CHEMOTHERAPY PREPARATION AND STABILITY CHART

BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 1/77 Activation Date: 2 March 2006 Revised Date: 1 July 2010

BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART

DRUG & STRENGTH (Storage Prior to Use,

Manufacturer, Preservative Status)

Reconstitute With:

To Give: Vial Stability

Product Product Stability Special Precautions/Notes

Aldesleukin 22 million IU

(1.3 mg) (Novartis) (F)(PFL)

no preservative1

1.2 mL SWI1,2 direct diluent against side of vial during reconstitution1 do not shake1

18 million IU/mL (1.1 mg/mL)1,2

48 h F1

50 mL D5W1

30 – 70 mcg/mL1

< 30 mcg/mL: dilute in

D5W containing human albumin 0.1%2

48 h F1

- cytotoxic3 - do not use in-line filter1,2 - avoid bacteriostatic water for injection or NS due to increased aggregation1

Alemtuzumab 30 mg/mL

(Genzyme previously Bayer)4 (F)(PFL)

do not shake no preservative5

N/A

filter NOT required5

30 mg/mL5

discard unused

portion5

SC syringe6

discard at the end of

the day F or RT

- cytotoxic7 - do not shake8

100 mL NS or D5W5

8 h F or RT5

**(PFL)8

Alemtuzumab 30 mg/3 mL

(Schering/Ilex) (F)(PFL)


N/A

use 5 micron filter to withdraw drug from ampoule8

10 mg/mL9

discard unused

portion9

SC syringe6

discard at the end of

the day F or RT8






Reconstitute With:



100 mL NS or D5W9

8 h F or RT8

**(PFL)8

Amifostine 500 mg

(MedImmune) (RT)

no preservative10

9.7 mL NS only10

50 mg/mL10

24 h F, 5 h RT10

25–50 mL*NS only10

5–40 mg/mL:

24 h F,10 5 h RT

- noncytotoxic10 - discard cloudy solution11

Amsacrine 75 mg/1.5 mL (Erfa Canada)

(RT) no preservative12

glass syringes

preferred during reconstitution;

max. time in plastic syringe12: 15 min

13.5 mL supplied diluent (L-lactic

acid)1

transfer 1.5mL from

ampoule into the diluent vial12

5 mg/mL12

24 h RT12

PFL12

500 mL D5W12

(plastic or glass container)12

7 d F, 48 h RT12,13,14

- cytotoxic15





Reconstitute With:



Asparaginase16 (asparaginase E. coli)

10,000 units (Orphan

Pharmaceutical International)

(F) no preservative17

do not shake; roll to

reconstitute18,11 4 mL SWI19

Intradermal test11: Reconstitute with

5 mL SWI to give 2000 units/mL

Transfer 0.1 mL to 10 mL vial (or 12 mL syringe)

Add 9.9 mL SWI roll to dissolve to give 20 units/mL

2 unit test dose = 0.1 mL

(Note: the rest of the reconstituted vial

has a concentration of 2000 units/mL)11

2500 units/mL16

48 h F, RT16

syringe16

14 d F20, 16

- cytotoxic3

50 mL*NS or D5W20,13

14 d F,20,13 2 d RT20,21





Reconstitute With:



Erwinia asparaginase (asparaginase Erwinia

chrysanthemi) 10,000 units

(Orphan Pharmaceuticals

International) (F)

no preservative22


reconstitute22

1-2 mL NS22

10000-5000

units/mL

15 min in original container; 8 h in a

glass or polypropylene

syringe22

glass or

polypropylene syringe22

8 h in a glass or polypropylene

syringe22

- cytotoxic3





Reconstitute With:



PEG-asparaginase (pegasparagase)

(pegylated asparaginase E. coli)

750 units/mL (Enzon)


N/A

750 units/mL23

discard unused

portion23

IM: maximum volume

2 mL; if >2 mL use multiple sites23

syringe: 4 h23,24

- cytotoxic3 - discard cloudy solution23 - do not shake23 - do not use if stored out of refrigerator for > 48 h23 - do not use if previously frozen23

IV: 100 mL NS or D5W23

bag: 4 h23,24





Reconstitute With:



Azacitidine 100 mg

(Celgene) (RT)

no preservative25

4 mL SWI25 shake vigorously25

25 mg/mL25

8 h F,

45 min RT25

SC syringe25

45 min RT25

prepare immediately before use and use

within 45 min, or discard.

- cytotoxic3 - discard if contains large particles25 - re-suspend syringe contents before injection by vigorously rolling syringe between palms25

BCG 81 mg

(Sanofi Pasteur) (F)(PFL)

preservative26


reconstitute26

3 mL supplied diluent26

record time of reconstitution

10.5 ± 8.7×108

CFU/vial (Connaught

strain)26

2 h F, RT26

50 mL NS26

2 h F or RT after reconstitution26

**(PFL)26

- cytotoxic7





Reconstitute With:



BCG (Tice substrain)

50 mg = 1 to 8 x 108 CFU

(Hospira/Organon) (F)(PFL)

no preservative27

1 mL preservative

free NS for injection27

use reconstitution device provided

allow to stand for a few minutes, then

gently swirl to suspend27

1 to 8×108 CFU/vial27

2 h F (PFL)27

transfer from vial to 60 mL syringe, rinse

vial with another 1 mL NS. Add rinse to

same 60 mL syringe. qs to 50 mL with NS27

2 h F27

- cytotoxic3 - overfill unknown - protect from light27 - do not filter27





Reconstitute With:



Bendamustine 25 mg single-use vial 100 mg single-use vial

(Cephalon) (RT)(PFL)

no preservative28

25 mg vial: add 5

mL SWI 100 mg vial: add 20

mL SWI28

Shake well to yield a clear, colourless to a pale yellow solution.

Expected to completely dissolve within 5 minutes28

5 mg/mL28

30 minutes28

500 mL NS28

0.2-0.6 mg/mL28

24 h F, 3 h RT28

- cytotoxic3

Bevacizumab 100 mg/4 mL

400 mg/16 mL (Roche) (F)(PFL)


N/A

25 mg/mL29

discard unused

portion29

1.4-16.5 mg/mL30

100-250 mL NS

only29,30

48 h F, RT21,29,30


Bleomycin 15 IU

(NB: dose in units only) (Bristol)


6 mL*NS31

2.5 IU/mL

48 h F31

50 mL*NS31

24 h RT31

- cytotoxic7 - no overfill32





Reconstitute With:



Bleomycin 15 IU

(NB: dose in units only) (Hospira) (F)(PFL)

no preservative33

6 mL*NS or SWI33

2.5 IU/mL33

48 h F, 24 h RT33

50 mL *NS, SWI33

24 h RT34

- cytotoxic7 - no overfill35

Bortezomib 3.5 mg

(Ortho Biotech formally Millennium) (RT)(PFL)

no preservative36

3.5 mL NS36

1 mg/mL36

2d RT13,37

syringe36

8 h RT38

- cytotoxic7





Reconstitute With:



Busulfan 60 mg/10 mL

(Orphan Medical) (F)

no preservative39

N/A

use 5-micron nylon filter provided with

ampoule to withdraw drug39

6 mg/mL39

discard unused

portion39

NS or D5W (dilute in volume 10 times the busulfan volume to ~

0.5 mg/mL)39

complete

administration within 12 h F: NS39

8 h RT: NS, D5W

- cytotoxic7

Carboplatin 50 mg/5 mL

150 mg/15 mL 450 mg/45 mL

(Hospira) (RT)(PFL)

no preservative40

N/A

10 mg/mL40

discard unused

portion40

0.3-10 mg/mL41

NS, D5W11,40

do NOT use

aluminum-containing needle or syringe41

24 h RT,42 48 h F40

- cytotoxic7 - do NOT use aluminum-containing needle, syringe or tubing41

Carboplatin 50 mg/5 mL

150 mg/15 mL 450 mg/45 mL (Novopharm)

(RT)(PFL) no preservative43

N/A

10 mg/mL43

discard unused

portion RT43

0.5-10 mg/mL44

NS, D5W11,43,45

do NOT use


8 h RT43






Reconstitute With:



Carmustine 100 mg

(Bristol Labs) (F)

no preservative46

3 mL diluent (supplied)46

diluent to reach RT, then dissolve drug with 3 mL diluent; add 27 mL SWI46


3.3 mg/mL in 10%

ethanol46

24 h F, 8 h RT46

glass46 or polyolefin

container11

500 mL NS or D5W46

24 h F: in glass,46 or polyolefin container11

use within 4 h of

reconstitution RT46

- cytotoxic7 - do not use if product has oily droplets46

Cetuximab 100 mg/50 mL 200 mg/100 mL (ImClone/BMS)

(F) do not dilute do not shake

no preservative47

N/A

2 mg/mL47

discard unused

portion after 12 h F, 8 h RT47

syringe47

sterile evacuated container or bag e.g.

polyolefin, polyethylene, ethylene vinyl acetate, DEHP

plasticized PVC, PVC bag, or glass47

12 h F, 8 h RT47

12 h F, 8 h RT47

- cytotoxic3 - administer with a 0.2 or 0.22 micron low protein binding in-line filter47 - normal saline may be used to flush the line47 - solution may contain white particulates which do not affect product quality47





Reconstitute With:



Cisplatin 10 mg/10 mL 50 mg/50 mL

100 mg/100mL (Hospira) (RT)(PFL)

no preservative48

N/A

1 mg/mL48

48 h RT49

< 60 mg: 100 mL NS*> 60 mg: 250 mL NS*

500 or 1000 mL *NS, D5-NS, D5-1/2S; D5-NS with mannitol; D5-

1/2S with mannitol48,50; D5W-1/3S with mannitol48

do NOT use


48 h RT49


Cladribine 10 mg/10 mL

(Janssen-Ortho) (F)(PFL)

no preservative51

N/A

1 mg/mL51

discard unused

portion51

SC syringe52

cassette51

48h F, end of day

RT13,51,53,54

- cytotoxic7 - shake vigorously to dissolve any precipitates from refrigeration11 - bacteriostatic NS contains benzyl alcohol51

500 mL NS only51

Do NOT use D5W51

24 h RT51





Reconstitute With:



qs to 100 mL with bacteriostatic NS

only via SIMS DELTEC INC. MEDICATION

CASSETTES®51; filter drug and diluent

through 0.22u filter as each solution is being

introduced into the medication

at least 7 days51

Clodronate 300 mg/10 mL

(Oryx) (RT)

no preservative55

N/A

30 mg/mL

discard unused

portion55

500 mL NS or D5W55

12 h RT55

- noncytotoxic





Reconstitute With:



Cyclophosphamide 200 mg 500 mg

1000 mg 2000 mg (Baxter)


NS56

200 mg: 10 mL 500 mg: 25 mL

1000 mg: 50 mL 2000 mg: 100 mL56

20 mg/mL56

72 h F,56,57 24 h

RT56

< 1 g: 100 mL NS* > 1 g: 250 mL NS* high dose in BMT: may need 500 NS*

NS, D5W, D5NS56

72 h F,56,57 24 h RT56

- cytotoxic7

Cyclosporine 50 mg/1 mL 250 mg/5 mL

(Novartis) (RT)(PFL)

no preservative58

N/A

50 mg/mL58

discard unused

portion58

NS, D5W58

dilute to concentration

between 1:20 and 1:10058

dilute immediately prior

to use58

- cytotoxic3 - polyoxyethylated castor oil/ethanol vehicle58 - do NOT refrigerate or freeze58 - use non-PVC bag and tubing59





Reconstitute With:



Cytarabine 100 mg/1 mL

1000 mg/10mL 2000 mg/20mL

(Hospira) (RT)(PFL)

no preservative60

N/A

record time of

puncture

100 mg/mL60

24 h RT60

100 mL*NS, Water for

Injection, D5W, Lactated Ringer’s60

72 h F, 24 h RT from initial vial puncture60

- cytotoxic7 - do not use for IT injection

Cytarabine IT injection60 100 mg/1 mL

1000 mg/10mL 2000 mg/20mL

(Hospira) (RT)(PFL)

no preservative60

N/A

record time of

puncture

100 mg/mL60

24 h RT60

diluents containing

preservatives should NOT be used for

intrathecal administration60

qs to 6 mL with

preservative free NS61

use within 4 h of initial

vial puncture11,13

- cytotoxic7 - auxiliary label62: “IT” - label to include route in full (i.e., INTRATHECAL injection) attached to both syringe and outer ziplock bag62





Reconstitute With:



Cytarabine SC injection:

100 mg (Pfizer)


100 mg: 5 mL BWI63

100 mg:

20 mg/mL63

48 h RT63,64

syringe

14 d F, 48 h RT64

- cytotoxic7 - for high dose use, do not use diluent containing benzyl alcohol65 - do not use for IT injection

Dacarbazine 100 mg 200 mg

(Abraxis) (F)(PFL)

no preservative66

100 mg: 9.9 mL

SWI66 200 mg: 19.7 mL

SWI66

10 mg/mL66

72 h F, 8 h RT66

250-500 mL*NS or

D5W

24 h F, 8 h RT66

**(PFL)11,66 see Special

Precautions/Notes Column

- cytotoxic7 - protect container from light during storage and administration67 - overfill unknown

Dacarbazine 200 mg 600 mg

(Hospira) (F)(PFL)

no preservative68

200 mg: 19.7 mL

SWI68 600 mg: 59.1 mL

SWI68

10 mg/mL68

48 h F, 8 h RT68

(PFL)69

0.19–3.0 mg/mL13,68

250-500 mL*NS or

D5W

24 h F68

**(PFL)67

see Special Precautions/Notes

Column

- cytotoxic7 - protect container from light during storage and administration67 - no overfill69,35





Reconstitute With:



Dactinomycin 0.5 mg

(Ovation)70 (RT)(PFL)

no preservative71

1.1 mL

SWI(preservative free)71

Do NOT use SWI with preservative

(may form precipitate)71

0.5 mg/mL71

(500 mcg/mL)

24 h F, RT72

syringe71,73

24 h F, RT74

- cytotoxic3 - do not filter71,73 .




Reconstitute With:



Daunorubicin 20 mg

(Erfa Canada Inc.)75 (RT)(PFL)76

no preservative77

4 mL SWI75

5 mg/mL75,78

48 h F, 24 h RT77

100-250 mL in

isotonic solution e.g., NS75

no data for D5W77

24 h RT, 48 h F75

- cytotoxic3





Reconstitute With:



Daunorubicin 20 mg

(Novopharm) (RT)(PFL)

no preservative79

4 mL SWI79

5 mg/mL79

24 h RT, 48 h F79

(PFL)79

100-250 mL NS or D5W11

48 h F, 24 h RT79

**(PFL)79

- cytotoxic7

Dexrazoxane 250 mg 500 mg (Pfizer)


supplied diluent80:

250 mg: 25 mL 500 mg: 50 mL

10 mg/mL80

6 h F80

empty viaflex bag80

6 h RT81

- cytotoxic82

Docetaxel 20 mg/0.5 mL 80 mg/2 mL

(Sanofi-Aventis) (F, RT) (PFL)

no preservative83

supplied diluent :

- if vials were refrigerated, allow to

warm for 5 min at RT. Withdraw entire

contents of the diluent and inject the

entire contents of the syringe into the

corresponding concentrate vial. Mix

by repeated inversions for 45 sec

DO NOT SHAKE Let sit for 5 minutes83,84

10 mg/mL83

48 h F, RT13,85

0.3–0.74 mg/mL

(e.g., 250 mL NS or

D5W)83

complete

administration within 4 h F,83 48 h RT86,87

- cytotoxic7 - non-PVC bag and tubing only83





Reconstitute With:



Doxorubicin

10 mg 50 mg 150 mg

(Hospira) (RT)(PFL)

no preservative88

NS, SWI, D5W88

(NS reconstitution takes longer) 10 mg: 5 mL 50 mg: 25 mL 150 mg: 75 mL

2 mg/mL88

48 h F, 24 h

RT13,88

syringe88

48 h F, 24 h RT13,89

- cytotoxic7

0.2–2 mg/mL90

100 mL*NS88

48 h F, 24 h RT13,90





Reconstitute With:



Doxorubicin 10 mg/5 mL 20 mg/10 mL 50 mg/25 mL

200 mg/100 mL (Novopharm)

(F)(PFL) no preservative91

N/A

record time of

puncture

2 mg/mL

8 h91

syringe91

48 h F, 24 h RT91

from initial vial puncture

- cytotoxic7

Doxorubicin 10 mg/5 mL 50 mg/25 mL

200 mg/100 mL (Pfizer)


N/A

2 mg/mL92

discard unused

portion92,74

syringe92

48 h F, 24 h RT92

- cytotoxic3

Doxorubicin Pegylated Liposomal

20 mg/10 mL 50 mg/25 mL

(Schering) (F)

no preservative93

N/A

2 mg/mL93

discard unused

portion93

< 90 mg: 250 mL

D5W only93

≥ 90 mg: 500mL D5W only

24 h F93

- cytotoxic7 - do not filter93





Reconstitute With:



Epirubicin 10 mg/5 mL 50 mg/25 mL

200 mg/100 mL (Pfizer) (F)(PFL)

no preservative94

N/A

record time of

puncture

2 mg/mL94

8 h94

syringe94

48 h F, 24 h RT from initial vial puncture94

- cytotoxic7

100 mL*NS or D5W11

2 d F, RT: NS or

D5W49





Reconstitute With:



Etoposide 100 mg/5 mL

500 mg/25 mL 1000 mg/50 mL

(BMS) (RT)

preservative95

N/A

20 mg/mL95

14 d RT11,13,96,97,98

0.2– 0.4 mg/mL95

500 mL*NS or D5W95

0.2 mg/mL: 48 h RT13,95 0.4 mg/mL: 24 h RT95

- cytotoxic7 - use non-PVC bag and tubing only

Etoposide 100 mg/5 mL

200 mg/10 mL 500 mg/25 mL 1000 mg/50 mL

(Novopharm) (RT)(PFL)

no preservative99

N/A

20 mg/mL99

discard unused

portion99

NS

Stabilty is

concentration dependent

0.2-0.3 mg/mL: 7 d F,100 2 d RT87,100 0.4-0.5 mg/mL: 1 d F,100 1 d RT100 0.6-9.0mg/mL: generally unstable100 9.5 mg/mL: 2 d F,100 1d RT100 10-12 mg/mL: 7 d F,100 2 d RT87,100

- cytotoxic7 - use non-PVC bag and tubing only

D5W99

4 h RT99,101





Reconstitute With:



Fludarabine 50 mg

(Berlex) (F)

no preservative102

2 mL SWI102

25 mg/mL102

48 h F or RT13,49

dilute to maximum of

1 mg/mL102,103

100 mL*NS or D5W102

48 h F, RT13,49

- cytotoxic7

Fludarabine 50 mg

(Novopharm) (F)

no preservative104

N/A

25 mg/mL104

discard unused

portion104

dilute to maximum of

1 mg/mL104

100 mL*NS or D5W

48 h F, 24 h RT104

- cytotoxic7





Reconstitute With:



Fluorouracil 5000 mg/100 mL

(Hospira) (RT)(PFL)

no preservative105

N/A

50 mg/mL105

8 h RT105,106

syringe13

48 h RT13,21,106

- cytotoxic7

2-10 mg/mL in

D5W105,106

50-1000 mL*D5W

24 h RT105,106

CIVI: ambulatory

pump106

complete within

8 d11,13,107





Reconstitute With:



Gemcitabine 200 mg

1000 m g (Eli-Lilly)


200 mg: 5 mL NS 1000 mg: 25 mL

NS108

38 mg/mL108

48 h RT108,109

syringe108

48 h RT,13,108,109

- cytotoxic7

0.1–10 mg/mL

NS108,109

48 h F, RT13,108,109





Reconstitute With:



Gemcitabine 200 mg

1000 mg 2000 mg (Hospira)

RT110 no preservative111

200 mg vial: 5 mL

NS 1000 mg vial: 25 mL


NS110

38 mg/mL110

48 RT110,112,74

syringe110

24 h RT110,112

- cytotoxic7

26 mg/mL-0.1 mg/mL

NS110,112

48 h RT112,74

Gemcitabine 200 mg

1000 mg (Novopharm)

RT no preservative113

200 mg vial: 5mL


NS114

38 mg/mL114

24 h RT114

38 mg/mL – 0.1

mg/mL NS114

24 RT114

- cytotoxic7

Gemcitabine 200 mg

1000 mg (Sandoz Standard)

RT no preservative115

200 mg vial: 5 mL


NS115

38 mg/mL115

48 h RT115,116

syringe115

48 h RT115,117,116

- cytotoxic7





Reconstitute With:



38 mg/mL-0.1 mg/mL

NS or D5W115,118

48 h RT13,119





Reconstitute With:



Idarubicin 5 mg

10 mg (Pfizer)


vial under negative

pressure120

5 mg: 5 mL SWI 10 mg: 10 mL

SWI120

1 mg/mL120

48 h F,120 24 h RT

(PFL)120

syringe

48 h F,13, 120 24 h RT13

(PFL)120

- cytotoxic7

Idarubicin 5 mg/5 mL

10 mg/10 mL 20 mg/20 mL

(Pfizer) (F)(PFL)

no preservative120

N/A

1 mg/mL120

same as

reconstituted solution121

syringe

Discard 48 h F,13,120 24 h RT13

(PFL)120

- cytotoxic7

Ifosfamide 1000 m g 3000 mg (Baxter) (RT) 11

no preservative122

1000 mg: 20 mL

SWI122 3000 mg: 60 mL

SWI

shake well

50 mg/mL122

48 h F13,122

0.6–20 mg/mL122

500–1000 mL*NS,

D5W, D5-NS, D5-1/2NS, Lactated

Ringer’s11,122

72 h F122

24 h F, RT when mixed with mesna11

D5W or Lactated

Ringer’s when mixed

- cytotoxic7

Interferon Alfa -2b 18 million IU/3 mL

(Schering) (F)(or up to 7 days at

RT before use) no preservative123

N/A

6 million IU/mL123

48 h F13,123

syringe123

2 d F13,124

- cytotoxic7





Reconstitute With:



≥ 0.3 million IU/mL123

50 mL NS123

24 h F, RT124

Interferon Alfa -2b 25 million IU/2.5 mL

(Schering) (F)(or up to 7 days at

RT before use) no preservative123

N/A

10 million IU/mL123

48 h F13,123

syringe123

2 d F13,124

- cytotoxic7

≥ 0.3 million IU/mL123

50 mL NS123

24 h F, RT124

Interferon Alfa -2b 10 million IU (Schering)


1 mL supplied

diluent (SWI) 123

do not shake; roll to reconstitute123

10 million IU/mL123

24 h F123

syringe123

24 h F, RT124

- cytotoxic7

> 0.1 million IU/mL124

100 mL NS125

48 h RT11,13





Reconstitute With:



1 mL BWI123


reconstitute123

48 h F, RT13,123

syringe125

14 d F, 48 h RT13,125

100 mL NS125

48 h RT11,13

Interferon Alfa -2b 18 million IU (Schering)


1 mL supplied

diluent123

do not shake; roll to reconstitute123

18 million IU/mL123

24 h F123

syringe123

24 h F, RT124

- cytotoxic7

> 0.1 million IU/mL126

100 mL NS125

48 h RT11,13

1 mL BWI123


reconstitute123

48 h F, RT13

syringe123

14 d F13,125

100 mL NS125

48 h RT11,13





Reconstitute With:



Irinotecan 40 mg/2 mL 100 mg/5 mL

500 mg/25 mL (Hospira) (RT)(PFL)

no preservative127

N/A

20 mg/mL127

2 days RT13,128,129

0.12– 2.8 mg/mL127

500 mL11 D5W

(preferred), NS127

24 h RT: D5W, NS127

48 h F: D5W

(PFL)127

- cytotoxic7 - do NOT refrigerate if in NS130


(Pfizer) (RT)(PFL)

no preservative130

N/A

20 mg/mL130

discard unused

portion130

0.12– 2.8 mg/mL130

500 mL11 D5W

(preferred), NS130

24 h RT: D5W, NS130

48 h F: D5W

(PFL)130

- cytotoxic7 - do NOT refrigerate if in NS130


(Sandoz) (RT)(PFL)

no preservative131

N/A

20 mg/mL131

discard unused

portion131,74

0.12-2.8 mg/mL131

D5W (recommended)

NS131

24 h RT: D5W NS131

48 h F: D5W131

(PFL)131

- cytotoxic3





Reconstitute With:



Ixabepilone 15 mg

(contains 16 mg) 45 mg

(contains 47 mg) (BMS)


8 mL supplied

diluent

23.5 mL supplied diluent

2 mg/mL

2 mg/mL

1 h RT132

0.2 – 0.6 mg/mL in Lactated Ringer’s Injection USP (use non-PVC infusion

container)132

6 h RT132

- cytotoxic3 - use 0.2-1.2 micron in-line filter132 - use non-PVC (i.e., DEHP-free) administration set132

Leucovorin 50 mg/5 mL

500 mg/50 mL (Hospira) (F)(PFL)

no preservative133

N/A

10 mg/mL133

5 mL vial: discard unused portion133

50 mL vial: 8 h

syringe134

7 d F134

48 h RT87,134

- noncytotoxic

0.05-10 mg/mL133

24 h RT133: NS, D5W,

Lactated Ringer’s, Ringer’s

50-250 mL* NS, D5W, Lactated

Ringer’s, Ringer’s, D10W, D5-NS

8 h RT133: D10W, D5-

NS





Reconstitute With:



Leucovorin 50 mg/5 mL

500 mg/50 mL (Novopharm) (F)(PFL)135

N/A135

10 mg/mL135

5 mL vial: discard unused portion135

50 mL vial:

discard unused portion135

syringe

8 h135,13

- noncytotoxic

0.060-1.0 mg/mL135

24 h RT NS, Lactated Ringer’s, Ringer’s135

50-250 mL* NS, D5W, Lactated

Ringer’s, Ringer’s, D10W, D10NS135

12 h RT D5W,

D10W135

6 h RT D5NS135





Reconstitute With:



Mechlorethamine 10 mg

(Ovation Pharmaceuticals/Merck)

no preservative136

do NOT use if

discoloured or water droplets form in vial

before reconstitution136

10 mL SWI or NS136


1 mg/mL136

use within 4 h of

reconstitution RT11,13

syringe136

complete

administration 4 h of reconstitution

RT11,13,136

- cytotoxic7

100 mL NS49,136

complete

administration within 4 h of reconstitution

RT13,49,136





Reconstitute With:



Medroxyprogesterone 250 mg/5 mL

(Pfizer) (RT)

preservative18

N/A

record time of

puncture

50 mg/mL18

use within 4 h of

initial puncture11,137

syringe: IM only18


vial puncture11,137

- cytotoxic7 - auxiliary label: shake before use18

Medroxyprogesterone Depo

150 mg/1mL (Pfizer)

(RT) preservative18

N/A

record time of

puncture

150 mg/mL18

use within 4 h of

initial puncture11,137

syringe: IM only18


puncture11,137

- cytotoxic7 - auxiliary label: shake before use18

Melphalan 50 mg (GSK)


10mL supplied

diluent138

immediately after adding diluent,

shake vigorously138


5 mg/mL138

2 h RT138

do NOT

refrigerate

0.1– 0.45 mg/mL in

NS only138

(e.g., > 45 mg and < 110 mg in 250 mL

NS)*

complete

administration within 60 min from time of

initial reconstitution at RT11

- cytotoxic7


Mesna 1000 mg/10mL

(PPC) (RT)

preservative139

N/A

100 mg/mL139

14 d F, RT13,139

> 1mg/mL139

NS or D5W

48 h F, 24 h RT139

- noncytotoxic

Methotrexate 50 mg/2mL

500 mg/20mL 1 g/40mL 5 g/200mL (Hospira) (RT)(PFL)

no preservative140

N/A

25 mg/mL140

50mg: discard

unused portion140

500mg, 1 g, 5 g: 8 h F, RT140

syringe

2 d F, RT11,141,142

- cytotoxic7 - for high-dose regimens (e.g., 1-8 g/m2 as a single dose)143 use preservative-free methotrexate11 - do not use for IT injection

0.4–2 mg/mL140

100 mL* NS, D5W

high dose (e.g., 1-8

g/m2 as a single dose)143,144-146: 500–

1000 mL*

24 h RT140


Methotrexate IT Injection140:

Only preservative free methotrexate may be administered by the intrathecal route140

50 mg/2mL147 (Hospira) (RT)(PFL)

no preservative140

N/A

25 mg/mL140

discard unused

portion140

qs to 6 mL with



puncture11,13

- cytotoxic7 - auxiliary label62: “IT” - label to include route in full (i.e., INTRATHECAL injection) attached to both syringe and outer ziplock bag62

Methotrexate 50 mg/2mL

500 mg/20mL (Hospira) (RT)(PFL)

preservative140

N/A

25 mg/mL140

24 h F141

syringe

14 d F87,141

- cytotoxic7 - high-dose regimen(e.g., 1-8 g/m2 as a single dose)144-146: use preservative-free methotrexate11 - do not use for IT injection

0.4–2 mg/mL140

e.g., 100 mL*NS,

D5W140

4 h RT140

Mitomycin 5 mg

20 mg (Novopharm)


SWI

5 mg: 10 mL 20 mg: 40 mL

shake well148

0.5 mg/mL148

48 h F, RT13,148

(PFL)148

syringe13

14 d F, 48 h RT13,148

- cytotoxic7


0.02-0.04 mg/mL148

NS, D5W, sodium

lactate148

3 h RT: D5W 12 h RT: NS

24 h RT: sodium lactate148

Mitomycin 5 mg

20 mg (BMS)


SWI

5 mg: 10 mL 20 mg: 40 mL

shake well149

0.5 mg/mL149

48 h F, RT13,149

(PFL)149

syringe11

14 d F, 48 h RT11,21

- cytotoxic7

0.02–0.04 mg/mL

NS, D5W, sodium

lactate149

12 h RT: NS

3h: D5W 24 h: sodium lactate149





Reconstitute With:



Mitoxantrone 20 mg/10 mL

25 mg/12.5 mL (Hospira) (RT)(PFL)

no preservative150

N/A

2 mg/mL150

discard unused

portion150

0.2-0.6 mg/mL150

NS, D5W150

> 50 mL*150

NS: 24 h F, RT150

**(PFL)150

- cytotoxic7

Mitoxantrone 20 mg/10 mL (Novopharm)


N/A

2 mg/mL151

discard unused

portion151

NS, D5W151

> 50 mL*151

24 h RT151

**(PFL)152

- cytotoxic7

Mitoxantrone 20 mg/10 mL

(Pharmaceutical Partners of Canada)


N/A

2 mg/mL153

discard unused

portion153

NS, D5W2

> 50 mL*153

24 h RT153

- cytotoxic7


Octreotide 50 mcg/mL; 100

mcg/mL; 500 mcg/mL (Novopharm)

(F)(PFL) no preservative

multidose vials (5mL): 200 µg/mL (F)(PFL)

preservative154

N/A

50 mcg/mL

100 mcg/mL 500 mcg/mL154

discard unused

portion154

sc syringe154

single use vials: use

within 4 h multidose vials: use within 14 d F74,154

- noncytotoxic

200 mcg/mL154

14 d F74,154

infusion: NS154

single use vials or

multidose vials: 24 h RT154

Octreotide (Sandostatin)

1000 mcg/5 mL (Novartis) (F)(PFL)

preservative18

N/A

200 mcg/mL18

discard unused

portion155

50–200 mL NS18,11,156

SC infusion: adjust volume to ensure infusion rate of 25

mcg/h18

24 h RT18

- noncytotoxic10





Reconstitute With:



Octreotide (Sandostatin) 50 mcg/1 mL

100 mcg/1 mL 500 mcg/1 mL

(Novartis) (F)(PFL)

no preservative18

N/A

50 mcg/mL

100 mcg/mL 500 mcg/mL18

discard unused

portion18

50-100 mL11,156

NS18

SC infusion: adjust volume to ensure infusion rate of 25

mcg/h18

24 h RT18

- noncytotoxic10

Octreotide (Sandostatin LAR)

10 mg 20 mg 30 mg

(Novartis) (F)(PFL)

preservative155

2 mL supplied

diluent

gently run 2 mL down sides of the

vial; do NOT disturb for 2–5 min, then swirl moderately18


10 mg: 5 mg/mL 20 mg: 10 mg/mL

30 mg: 15 mg/mL18

discard unused

portion18

deep intragluteal

administration only18


reconstitution18,13

- noncytotoxic10 - do NOT shake





Reconstitute With:



Oxaliplatin 50 mg/10 mL

100 mg/20 mL 200 mg/40 mL

(Sanofi-Aventis) (RT)(PFL)

no preservative157

N/A

5 mg/mL157

discard unused

portion157

0.2-1.3 mg/mL158

1.3–2 mg/mL157,158

250–500 mL D5W157

do NOT use NS or

other chloride-containing solution157

do NOT use

aluminum-containing needle and syringe157

0.2-1.3 mg/mL:

14 d F, 48 h RT159,87,158

1.3-2 mg/mL: 48 h F, 24 h RT157






Reconstitute With:



Oxaliplatin 50 mg 100 mg

(Sigmacon) (RT)

no preservative160

SWI, D5W:

50 mg: 10 mL 100 mg: 20 mL

do NOT use NS or

other chloride-containing solution160

do NOT use aluminum-

containing needle and syringe160

5 mg/mL160

24 h F160

500 mL D5W

do NOT use NS or

other chloride-containing solutions

(degrades)160

do NOT use aluminum-containing needle and syringe160

24 h F, 6 h RT160


Paclitaxel 30 mg/5 mL

100 mg/16.7 mL 300 mg/50 mL

(Biolyse) (RT)161

no preservative

N/A

6 mg/mL162

8 h RT162

- cytotoxic7 - use non-PVC bag and tubing with in-line filter162

0.3–1.2 mg/mL in NS, D5W162 (e.g., 100–1000 mL)*

0.1 mg/mL in NS163 0.012-0.1 mg/mL164

0.3-1.2 mg/mL: 24 h RT162 0.1 mg/mL: 44 h F, RT163 0.012-0.09 mg/mL: 16 h RT164


Paclitaxel 30 mg/5 mL

100 mg/16.7 mL 300 mg/50 mL

(BMS) (RT)(PFL)

no preservative165

N/A

6 mg/mL165

30 mg: 48 h

RT13,165 100 mg: 48 h

RT13,165 300 mg: 24 h

RT165

0.3–1.2 mg/mL in NS, D5W, D5-NS, D5 in

Ringer’s165

(e.g.,100–1000 mL)*

24 h RT165

- cytotoxic7 - use non-PVC and tubing with in-line filter165

0.1–1 mg/mL in NS,

D5W166

Devices with spikes e.g., chemo

dispensing pins, should not be used

with paclitaxel vials165

48 h F, RT166





Reconstitute With:



Paclitaxel, nab 100 mg paclitaxel and approximately 900 mg

human albumin (Abraxis Oncology)


inject 20 mL NS over > 1 min (a

chemo pin may be used)168

- direct flow to INSIDE vial wall

- stand solution for > 5 min

- gently swirl and/or invert vial

slowly for > 2 min167

5 mg/mL167

8 h F, PFL167

in empty

sterile PVC or non-PVC infusion

bag167,168

8 h RT167

- cytotoxic167 - do NOT filter167 - non-PVC tubing is NOT needed - the use of an in-line filter is not recommended168

Pamidronate 30 mg/10 mL 60 mg/10 mL 90 mg/10 mL

(Hospira) (RT)

no preservative169

N/A

3 mg/mL 6 mg/mL

9 mg/mL169

discard unused

portion169

0.06–0.36 mg/mL NS,

D5W169

do NOT mix with calcium containing

solution (e.g., Ringer’s)169

e.g., 250 mL NS170

24 h F followed by 24 h

RT (total 48 h)169

**(PFL)169

- noncytotoxic171


Pamidronate 30 mg/10 mL 60mg/10 mL 90 mg/10 mL

(Sandoz Canada) RT

no preservative172

N/A172

3 mg/mL 6 mg/mL

9 mg/mL172

discard unused

portion172,74

NS or D5W172

do NOT mix with

calcium containing solution (e.g., Ringer’s)172

24 h RT172

- noncytotoxic171





Reconstitute With:



Panitumumab 100 mg/5 mL

200 mg/10 mL 400 mg/20 mL

(Amgen) (F)(PFL)


N/A

20 mg/mL173

discard unused

portion173

≤1000 mg: 100 mL

NS173

>1000mg: 150 mL NS173

1-10mg/mL173,174

24 h F, 6 h RT173,174

- cytotoxic3 - administer with 0.2 or 0.22 micron low protein binding in-line filter173 - solution may contain particulates which do not affect product quality173 - do not administer if discoloured173

Pemetrexed 100 mg 500 mg (Eli Lilly)


100 mg: 4.2 mL

preservative-free NS

500 mg: 20 mL preservative-free

NS175

25 mg/mL175

24 h F, RT175

100 mL

preservative-free NS175

do NOT mix with calcium containing

solution (e.g., Ringer’s)176

24 h F, RT175

- cytotoxic7

Porfimer 15 mg 75 mg

(Axcan) (RT)(PFL)

no preservative177

6.6 mL D5W

31.8 mL D5W177


2.5 mg/mL177

24 h F

(PFL)177

syringe177


reconstitution13,178

**(PFL)177

- noncytotoxic7 - avoid contact with skin and eyes; protect exposed area from light177


Raltitrexed 2 mg

(AstraZeneca) (F, RT)(PFL)

no preservative179

4 mL SWI179

0.5 mg/mL179

24 h F, RT179

50–250 mL NS,

D5W179

24 h F, RT179

- cytotoxic7

Raltitrexed 2 mg

(Hospira) (F, RT)(PFL)

no preservative180

4 mL SWI180

0.5 mg/mL180

24 h F, RT180

50–250 mL NS,

D5W180

24 h F, RT180

- cytotoxic3





Reconstitute With:



Rituximab 100 mg/10 mL 500 mg/50 mL

(Roche) (F)(PFL)

no preservative181

N/A

10 mg/mL181

discard unused

portion181

1–4 mg/mL in NS,

D5W) 181

(e.g., 500 mg/250 mL, 1000 mg/500 mL)*

24 h F + additional 12

h RT181

- noncytotoxic3

syringe182

48 h F, 24 h RT182

Streptozocin 1g

(Pfizer) (F)(PFL)

no preservative182

9.5mL NS, SWI,

D5W182

100 mg/mL182

48 h F,182 24 h RT

50-500 mL*NS, D5W,

SWI182

48 h F, 24 h RT182

- cytotoxic7





Reconstitute With:



Temozolomide 100 mg

(Schering) (F)

do not dilute183 do not shake183

no preservative183

41 mL SWI183

2.5 mg/mL183

14 h F, RT183

empty 250 mL PVC

bag183

14 h RT183

- cytotoxic{3

Temsirolimus 30 mg/1.2 mL

(Wyeth) (F)(PFL)184,185

no preservative186

1.8 mL supplied

diluent184,185

10 mg/mL184,185

24 h RT184,185

(PFL)184

250 mL NS184,185

Complete

administration within 6 h184,185

- cytotoxic3 - use non-PVC bag and non-PVC tubing with in-line filter184,185

Teniposide 15 mg/1.5 mL

(Bristol) (RT)

preservative18

N/A

10 mg/mL18

discard unused

portion18

0.1, 0.2, 0.4, or 1 mg/mL in NS or

D5W18

0.1, 0.2, 0.4mg/mL: 24

h RT18

1 mg/mL: complete administration within 4h of preparation18

- cytotoxic7 - do NOT refrigerate18 - use non-PVC bag and tubing18





Reconstitute With:



Thiotepa 15 mg

(Bedford) (F)(PFL)

no preservative187

1.5 mL SWI187

filter through 0.22

micron filter187 record time of reconstitution

10 mg/mL187

8 h F187

50 mL* NS187


reconstitution188,187 **(PFL)187,189

- cytotoxic7 - do not use if precipitates or remains opaque187 - do not use for IT injection

syringe: reconstituted solution is hypotonic and must be further diluted with NS prior

to use187 (final concentration of 0.5-1

mg/ml is nearly isotonic)190

use within 4 h of initial reconstitution188,187 **(PFL)187,189





Reconstitute With:



Thiotepa IT injection:

15 mg (Bedford) (F)(PFL)

no preservative187

diluents containing

preservatives should NOT be used for

intrathecal administration

1.5 mL SWI187

filter through 0.22

micron filter187 record time of reconstitution

10 mg/mL187

8 h F187

qs to 6 mL with



reconstitution188,187 **(PFL)187,189

- auxiliary label61 “IT” - label to include route in full (i.e., INTRATHECAL injection) attached to both syringe and outer ziplock bag61 - cytotoxic7 - do not use if precipitates or remains opaque187

Thyrotropin alfa 1.1 mg

(Genzyme) (F)(PFL)

no preservative192

1.2 mL SWI192

swirl contents192; do

not shake

0.9 mg/mL192

24 h F192

syringe192

24 h F192

- noncytotoxic





Reconstitute With:



Tocilizumab 80 mg/4 mL

200mg/10 mL 400 mg/20 mL (Genentech)


N/A

20 mg/mL193

6 h193, 21

100 mL NS

dilute to 100 mL final volume by withdrawing volume of NS from 100 mL bag equal to volume of drug required for dose prior to adding drug193

24h F193; 6 h RT194

- cytotoxic3 - to prevent foaming: slowly add drug to infusion bag and gently invert bag to mix193





Reconstitute With:



Topotecan 4 mg

(GSK) (RT)(PFL)

no preservative195,196

4 mL SWI195

1 mg/mL195

24 h F, RT195

0.01–0.5 mg/mL197

50 mL NS, D5W195

24 h F, RT195

- cytotoxic7

Topotecan 4 mg

(GSK) (RT)(PFL) single use

no preservative198

4 mL SWI198

1 mg/mL198

24 h F, RT198

0.020 – 0.5 mg/mL198

24 h F, RT198

cytotoxic3

Trastuzumab 440 mg (Roche)

(F) preservative199

20 mL supplied BWI

swirl vial gently; allow to stand

undisturbed for 5 min199

21 mg/mL199

14 d F13,199

250mL NS199

do NOT use dextrose containing solutions199

24 h F, RT199

- noncytotoxic3 - do NOT shake199





Reconstitute With:



Treosulfan 1 g 5 g

(medac) (RT)

no preservative200

pre-heat SWI to 30°C (not higher) shake vial carefully before adding the warmed SWI 1 g vial: 20 mL SWI, while slightly shaking vial and syringe; continue shaking the reconstituted solution for another 2 min{{10494}} 5 g vial: 100 mL SWI, while slightly shaking vial and syringe; continue shaking the reconstituted solution for another 2 min200

50 mg/mL200

48 h RT13,200

undiluted201

dilute with NS or D5W in empty infusion bag for final concentration

= 20 mg/mL200

48 h RT13,200

- cytotoxic3 - compatible with polytetrafluoroethylene filters200 - may require vigorous shaking to reconstitute200





Reconstitute With:



Vinblastine 10 mg/10 mL

(Hospira) (F)(PFL)

no preservative154

N/A

1 mg/mL154

discard unused

portion154

syringe11,154

4 h F, RT202,203

- cytotoxic7 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205

100–250 mL NS, D5W206

24 h F, RT202,203





Reconstitute With:



Vincristine 2 mg/2 mL 5 mg/5 mL (Hospira) (F)(PFL)

no preservative207

N/A

1 mg/mL207

8 h F, RT207

50 mL*NS, D5W207

24 h F, 6 h RT,207

**(PFL)207


Vincristine 1 mg/1 mL 2 mg/2 mL 5 mg/5 mL

(Novopharm) (F)(PFL)

preservative208

N/A

1 mg/mL208

14 d F, RT208

50 mL*NS, D5W208

72 h F, 24 h RT65

**(PFL)208






Reconstitute With:



Vinorelbine 10 mg/1 mL 50 mg/5 mL

(GSK) (F)(PFL)

no preservative209

N/A

10 mg/mL209

discard unused

portion209

syringe: 1.5 – 3.0 mg/mL in NS or

D5W209

24 h F, RT209


0.5 – 2.0 mg/mL209

50 mL*NS, D5W, ½NS, D5½NS,

Ringer’s, Ringer’s Lactate209

24 h F, RT209

Vinorelbine 10 mg/1 mL 50 mg/5 mL

(Hospira) (F)(PFL)

no preservative210

N/A

10 mg/mL210

discard unused

portion210

syringe: 1.5 – 3.0 mg/mL in NS or

D5W210

24 h F, RT210






Reconstitute With:



0.5 – 2.0 mg/mL210

50 mL* NS, D5W,

½NS, D5½NS, Ringer’s, Ringer’s

Lactate210

24 h F, RT210

Vinorelbine 10 mg/1 mL 50 mg/5mL

(Pierre Fabre Pharma Canada) (F)(PFL)

no preservative211

N/A211

10 mg/mL211

discard unused

portion211

syringe: 1.5-3.0

mg/mL in D5W or NS211

24 h F, RT211


0.5-2.0 mg/mL211

NS, D5W, ½NS,

D5½NS, Ringer’s, Ringer’s Lactate211

24 h F, RT211



* Suggested volume based on usual dose range and any concentration range of stability data ** Protect from light means minimizing exposure to direct sunlight over a storage period. More specific information on protection from light (eg, protecting container and tubing during administration) will be indicated in the Under the Special Precautions/Notes column. Centres are not to change the content locally but should forward suggestions to the Cancer Drug Manual staff. Explanatory Notes Stability data assume products prepared using standard aseptic technique in biological safety cabinet at low risk for contamination according to the classification outlined in USP 797.21,212 Vial stability: Stability of solution after first puncture or reconstituted solution Storage temperature: If information states same stability with refrigerator and room temperature storage, then bold refrigerated as preferred (ie, to minimize growth of micro-organisms). Cytotoxic: hazardous (see Policy II-20 for more details). Discard unused portion: Unused portion from single use vials should be discarded at the end of the day. State “overfill known” if the manufacturer states overfill within acceptable limits is present. PFL = protect from light RT = room temperature F = refrigerated SWI = sterile water for injection NS = normal saline D5W = dextrose 5% BWI = bacteriostatic water for injection


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CHEMOTHERAPY PREPARATION AND STABILITY CHART