Polycythaemia vera (specialist use only)
▶ Adult: Initially 15–20 mg/kg daily, adjusted according
to response, for information on dose adjustment based
on haematocrit and platelet count—consult product
literature; usual dose 500–1000 mg daily, dosage
should be based on actual or ideal body weight,
Essential thrombocythaemia (specialist use only)
▶ Adult: Initially 15 mg/kg daily, adjusted according to
response, for information on dose adjustment based on
platelet count and white cell count—consult product
literature, dosage should be based on actual or ideal
body weight, whichever is less
Chronic myeloid leukaemia (specialist use only)
▶ Adult: Initially 40 mg/kg daily, then reduced to
20 mg/kg daily, adjusted according to response, for
information on dose adjustment based on white cell
count—consult product literature, dosage should be
based on actual or ideal body weight, whichever is less
Chronic myeloid leukaemia (specialist use only)| Cancer of
the cervix (specialist use only)
▶ Adult: 20–30 mg/kg daily, alternatively 80 mg/kg every
3 days, for information on dose adjustment based on
platelet count, white cell count and actual or ideal body
weight—consult product literature
Sickle-cell disease [prevention of recurrent vaso-occlusive
crises] (initiated by a specialist)
▶ Adult: Initially 15 mg/kg daily, increased in steps of
2.5–5 mg/kg daily, dose to be increased every 12 weeks
according to response; usual dose 15–30 mg/kg daily;
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
l CAUTIONS Leg ulcers (review treatment if cutaneous
vasculitic ulcerations develop)
l INTERACTIONS → Appendix 1: hydroxycarbamide
▶ Common or very common Alopecia . anaemia . appetite
l CONCEPTION AND CONTRACEPTION Manufacturer advises
effective contraception before and during treatment.
l PREGNANCY Avoid (teratogenic in animal studies). See
also Pregnancy and reproductive function in Cytotoxic drugs
l BREAST FEEDING Discontinue breast-feeding.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe impairment
(unless used for malignant conditions).
l RENAL IMPAIRMENT In sickle-cell disease, avoid if eGFR
less than 30 mL/minute/1.73 m2
Dose adjustments In sickle-cell disease, reduce initial dose
by 50% if eGFR less than 60 mL/minute/1.73 m2
▶ Monitor renal and hepatic function before and during
▶ Monitor full blood count before treatment, and repeatedly
throughout use; in sickle-cell disease monitor every
2 weeks for the first 2 months and then every 2 months
thereafter (or every 2 weeks if on maximum dose).
▶ Patients receiving long-term therapy for malignant disease
should be monitored for secondary malignancies.
l PATIENT AND CARER ADVICE Patients receiving long-term
therapy with hydroxycarbamide should be advised to
protect skin from sun exposure.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule, oral
Hydroxycarbamide 100 mg Siklos 100mg tablets | 60 tablet P £100.00 DT = £100.00
Hydroxycarbamide 1 gram Siklos 1000mg tablets | 30 tablet P £500.00 DT = £500.00
▶ Hydroxycarbamide (Non-proprietary)
Hydroxycarbamide 500 mg Hydroxycarbamide 500mg capsules | 100 capsule P £86.00 DT = £12.14
▶ Droxia (Imported (United States))
Hydroxycarbamide 300 mg Droxia 300mg capsules | 60 capsule P s
▶ Hydrea (Bristol-Myers Squibb Pharmaceuticals Ltd)
Hydroxycarbamide 500 mg Hydrea 500mg capsules | 100 capsule P £10.47 DT = £12.14
l DRUG ACTION Mitotane selectively inhibits the activity of
the adrenal cortex, necessitating corticosteroid
Symptomatic treatment of advanced or inoperable
▶ Adult: Initially 2–3 g daily in 2–3 divided doses
adjusted according to plasma-concentration
monitoring, in severe illness initial dose can be
increased up to 6 g daily, reduce dose or interrupt
treatment if signs of toxicity, discontinue if inadequate
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
l CAUTIONS Avoid in Acute porphyrias p. 1058 .risk of
accumulation in overweight patients
l INTERACTIONS → Appendix 1: mitotane
BNF 78 Cytotoxic responsive malignancy 935
Immune system and malignant disease
l CONCEPTION AND CONTRACEPTION Contraceptive advice
required, see Pregnancy and reproductive function in
l PREGNANCY Manufacturer advises avoid. See also
Pregnancy and reproductive function in Cytotoxic drugs
l BREAST FEEDING Discontinue breast-feeding.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe impairment
(limited information available).
Monitoring In mild to moderate hepatic impairment,
monitoring of plasma-mitotane concentration is
l RENAL IMPAIRMENT Manufacturer advises caution in mild
to moderate impairment. Avoid in severe impairment.
Monitoring In mild to moderate renal impairment,
monitoring of plasma-mitotane concentration is
▶ Plasma-mitotane concentration for optimum response
▶ Monitor plasma-mitotane concentration—consult product
l PRESCRIBING AND DISPENSING INFORMATION
Corticosteroid replacement therapy Corticosteroid
replacement therapy is necessary with treatment with
mitotane. The dose of glucocorticoid should be increased
in case of shock, trauma, or infection.
l PATIENT AND CARER ADVICE Patients should be warned to
contact doctor immediately if injury, infection, or illness
occurs (because of risk of acute adrenal insufficiency).
Driving and skilled tasks Central nervous system toxicity
may affect performance of skilled tasks (e.g. driving).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2, 10, 21
▶ Lysodren (HRA Pharma UK Ltd)
Mitotane 500 mg Lysodren 500mg tablets | 100 tablet P £590.97
l DRUG ACTION Panobinostat is a histone deacetylase
inhibitor, which promotes cell-cycle arrest and apoptosis
of tumour cells via multiple pathways.
Treatment of relapsed or refractory multiple myeloma (in
combination with bortezomib and dexamethasone), in
patients who have received at least two prior regimens,
including bortezomib and an immunomodulatory agent
▶ Adult 18–74 years: 20 mg once daily, on days 1, 3, 5, 8,
10 and 12 of a 21-day cycle for 8 cycles. Patients with
clinical benefit should continue treatment for 8
additional cycles; total duration 16 cycles (48 weeks),
for doses of dexamethasone and bortezomib, or dose
adjustment due to side-effects—consult product
▶ Adult 75 years and over: 20 mg once daily, on days 1, 3,
5, 8, 10 and 12 of a 21-day cycle for 8 cycles. Patients
with clinical benefit should continue treatment for 8
additional cycles; total duration 16 cycles (48 weeks),
alternatively initially 15 mg once daily, on days 1, 3, 5,
8, 10 and 12 of a 21-day cycle for 1 cycle, increased if
tolerated to 20 mg once daily, on days 1, 3, 5, 8, 10 and
12 of a 21-day cycle for 7 subsequent cycles, patients
with clinical benefit should continue treatment for 8
additional cycles; total duration 16 cycles (48 weeks),
lower dose may be used for the first cycle depending on
patient’s condition and co-morbidities, for doses of
dexamethasone and bortezomib, or dose adjustment
due to side-effects—consult product literature
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶ Manufacturer advises reduce dose to 10 mg with
concurrent use of potent inhibitors of CYP3A4; if the
potent inhibitor of CYP3A4 is to be continued, consider
increasing the dose to 15 mg if tolerated.
▶ Manufacturer advises avoid potent inhibitors of
CYP3A4 if possible in patients taking a reduced
panobinostat dose due to side-effects, or in those with
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
l CAUTIONS Coagulation disorders . elderly . QT-interval
prolongation .risk factors for QT-interval prolongation
▶ Risk factors for QT-interval prolongation Patients at risk of
developing QT-interval prolongation include those with
long QT syndrome, or uncontrolled or significant cardiac
l INTERACTIONS → Appendix 1: panobinostat
▶ Common or very common Anaemia . antibiotic associated
▶ Uncommon Haemorrhagic shock . myocardial infarction
SIDE-EFFECTS, FURTHER INFORMATION Side-effects are
reported when used in combination with bortezomib and
Gastro-intestinal disorders Manufacturer advises that
patients are treated with anti-diarrhoeals, or any
additional treatment, in accordance with local treatment
guidelines at the first sign of abdominal cramping or onset
l CONCEPTION AND CONTRACEPTION Manufacturer advises
exclude pregnancy before starting treatment in women of
child-bearing potential, and ensure highly effective
contraception used during treatment and for 3 months
after last dose. Women using hormonal contraceptives
should also use a barrier method of contraception. Highly
effective contraception also required for men and their
936 Cytotoxic responsive malignancy BNF 78
Immune system and malignant disease
female partners during treatment and for 6 months after
l PREGNANCY Manufacturer advises avoid unless potential
benefit outweighs risk—toxicity in animal studies. See also
Pregnancy and reproductive function in Cytotoxic drugs
l BREAST FEEDING Manufacturer advises avoid—no
l HEPATIC IMPAIRMENT Manufacturer advises frequent
monitoring of hepatic function in mild and moderate
impairment, particularly during the dose escalation phase;
avoid in severe impairment—no information available.
Dose adjustments Manufacturer advises reduce initial dose
to 15 mg during the first treatment cycle in mild
impairment—dose may be increased to 20 mg based on
patient tolerability; reduce initial dose to 10 mg during the
first treatment cycle in moderate impairment—dose may
be increased to 15 mg based on patient tolerability.
▶ Manufacturer advises monitor full blood count before
treatment, then frequently during treatment; reduce dose
or interrupt treatment if thrombocytopenia or neutropenia
occur—consult product literature.
▶ Manufacturer advises monitor ECG before treatment and
repeat periodically before each treatment cycle; QTcF
should be <480 milliseconds before treatment initiation—
▶ Manufacturer advises monitor electrolytes before
treatment and periodically as clinically indicated,
especially in patients with diarrhoea; monitor thyroid and
pituitary function (free T4 and TSH) as clinically indicated;
monitor hepatic function before treatment and regularly
during treatment as clinically indicated.
▶ Manufacturer advises monitor patients over 65 years more
frequently, especially for thrombocytopenia and gastrointestinal toxicity.
l PATIENT AND CARER ADVICE Manufacturer advises that
patients and their carers should be told to seek medical
advice if severe gastro-intestinal toxicity occurs.
Missed doses Manufacturer advises if a dose is missed, it
can be taken up to 12 hours after the specified dose time.
Driving and skilled tasks Dizziness may affect performance
of skilled tasks (e.g. driving).
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Panobinostat for treating multiple myeloma after at least
2 previous treatments (January 2016) NICE TA380
Panobinostat, in combination with bortezomib and
dexamethasone, is recommended as an option for treating
relapsed or refractory multiple myeloma in patients who
have received at least 2 prior regimens including
bortezomib and an immunomodulatory agent when the
manufacturer provides panobinostat with the discount
agreed in the patient access scheme.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 25
▶ Farydak (Novartis Pharmaceuticals UK Ltd) A
Panobinostat (as Panobinostat lactate anhydrous)
10 mg Farydak 10mg capsules | 6 capsule P £3,492.00
Panobinostat (as Panobinostat lactate anhydrous) 15 mg Farydak
15mg capsules | 6 capsule P £3,492.00
Panobinostat (as Panobinostat lactate anhydrous)
20 mg Farydak 20mg capsules | 6 capsule P £4,656.00
l DRUG ACTION Pegaspargase breaks down the amino acid
L-asparagine, thereby interfering with the growth of
malignant cells, which are unable to synthesise Lasparagine.
Acute lymphoblastic leukaemia (in combination with
other antineoplastic drugs) (specialist use only)
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult 18–21 years: 2500 units/m2 every 14 days
▶ Adult 22 years and over: 2000 units/m2 every 14 days
l CONTRA-INDICATIONS History of pancreatitis . history of
serious haemorrhagic event with previous L-asparaginase
therapy . history of serious thrombosis with previous Lasparaginase therapy
l CAUTIONS Concomitant use of other hepatotoxic drugs
(particularly in pre-existing hepatic impairment)—monitor
count at start of treatment is possible—may be associated
with significant rise in serum uric acid and development of
▶ Hypersensitivity reactions Serious hypersensitivity reactions,
including life-threatening anaphylaxis, can occur—
pegaspargase should only be administered when
appropriately trained staff and resuscitation facilities are
immediately available; manufacturer advises patients
should be closely monitored for signs of hypersensitivity
during treatment and for an hour after administration. In
the event of a hypersensitivity reaction, treatment should
be stopped immediately and appropriate management
l INTERACTIONS → Appendix 1: pegaspargase
▶ Common or very common Abdominal pain . bone marrow
suspected and do not restart if confirmed). peripheral
neuropathy .rash . seizure . stomatitis . syncope . thrombosis (discontinue). vomiting
▶ Rare or very rare Acute kidney injury . posterior reversible
encephalopathy syndrome (PRES).tremor
(monitor if symptoms present).toxic epidermal necrolysis
SIDE-EFFECTS, FURTHER INFORMATION There have been
rare reports of cholestasis, icterus, hepatic cell necrosis
and hepatic failure with fatal outcome in patients
l CONCEPTION AND CONTRACEPTION Manufacturer advises
effective contraception in men and women of childbearing potential during treatment and for at least
6 months after discontinuing treatment; pegaspargase
may reduce effectiveness of oral contraceptives—
additional precautions (e.g. barrier method) are required,
see also Pregnancy and reproductive function in Cytotoxic
l PREGNANCY Manufacturer advises avoid unless essential.
See also Pregnancy and reproductive function in Cytotoxic
l BREAST FEEDING Manufacturer advises avoid—no
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
▶ Manufacturer advises trough serum asparaginase activity
levels may be measured before the next administration of
BNF 78 Cytotoxic responsive malignancy 937
Immune system and malignant disease
pegaspargase; consider switching to a different
asparaginase preparation if target levels not reached—seek
▶ Manufacturer advises monitor plasma and urine glucose
levels during treatment; monitor coagulation profile at
baseline and periodically during and after treatment
(particularly with concomitant use of other drugs that
inhibit coagulation); monitor serum amylase.
l DIRECTIONS FOR ADMINISTRATION Manufacturer advises
for intramuscular injection, volumes over 3 mL must be
divided between more than one site.
l HANDLING AND STORAGE Manufacturer advises store in a
Pancreatitis Manufacturer advises patients and carers
should be told how to recognise signs and symptoms of
pancreatitis and advised to seek medical attention if
symptoms such as persistent, severe abdominal pain
Driving and skilled tasks Manufacturer advises patients and
carers should be counselled on the effects on driving and
performance of skilled tasks—increased risk of confusion
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Pegaspargase for treating acute lymphoblastic leukaemia
Pegaspargase, as part of antineoplastic combination
therapy, is recommended as an option for treating acute
lymphoblastic leukaemia only in patients with untreated
Patients whose treatment was started within the NHS
before this guidance was published may continue
treatment until they and their clinician consider it
www.nice.org.uk/guidance/ta408
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (October
2016) that pegaspargase (Oncaspar ®) is accepted for use
within NHS Scotland as a component of antineoplastic
combination therapy in acute lymphoblastic leukaemia.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Oncaspar (Servier Laboratories Ltd) A
Pegaspargase 750 unit per 1 ml Oncaspar 3,750units/5ml solution
for injection vials | 1 vial P £1,296.19
l DRUG ACTION Procarbazine is a mild monoamine-oxidase
▶ Adult: (consult local protocol)
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
l CONTRA-INDICATIONS Pre-existing severe leucopenia . pre-existing severe thrombocytopenia
monoamineoxidase inhibitor (dietary restriction is rarely
l INTERACTIONS → Appendix 1: procarbazine
▶ Common or very common Appetite decreased
l CONCEPTION AND CONTRACEPTION Contraceptive advice
required, see Pregnancy and reproductive function in
l PREGNANCY Avoid (teratogenic in animal studies and
isolated reports in humans). See also Pregnancy and
reproductive function in Cytotoxic drugs p. 888.
l BREAST FEEDING Discontinue breast-feeding.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe impairment.
l RENAL IMPAIRMENT Caution in mild to moderate
impairment. Avoid in severe impairment.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 4
▶ Procarbazine (Non-proprietary)
Procarbazine (as Procarbazine hydrochloride)
50 mg Procarbazine 50mg capsules | 50 capsule P £411.35–
l DRUG ACTION Raltitrexed is a thymidylate synthase
Palliation of advanced colorectal cancer when fluorouracil
and folinic acid cannot be used
▶ Adult: (consult local protocol)
l INTERACTIONS → Appendix 1: raltitrexed
▶ Common or very common Alopecia . anaemia . appetite
▶ Frequency not known Gastrointestinal haemorrhage
l CONCEPTION AND CONTRACEPTION Ensure effective
contraception during and for at least 6 months after
l PREGNANCY See Pregnancy and reproductive function in
l BREAST FEEDING Discontinue breast-feeding.
l HEPATIC IMPAIRMENT Manufacture advises caution in
mild to moderate impairment; avoid in severe impairment,
jaundice or decompensated disease (no information
l RENAL IMPAIRMENT Avoid if creatinine clearance less than
Dose adjustments Reduce dose and increase dosing
interval if creatinine clearance less than 65 mL/minute
938 Cytotoxic responsive malignancy BNF 78
Immune system and malignant disease
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Irinotecan, oxaliplatin, and raltitrexed for advanced colorectal
cancer (August 2005) NICE TA93
Raltitrexed is not recommended for the treatment of
advanced colorectal cancer. Its use should be confined to
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for infusion
Raltitrexed 2 mg Tomudex 2mg powder for solution for infusion vials
| 1 vial P £148.75 (Hospital only)
l DRUG ACTION Bexarotene is an agonist at the retinoid X
receptor, which is involved in the regulation of cell
differentiation and proliferation. Bexarotene can cause
regression of cutaneous T-cell lymphoma.
Skin manifestations of cutaneous T-cell lymphoma
refractory to previous systemic treatment
▶ Adult: Initially 300 mg/m2 once daily, adjusted
according to response, to be taken with a meal
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
l CAUTIONS Avoid in Acute porphyrias p. 1058 . hyperlipidaemia . hypothyroidism
l INTERACTIONS → Appendix 1: retinoids
▶ Common or very common Alopecia . anaemia . appetite
abnormal . skin nodule . skin reactions . skin ulcer.thyroid
disorder. vomiting . weight changes
abnormality .taste altered .thirst.tinnitus . white blood
l ALLERGY AND CROSS-SENSITIVITY Caution—
hypersensitivity to retinoids.
l CONCEPTION AND CONTRACEPTION Manufacturer advises
effective contraception during and for at least 1 month
after treatment in men and women.
l PREGNANCY Avoid. See also Pregnancy and reproductive
function in Cytotoxic drugs p. 888.
l BREAST FEEDING Discontinue breast-feeding.
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (November
2002) that bexarotene (Targretin ®) is recommended for
restricted use as a second-line treatment for patients with
advanced (stages IIb or III) cutaneous T-cell lymphoma
who have proved refractory both to local skin directed
therapy and to at least one systemic therapy.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Bexarotene 75 mg Targretin 75mg capsules | 100 capsule P £937.50
Induction of remission in acute promyelocytic leukaemia
(used in previously untreated patients as well as in those
who have relapsed after standard chemotherapy or who
▶ Adult: 45 mg/m2 daily in 2 divided doses maximum
duration of treatment is 90 days, consult product
literature for details of concomitant chemotherapy
l CAUTIONS Increased risk of thromboembolism during first
l INTERACTIONS → Appendix 1: retinoids
▶ Frequency not known Embolism and thrombosis . erythema
nodosum . genital ulceration . hepatotoxicity . hypercalcaemia . increased leucocytes . myocardial
infarction . myositis . necrotising fasciitis . QT interval
prolongation . stroke .thrombocytosis . vasculitis
SIDE-EFFECTS, FURTHER INFORMATION Retinoic acid
syndrome Fever, dyspnoea, acute respiratory distress,
pulmonary infiltrates, pleural effusion, hyperleucocytosis,
hypotension, oedema, weight gain, hepatic, renal and
multi-organ failure requires immediate treatment—
l CONCEPTION AND CONTRACEPTION Effective
contraception must be used for at least 1 month before
oral treatment, during treatment and for at least 1 month
after stopping (oral progestogen-only contraceptives not
l PREGNANCY Teratogenic. See Pregnancy and reproductive
function in Cytotoxic drugs p. 888.
l BREAST FEEDING Avoid (discontinue breast-feeding).
BNF 78 Cytotoxic responsive malignancy 939
Immune system and malignant disease
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments Manufacturer advises dose reduction to
Dose adjustments Reduce dose to 25 mg/m2
l MONITORING REQUIREMENTS Monitor haematological and
coagulation profile, liver function, serum calcium and
plasma lipids before and during treatment.
l PRESCRIBING AND DISPENSING INFORMATION Tretinoin is
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 21, 25
Tretinoin 10 mg Tretinoin 10mg capsules | 100 capsule P £300.00–£315.00 DT = £300.00
3.1 Cytotoxic drug-induced side
ANTIDOTES AND CHELATORS › IRON CHELATORS
l DRUG ACTION Dexrazoxane is an iron chelator.
Prevention of chronic cumulative cardiotoxicity caused by
doxorubicin or epirubicin treatment in advanced or
metastatic breast cancer patients who have received a
prior cumulative dose of 300 mg/m2 of doxorubicin or a
prior cumulative dose of 540 mg/m2 of epirubicin when
further anthracycline treatment is required
▶ Adult: Administer 10 times the doxorubicin-equivalent
dose or 10 times the epirubicin-equivalent dose, dose
to be given 30 minutes before anthracycline
▶ Adult: Initially 1 g/m2 daily (max. per dose 2 g) for
2 days, then 500 mg/m2 for 1 day, first dose to be given
as soon as possible and within 6 hours after injury
l CAUTIONS Myelosuppression (effects may be additive to
CARDIOXANE ® Manufacturer advises caution in patients
infarction in previous 12 months—no information
available . manufacturer advises caution in patients with
symptomatic valvular heart disease—no information
available . manufacturer advises caution in patients with
uncontrolled angina—no information available
l INTERACTIONS → Appendix 1: iron chelators
▶ Common or very common Alopecia . anaemia . appetite
tachycardia .thrombocytopenia .tremor. vaginal
haemorrhage . vomiting . weight decreased . wound
▶ Uncommon Acute myeloid leukaemia . lymphoedema . sepsis .thirst. vertigo
▶ Frequency not known Anaphylactic reaction
l CONCEPTION AND CONTRACEPTION Ensure effective
contraception during and for at least 3 months after
l PREGNANCY Avoid unless essential (toxicity in animal
l BREAST FEEDING Discontinue breast-feeding.
CARDIOXANE ® Manufacturer advises caution (no
Dose adjustments Manufacturer advises if anthracycline
dose is reduced, reduce the Cardioxane ® dose by a similar
SAVENE ® Manufacturer advises avoid (no information
CARDIOXANE ® DOSE ADJUSTMENTS Manufacturer
advises reduce dose by 50% if creatinine clearance less
SAVENE ® Manufacturer advises avoid—risk of
▶ Monitor for cardiac toxicity.
l DIRECTIONS FOR ADMINISTRATION Local coolants such as
ice packs should be removed at least 15 minutes before
CARDIOXANE ® For intravenous infusion, give
intermittently in Compound sodium lactate; reconstitute
each vial with 25 mL water for injections and dilute each
vial with 25–100 mL infusion fluid; give requisite dose over
SAVENE ® For intravenous infusion, give intermittently in
diluent; reconstitute each 500-mg vial with 25 mL of
diluent; dilute requisite dose further in remaining diluent
and give over 1–2 hours into a large vein in an area other
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for infusion
▶ Cardioxane (Clinigen Healthcare Ltd)
Dexrazoxane 500 mg Cardioxane 500mg powder for solution for
infusion vials | 1 vial P £156.57
Powder and solvent for solution for infusion
ELECTROLYTES: May contain Potassium, sodium
▶ Savene (Clinigen Healthcare Ltd)
Dexrazoxane 500 mg Savene 500mg powder for concentrate and
solvent for solution for infusion vials | 10 vial P s
DETOXIFYING DRUGS › UROPROTECTIVE DRUGS
Cytotoxic induced urothelial toxicity
▶ BY MOUTH, OR BY INTRAVENOUS INJECTION
▶ Adult: Dose to be calculated according to
oxazaphosphorine (cyclophosphamide or ifosfamide)
treatment (consult product literature)
940 Cytotoxic responsive malignancy BNF 78
No comments:
Post a Comment
اكتب تعليق حول الموضوع