Specific antidotes in the management of peripheral extravasation Specific antidote Drug/class of Warm/Cold drug compression Vinca Alkaloids Warm compression- Hyaluronidase 1500 IU Vincristine apply for 24 hours Draw up 1500IU hyaluronidase in 1 to 2ml water for injection or 0.9% sodium Vindesine Vinblastine chloride. Inject 0.1 to 0.2ml Vinorelbine subcutaneously at points of the compass around the circumference of the area of extravasation. Gently massage area to facilitate dispersal. Mustine Apply cold pack 3% Sodium Thiosulphate Dilute the – intermittently for solution provided before use dilute – 30minutes in every 1.2ml of 50% sodium thiosulphate to 2 hours for 24 20ml with water for injections. hours. Place a piece Infiltrate the site with 1 to 3ml of diluted of dry gauze solution using multiple “pin cushion” between skin and injections around the circumference of cold pack the area. Apply topical hydrocortisone 1% cream four times a day for the next 7 days or for as long as erythema persists Anthracyclines Apply cold pack Topical DMSO 50% Daunorubicn intermittently for Apply Topical DMSO 50% using a Doxorubicin 30minutes in every cotton bud every 2 hours at the extravasation site for 24 hours. Avoid Epirubicin 2 hours for 24 Idarubicn hours. Place a piece contact with good skin. For the next 7 of dry gauze days apply DMSO50% every 6 hours Mitoxantrone between skin and alternating with topical hydrocortisone Mitomycin C cold pack 1% cream every 3 hours. Do not use an occlusive cover. If blistering occurs, stop DMSO and seek further advice. Any other Automatic cold or No specific antidote needed cytotoxic drug warm compression is If signs of erythema persist then topical (See appendix 1 not required. 1% hydrocortisone cream may be for list.) However if symptoms used. Apply sparingly to the affected warrant then use area 4 times a day while symptoms intermittent cold persist. compression except in the case of oxaliplatin, cisplatin, or carboplatin when warm compression may be used.
Specific antidotes in the management of peripheral extravasation Drug/class of drug Warm/Cold compression Specific antidote Vinca Alkaloids Vincristine Vindesine Vinblastine Vinorelbine Warm compression- apply for 24 hours Hyaluronidase 1500 IU Draw up 1500IU hyaluronidase in 1 to 2ml water for injection or 0.9% sodium chloride. Inject 0.1 to 0.2ml subcutaneously at points of the compass around the circumference of the area of extravasation. Gently massage area to facilitate dispersal. Mustine Apply cold pack intermittently for 30minutes in every 2 hours for 24 hours. Place a piece of dry gauze between skin and cold pack 3% Sodium Thiosulphate – Dilute the solution provided before use – dilute 1.2ml of 50% sodium thiosulphate to 20ml with water for injections. Infiltrate the site with 1 to 3ml of diluted solution using multiple “pin cushion” injections around the circumference of the area. Apply topical hydrocortisone 1% cream four times a day for the next 7 days or for as long as erythema persists Anthracyclines Daunorubicn Doxorubicin Epirubicin Idarubicn Mitoxantrone Mitomycin C Apply cold pack intermittently for 30minutes in every 2 hours for 24 hours. Place a piece of dry gauze between skin and cold pack Topical DMSO 50% Apply Topical DMSO 50% using a cotton bud every 2 hours at the extravasation site for 24 hours. Avoid contact with good skin. For the next 7 days apply DMSO50% every 6 hours alternating with topical hydrocortisone 1% cream every 3 hours. Do not use an occlusive cover. If blistering occurs, stop DMSO and seek further advice. Any other cytotoxic drug (See appendix 1 for list.) Automatic cold or warm compression is not required. However if symptoms warrant then use intermittent cold compression except in the case of oxaliplatin, cisplatin, or carboplatin when warm compression may be used. No specific antidote needed If signs of erythema persist then topical 1% hydrocortisone cream may be used. Apply sparingly to the affected area 4 times a day while symptoms persist.