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Dexrazoxane intravenous infusion for Adults

Who can administer

May be administered by registered competent doctor or chemotherapy nurse

Important information

  • 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.

Available preparations

Savene 500mg vial, with 500ml diluent

Reconstitution

  • 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

Infusion fluids

  • Not required - the diluent bottle is used

Methods of intravenous administration

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

Dose in adults

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

  • Doses >1000 mg/m2 can give increases in transaminases and bilirubin
  • Monitor liver function in patients with known liver function disorders

Monitoring

Monitor FBCs

Further information

Savene diluent contains:  

  • Potassium (98 mg/500 ml or 5mmol/L)
  • Sodium (1.61 g/500 ml or 140mmol/L)

Storage

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

References

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

Therapeutic classification

Detoxifying agent for antineoplastic agents