Dexrazoxane intravenous infusion for Adults

Who can administer

May be administered by registered competent doctor or chemotherapy nurse

One treatment pack is kept in UHG, stored in the Inpatient Oncology ward in the treatment room
Cooling procedures such as ice packs should have been removed from the area at least 15 minutes before the administration of dexrazoxane in order to allow sufficient blood flow
Phenytoin: cytotoxic agents may reduce the absorption of phenytoin leading to an exacerbation of convulsions. Dexrazoxane is not recommended in combination with phenytoin
Reconstitution of Savene must take place using safe handling techniques, either in the Pharmacy Aseptic Services Unit or by using a Closed System Transfer Device (CSTD)(e.g. Equashield or Phaseal). This is to prevent exposure of health-care staff to the drug.
Equashield instructions
Phaseal: https://www.youtube.com/watch?v=whKZWkCPbc8
If a decision is made to use Dexrazoxane, the senior oncology pharmacist (in normal working hours) or the Chief pharmacist (if out of hours) must be contacted to discuss the best course of action for preparation of the dose.

Savene 500mg vial, with 500ml diluent

Using a Closed System Transfer Device (CSTD)- (see Important information), add 25 ml diluent provided to give a concentration of 20 mg dexrazoxane per ml - keep and store the opened diluent bottle under aseptic conditions because it is needed for the dilution of the concentrate
Mix manually by repeated inversions until the powder is dissolved - do not shake
Allow the concentrate to stand at room temperature for 5 minutes - check if the solution is homogeneous and clear. Concentrate is slightly yellow
Repeat these steps for each bottle of Savene required (using a single diluent bottle to reconstitute all the vials required)
Aseptically withdraw the corresponding dose volume from the appropriate number of vials
Inject the required volume back into the opened Savene diluent bottle
Gently rotate the bottle to ensure equal dispersion of the drug throughout the solution
Once the drug has been added to the diluents bottle label the bottle with the patient details

Intravenous infusion

Administer over 60 to 120 minutes into a large vein of an extremity or area other than the one affected by the extravasation
Cooling procedures such as ice packs should have been removed from the area at least 15 minutes before the administration of dexrazoxane in order to allow sufficient blood flow

Treatment should be given once daily for 3 consecutive days. The recommended dose is:

Day 1: 1000 mg/m2 (up to a maximum of 2000mg)
Day 2: 1000 mg/m2 (up to a maximum of 2000mg)
Day 3: 500 mg/m2
The first infusion should be initiated as soon as possible, within the first six hours after the accident
Treatment Day 2 and Day 3 should start at the same hour (+/- 3 hours) as Day 1
Check a recent chemotherapy prescription sheet to find out the patients body surface area

Renal Impairment

Since renal dysfunction may decrease the rate of elimination of dexrazoxane, patients with initial impaired renal function should be monitored for signs of haematological toxicity
If moderate to severe renal impairment, (CrCl<40ml/min) a dose reduction of 50% is required

Hepatic Impairment

Monitor FBCs

Savene diluent contains:

Store below 25 °C

Note: Due to cost, only one treatment pack is kept in UHG, stored in the Inpatient Oncology ward in the treatment room

SPC Savene. Accessed 11/1/2019

1. Clinigen Speciality Pharmaceuticals. Preparing Savene in aseptic facilities. Nov 2018

2: Injectable medicines guide Medusa, downloaded 4th Feb 2019

Detoxifying agent for antineoplastic agents