Doxorubicin Antidotes

• Dexrazoxane. Dexrazoxane is an iron chelator that prevents anthracycline-iron complexes and free radical formation causing oxidative damage.
• Dimethyl sulfoxide (DMSO)
• Hyaluronidase.
• DMSO.
• As L-asparaginase is a non-irritant, it is fairly benign.

What should be applied to an anthracycline extravasation?

Preclinical and clinical studies are leading to the clinical implementation of dexrazoxane as the first and only proven antidote in anthracycline extravasation. In two multicenter studies dexrazoxane has proven to be highly effective in preventing skin necrosis and ulceration.

How do you manage extravasation?

At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig.

How do you give a dog doxorubicin?

Doxorubicin must always be administered through a clean, “one stick” intravenous catheter. The vein being used should be intact and should not have been used within the 24 to 48 hours before doxorubicin administration.

How do you manage both infiltration and extravasation?

How is it treated?

1. Elevate the site as much as possible to help reduce swelling.
2. Apply a warm or cold compress (depending on the fluid) for 30 minutes every 2-3 hours to help reduce swelling and discomfort.
3. Medication-If recommended, medicine for extravasations is given within 24 hours for best effect.

How many hours after an epirubicin extravasation is the antidote initiated?

Extravasation Management. Apply ice for 6-12 hours following sodium thiosulfate antidote injection (Merck and Co., Inc., 2005). Preparation Prepare 1/6 molar solution. If 10% sodium thiosulfate solution: Mix 4 ml with 6 ml sterile water for injection.

How do you treat vincristine extravasation?

Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs.

Does doxorubicin cause extravasation injury?

Doxorubicin is one of the most widely used drugs and hence has the highest potential and risk for extravasation, and, therefore, dexrazoxane should be made available at all centers that administer anthracyclines chemotherapy.

What may indicate an extravasation injury?

Extravasation of intravenous fluids is marked initially by pain and swelling, which then progresses to blanching, blistering, and discolouration of the skin. Pain is the most useful symptom to alert the administrator to the possibility of a complication.

Is doxorubicin safe for dogs?

Despite these potential side effects, doxorubicin is still considered relatively safe and well tolerated by most pets.

What is doxorubicin toxicity?

While an effective anti-tumor agent, doxorubicin causes cumulative and dose-dependent cardiotoxicity, ranging from occult changes in myocardial structure and function to severe cardiomyopathy and congestive heart failure that may result in cardiac transplantation or death1,2,3,4,5,6.

How do you treat extravasation of contrast?

How Is Contrast Extravasation Treated? If contrast extravasation happens, we will have you raise your arm above the level of your heart and apply a cold compress to the IV site. An ice pack also helps to limit any pain you may have—both while you are at the medical center and over the next few days.

Can dexrazoxane be given to dogs with doxorubicin?

In veterinary medicine, Venable et al. described four case reports in dogs with doxorubicin extravasation; three dogs received varying doses of dexrazoxane within 2 hr of extravasation and 1 after 48 hr.

How long does it take for doxorubicin to work on dogs?

In a small study of 4 dogs with doxorubicin extravasation, 3 patients showed resolution of lesions with medical management alone after the extravasation was treated with dexrazoxane within 2 hours. 20 Repeated doses at 24 and 48 hours after the event may also improve outcome.

Can you give doxorubicin to a cat with renal failure?

Doxorubicin should be used with caution in feline patients with known renal dysfunction. 16 Doses can be reduced in these patients, but judicious monitoring of renal values and urine concentration is recommended, ideally before administration of each dose. Doxorubicin tissue extravasation has the potential to be catastrophic.

What are the treatment options for doxorubicin extravasation?

Administration of NSAIDs and pain medications should be considered. Application of a cold compress to the area for periods of 15 minutes multiple times during the first 24 hours may also help mitigate the effects of doxorubicin extravasation. The benefits of applying topical dimethyl sulfoxide (DMSO) to the area of extravasation are unclear.