doxorubicin

Warnings and precautions

Black Box Warning: Bone marrow sup- pression, extravasation, heart failure, secondary malignancy; requires an expe- rienced clinician, IM/SUBCUT use Black Box Warning: Do not give IM, SUBCUT Black Box Warning: If extravasation oc- curs, stop infusion and complete via an- other vein, preferably in another limb, use dexrazoxane topically •  Aluminum needles may be used dur- ing administration; avoid aluminum dur- ing storage •  Rapid injection can cause facial flush- ing or erythema along the vein Reconstitution: •  To avoid risks with reconstitution, the commercially available injection may be used; there are still risks involved in handling the injection •  Do not use diluents containing preser- vatives to reconstitute powder for ­injection •  Reconstitute 10, 20, 50, 100 mg of DOXOrubicin with 5, 10, 25, 50 mL, respectively, of nonbacteriostatic NS in- jection (2 mg/mL), shake until com- pletely dissolved; use reconstituted so- lution within 24 hr; do not expose to sunlight •  IV injection Inject reconstituted solution over >3-5 min via Y-site or 3-way stopcock into a free-flow- ing IV infusion of NS or D5W; a butterfly needle inserted into a large vein is preferred •  Increase fluid intake to 2-3 L/day to prevent urate, calculi formation •  Store at room temperature for 24 hr after reconstituting Y-site compatibilities: Alemtuzumab, alfentanil, amifostine, amikacin, anidula- fungin, argatroban, aztreonam, ­bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, car- mustine, caspofungin, ceftizoxime, chlor- proMAZINE, cimetidine, ciprofloxacin, CISplatin, cladribine, clindamycin, cyclo- phosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexamethasone, diltiazem, diphenhydrA­ MINE, DOBUTamine, DOCEtaxel, dolase- tron, DOPamine, doripenem, doxycy- cline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, erythromycin, esmolol, etoposide, etoposide phos- phate, famotidine, fenoldopam, fentaNYL, filgrastim, ­fluconazole, fludarabine, gem- citabine, ­gentamicin, granisetron, halo- peridol, hydrocortisone, HYDROmor- phone, ifosfamide, imipenem cilastatin, inamrinone, isoproterenol, ketorolac, labetalol, leucovorin, levorphanol, lido- caine, linezolid, LORazepam, mannitol, mechlorethamine, melphalan, meperi- dine, mesna, methotrexate, metoclo- pramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mor- phine, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprus- side, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pancuronium, phenylephrine, potassium chloride, procainamide, prochlorpera- zine, promethazine, propranolol, quinu- pristin-dalfopristin, ranitidine, sar- gramostim, sodium acetate, tacrolimus, teniposide, theophylline, thiotepa, ticar- cillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trastuzumab, tri- methobenzamide, vancomycin, vasopres- sin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid Black Box Warning: Bone marrow de- pression: CBC, differential, platelet count weekly; withhold or reduce dose of product if WBC is <1500/mm3 or platelet count is <50,000/mm3; notify prescriber of these results •  Renal studies: BUN, serum uric acid, urine CCr, electrolytes prior to, during therapy •  I&O ratio: report fall in urine output to <30 mL/hr •  Monitor temperature: fever might in- dicate beginning infection •  Hepatotoxicity: hepatic studies prior to, during therapy: bilirubin, AST, ALT, alka- line phosphatase as needed or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea Black Box Warning: Dysrhythmias: ECG; watch for ST-T wave changes, low QRS and T, possible dysrhythmias (sinus tachycardia, heart block, PVCs), ejection fraction prior to treatment, signs of irre- versible cardiomyopathy, can occur up to 6 mo after treatment begins •  Bleeding: hematuria, guaiac, bruising, petechiae of mucosa or orifices every 8 hr •  Effects of alopecia on body image; discuss feelings about body changes; al- most total alopecia is expected •  Buccal cavity every 8 hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia •  Alkalosis if severe vomiting is present Black Box Warning: Secondary malig- nancy: assess for AML and MDS, which may occur Black Box Warning: Extravasation: lo- cal irritation, pain, burning at injection site; a vesicant; if extravasation occurs, stop drug, restart at another site, apply ice, elevate extremity to reduce swelling; if resolution does not occur, surgical de- bridement may be required •  GI symptoms: frequency of stools, cramping •  Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

Source pages 426, 427, 428