LOW

See Rituxan Infusion administration sheet Dose adjust for renal impairment

MILD

MODERATE (30-90%)

VinBLAStine

1 mg/ml

VinCRIStine (Vincasar PFS)

1 mg/ml; discard unused solution

250 ml NS Dilute to (QS) to final vol. of 20 ml NS in 30 ml size syringe (To avoid potential IT admini.) Dilute to (QS) to final vol. of 20 ml NS in 30 ml size syringe (To avoid potential IT admini.)

24h @RT or Refrig.

NO

LOW (10%30%)

Pretreat for infusion related rxns. Dose adjust for hepatic FATAL IF GIVEN impairment. INTRATHECALLY. Special labeling to FOR IV USE ONLY avoid IT admini. FATAL IF GIVEN INTRATHECALLY. Dose adjust for FOR IV USE ONLY. hepatic impairment. Dose RARELY exceeds 2 Special labeling to avoid IT admini. mg/dose

24h @RT or refrig.

Slow IVP over 2-5 min via freeflowing IV

YES

VERY LOW

24h @RT or refrig.

Slow IVP over 2-5 min via freeflowing IV

YES

VERY LOW

^Use in conjunction with published references, MFG package inserts (PI)

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MARSHALL HEMATOLOGY ONCOLOGY QUICK REFERENCE FOR CHEMOTHERAPY PREPARATIONS^ MEDICATION VIAL CONC. AND STABILITY
EXPIRATION OF
EMETIC

TYPICAL SOLUTION FINAL PRODUCT

INFUSION RATE Slow IVP over 6-10 min via free flowing IV; flush line w/100 ml NS or D5W

VESICANT POTENTIAL

RN NOTES

MISC. NOTES

VINORELBINE (Navelbine)

10 mg/ml

NS or D5W to a conc = 1.5-3 mg/ml in a syringe

24h @RT

YES

Moderate

Dose adjust for Flush line with hepatic 100 ml NS or D5W impairment. Special labeling to to decrease phlebitis avoid IT admini.

REFERENCES: LexiComp, Inc. 2011. http://online.lexi.com/crlsql/servlet/crlonline . Micromedex 2.0, Thomson Reuters. 2011.

^Use in conjunction with published references, MFG package inserts (PI)

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