CHEMOTHERAPY PREPARATION AND STABILITY CHART

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Slide 1: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Aldesleukin 22 million IU (1.3 mg) (Novartis) (F)(PFL) no preservative1 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 - cytotoxic7 - do not shake8 Alemtuzumab 30 mg/mL (Genzyme previously Bayer)4 (F)(PFL) do not shake no preservative5 N/A filter NOT required 30 mg/mL5 5 discard unused portion5 SC syringe 6 discard at the end of the day F or RT 100 mL NS or D5W5 8 h F or RT5 (PFL)8 Alemtuzumab 30 mg/3 mL (Schering/Ilex) (F)(PFL) do not shake no preservative9 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 - cytotoxic7 - do not shake8 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 1/77 Slide 2: 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 100 mL NS or D5W9 8 h F or RT8 (PFL)8 Amifostine 500 mg (MedImmune) (RT) no preservative10 Amsacrine 75 mg/1.5 mL (Erfa Canada) (RT) no preservative12 9.7 mL NS only10 50 mg/mL10 24 h F, 5 h RT10 25–50 mLNS only10 5–40 mg/mL: 24 h F,10 5 h RT - noncytotoxic10 - discard cloudy solution11 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 2/77 Slide 3: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Asparaginase16 (asparaginase E. coli) 10,000 units (Orphan Pharmaceutical International) (F) no preservative17 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 mLNS or D5W20,13 14 d F,20,13 2 d RT20,21 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 3/77 Slide 4: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Erwinia asparaginase (asparaginase Erwinia chrysanthemi) 10,000 units (Orphan Pharmaceuticals International) (F) no preservative22 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes do not shake; roll to 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 4/77 Slide 5: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) PEG-asparaginase (pegasparagase) (pegylated asparaginase E. coli) 750 units/mL (Enzon) (F) no preservative23 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 5/77 Slide 6: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Azacitidine 100 mg (Celgene) (RT) no preservative25 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 - cytotoxic7 BCG 81 mg (Sanofi Pasteur) (F)(PFL) preservative26 do not shake; roll to 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 6/77 Slide 7: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) BCG (Tice substrain) 50 mg = 1 to 8 x 108 CFU (Hospira/Organon) (F)(PFL) no preservative27 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 7/77 Slide 8*: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Bendamustine 25 mg single-use vial 100 mg single-use vial (Cephalon) (RT)(PFL) no preservative28 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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) do not shake no preservative29 Bleomycin 15 IU (NB: dose in units only) (Bristol) (F) no preservative31 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 - cytotoxic7 - do not shake29 6 mLNS31 2.5 IU/mL 48 h F31 50 mLNS31 24 h RT31 - cytotoxic7 - no overfill32 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 8/77 Slide 9: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Bleomycin 15 IU (NB: dose in units only) (Hospira) (F)(PFL) no preservative33 Bortezomib 3.5 mg (Ortho Biotech formally Millennium) (RT)(PFL) no preservative36 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 6 mLNS or SWI33 2.5 IU/mL33 48 h F, 24 h RT33 50 mL NS, SWI33 24 h RT34 - cytotoxic7 - no overfill35 3.5 mL NS36 1 mg/mL36 2d RT13,37 syringe36 8 h RT38 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 9/77 Slide 10: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Busulfan 60 mg/10 mL (Orphan Medical) (F) no preservative39 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 aluminumcontaining 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 aluminum-containing needle or syringe43 8 h RT43 - cytotoxic7 - do NOT use aluminumcontaining needle, syringe or tubing43 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 10/77 Slide 11: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Carmustine 100 mg (Bristol Labs) (F) no preservative46 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 3 mL diluent (supplied)46 diluent to reach RT, then dissolve drug with 3 mL diluent; add 27 mL SWI46 record time of reconstitution 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 12 h F, 8 h RT47 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 - 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 11/77 Slide 12: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Cisplatin 10 mg/10 mL 50 mg/50 mL 100 mg/100mL (Hospira) (RT)(PFL) no preservative48 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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; D5NS with mannitol; D51/2S with mannitol48,50; D5W1/3S with mannitol48 do NOT use aluminum-containing needle or syringe48 48 h RT49 - cytotoxic7 - do NOT use aluminumcontaining needle, syringe or tubing48 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 12/77 Slide 13: 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 qs to 100 mL with bacteriostatic NS only via SIMS DELTEC INC. MEDICATION CASSETTES®51; filter at least 7 days51 drug and diluent through 0.22u filter as each solution is being introduced into the medication 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 13/77 Slide 14: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Cyclophosphamide 200 mg 500 mg 1000 mg 2000 mg (Baxter) (RT)(PFL) no preservative56 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 14/77 Slide 15: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Cytarabine 100 mg/1 mL 1000 mg/10mL 2000 mg/20mL (Hospira) (RT)(PFL) no preservative60 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A record time of puncture 100 mg/mL60 24 h RT60 100 mLNS, 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 15/77 Slide 16: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Cytarabine SC injection: 100 mg (Pfizer) (RT)(PFL) no preservative63 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 - cytotoxic7 - protect container from light during storage and administration67 - overfill unknown - cytotoxic7 - protect container from light during storage and administration67 - no overfill69,35 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 mLNS or D5W 24 h F, 8 h RT66 (PFL)11,66 see Special Precautions/Notes Column 24 h F68 (PFL)67 see Special Precautions/Notes Column 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 mLNS or D5W BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 16/77 Slide 17: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Dactinomycin 0.5 mg (Ovation)70 (RT)(PFL) no preservative71 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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, RT 74 - cytotoxic3 - do not filter71,73 . BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Daunorubicin 20 mg (Erfa Canada Inc.)75 (RT)(PFL)76 no preservative77 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 17/77 Slide 18: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Daunorubicin 20 mg (Novopharm) (RT)(PFL) no preservative79 Dexrazoxane 250 mg 500 mg (Pfizer) (RT) no preservative80 Docetaxel 20 mg/0.5 mL 80 mg/2 mL (Sanofi-Aventis) (F, RT) (PFL) no preservative83 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 6 h RT81 - cytotoxic7 supplied diluent80: 250 mg: 25 mL 500 mg: 50 mL 10 mg/mL80 6 h F80 empty viaflex bag80 - cytotoxic82 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 18/77 Slide 19: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Doxorubicin 10 mg 50 mg 150 mg (Hospira) (RT)(PFL) no preservative88 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 mLNS88 48 h F, 24 h RT13,90 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 19/77 Slide 20: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Doxorubicin 10 mg/5 mL 20 mg/10 mL 50 mg/25 mL 200 mg/100 mL (Novopharm) (F)(PFL) no preservative91 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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) (F) no preservative92 Doxorubicin Pegylated Liposomal 20 mg/10 mL 50 mg/25 mL (Schering) (F) no preservative93 N/A 2 mg/mL92 discard unused portion92,74 syringe92 48 h F, 24 h RT92 - cytotoxic3 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 20/77 Slide 21: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Epirubicin 10 mg/5 mL 50 mg/25 mL 200 mg/100 mL (Pfizer) (F)(PFL) no preservative94 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A record time of puncture 2 mg/mL94 8 h94 syringe94 48 h F, 24 h RT from initial vial puncture94 - cytotoxic7 100 mLNS or D5W11 2 d F, RT: NS or D5W49 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 21/77 Slide 22: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Etoposide 100 mg/5 mL 500 mg/25 mL 1000 mg/50 mL (BMS) (RT) preservative95 Etoposide 100 mg/5 mL 200 mg/10 mL 500 mg/25 mL 1000 mg/50 mL (Novopharm) (RT)(PFL) no preservative99 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A 20 mg/mL95 14 d RT11,13,96,97,98 0.2– 0.4 mg/mL95 500 mLNS 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 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 4 h RT99,101 - cytotoxic7 - use non-PVC bag and tubing only D5W99 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 22/77 Slide 23: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Fludarabine 50 mg (Berlex) (F) no preservative102 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 2 mL SWI102 25 mg/mL102 48 h F or RT13,49 dilute to maximum of 1 mg/mL102,103 100 mLNS 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 mLNS or D5W 48 h F, 24 h RT104 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 23/77 Slide 24: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Fluorouracil 5000 mg/100 mL (Hospira) (RT)(PFL) no preservative105 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 mLD5W 24 h RT105,106 CIVI: ambulatory pump106 complete within 8 d11,13,107 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 24/77 Slide 25: 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 Gemcitabine 200 mg 1000 m g (Eli-Lilly) (RT) no preservative108 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 25/77 Slide 26: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Gemcitabine 200 mg 1000 mg 2000 mg (Hospira) RT110 no preservative111 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 200 mg vial: 5 mL NS 1000 mg vial: 25 mL NS 2000 mg vial: 50 mL NS110 38 mg/mL110 48 RT110,112,74 syringe110 24 h RT110,112 - cytotoxic7 26 mg/mL-0.1 mg/mL NS110,112 Gemcitabine 200 mg 1000 mg (Novopharm) RT no preservative113 Gemcitabine 200 mg 1000 mg (Sandoz Standard) RT no preservative115 200 mg vial: 5mL NS 1000 mg vial: 25 mL NS114 38 mg/mL114 24 h RT114 38 mg/mL – 0.1 mg/mL NS114 48 h RT112,74 24 RT114 - cytotoxic7 200 mg vial: 5 mL NS 1000 mg vial: 25 mL NS115 38 mg/mL115 48 h RT115,116 syringe115 48 h RT115,117,116 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 26/77 Slide 27: 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 38 mg/mL-0.1 mg/mL NS or D5W115,118 48 h RT13,119 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 27/77 Slide 28: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Idarubicin 5 mg 10 mg (Pfizer) (RT)(PFL) no preservative120 Idarubicin 5 mg/5 mL 10 mg/10 mL 20 mg/20 mL (Pfizer) (F)(PFL) no preservative120 Ifosfamide 1000 m g 3000 mg (Baxter) (RT) 11 no preservative122 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes vial under negative pressure120 5 mg: 5 mL SWI 10 mg: 10 mL SWI120 N/A 1 mg/mL120 48 h F,120 24 h RT (PFL)120 syringe 48 h F,13, 120 24 h RT13 (PFL)120 - cytotoxic7 1 mg/mL120 same as reconstituted solution121 syringe Discard 48 h F,13,120 24 h RT13 (PFL)120 - cytotoxic7 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 mLNS, 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 2 d F13,124 - 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 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 28/77 Slide 29: 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 ≥ 0.3 million IU/mL123 50 mL NS123 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 24 h F, RT124 2 d F13,124 - cytotoxic7 ≥ 0.3 million IU/mL123 50 mL NS123 Interferon Alfa -2b 10 million IU (Schering) (F) no preservative123 1 mL supplied diluent (SWI) 123 do not shake; roll to reconstitute123 > 0.1 million IU/mL124 100 mL NS125 10 million IU/mL123 24 h F123 syringe123 24 h F, RT124 24 h F, RT124 - cytotoxic7 48 h RT11,13 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 29/77 Slide 30: 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 1 mL BWI123 do not shake; roll to reconstitute123 48 h F, RT13,123 syringe125 14 d F, 48 h RT13,125 100 mL NS125 Interferon Alfa -2b 18 million IU (Schering) (F) no preservative123 1 mL supplied diluent123 do not shake; roll to reconstitute123 > 0.1 million IU/mL126 100 mL NS125 1 mL BWI123 do not shake; roll to reconstitute123 100 mL NS125 48 h F, RT13 syringe123 18 million IU/mL123 24 h F123 syringe123 48 h RT11,13 24 h F, RT124 - cytotoxic7 48 h RT11,13 14 d F13,125 48 h RT11,13 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 30/77 Slide 31: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Irinotecan 40 mg/2 mL 100 mg/5 mL 500 mg/25 mL (Hospira) (RT)(PFL) no preservative127 Irinotecan 40 mg/2 mL 100 mg/5 mL (Pfizer) (RT)(PFL) no preservative130 Irinotecan 40 mg/2 mL 100 mg/5 mL (Sandoz) (RT)(PFL) no preservative131 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 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 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 31/77 Slide 32: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Ixabepilone 15 mg (contains 16 mg) 45 mg (contains 47 mg) (BMS) (F)(PFL) no preservative132 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 - noncytotoxic 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 0.05-10 mg/mL133 24 h RT133: NS, D5W, Lactated Ringer’s, Ringer’s 8 h RT133: D10W, D5NS 50-250 mL* NS, D5W, Lactated Ringer’s, Ringer’s, D10W, D5-NS BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 32/77 Slide 33: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Leucovorin 50 mg/5 mL 500 mg/50 mL (Novopharm) (F)(PFL)135 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 12 h RT D5W, D10W135 6 h RT D5NS135 50-250 mL* NS, D5W, Lactated Ringer’s, Ringer’s, D10W, D10NS135 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 33/77 Slide 34: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Mechlorethamine 10 mg (Ovation Pharmaceuticals/Merck) no preservative136 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes do NOT use if discoloured or water droplets form in vial before reconstitution136 10 mL SWI or NS136 record time of reconstitution 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 34/77 Slide 35: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Medroxyprogesterone 250 mg/5 mL (Pfizer) (RT) preservative18 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A record time of puncture 50 mg/mL18 use within 4 h of initial puncture11,137 syringe: IM only18 use within 4 h of initial vial puncture11,137 - cytotoxic7 - auxiliary label: shake before use18 Medroxyprogesterone Depo 150 mg/1mL (Pfizer) (RT) preservative18 Melphalan 50 mg (GSK) (RT)(PFL) no preservative138 N/A record time of puncture 10mL supplied diluent138 immediately after adding diluent, shake vigorously138 record time of reconstitution 150 mg/mL18 use within 4 h of initial puncture11,137 syringe: IM only18 use within 4 h of initial puncture11,137 - cytotoxic7 - auxiliary label: shake before use18 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 35/77 Slide 36: Mesna 1000 mg/10mL (PPC) (RT) preservative139 Methotrexate 50 mg/2mL 500 mg/20mL 1 g/40mL 5 g/200mL (Hospira) (RT)(PFL) no preservative140 N/A 100 mg/mL139 14 d F, RT13,139 > 1mg/mL139 NS or D5W 48 h F, 24 h RT139 - noncytotoxic 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 36/77 Slide 37: Methotrexate IT Injection140: Only preservative free methotrexate may be administered by the intrathecal route140 50 mg/2mL147 (Hospira) (RT)(PFL) no preservative140 Methotrexate 50 mg/2mL 500 mg/20mL (Hospira) (RT)(PFL) preservative140 N/A 25 mg/mL140 discard unused portion140 qs to 6 mL with preservative free NS61 use within 4 h of initial puncture11,13 - cytotoxic7 - auxiliary label62: “IT” - label to include route in full (i.e., INTRATHECAL injection) attached to both syringe and outer ziplock bag62 - 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 N/A 25 mg/mL140 24 h F141 syringe 14 d F87,141 0.4–2 mg/mL140 e.g., 100 mLNS, D5W140 Mitomycin 5 mg 20 mg (Novopharm) (RT)(PFL) no preservative148 SWI 5 mg: 10 mL 20 mg: 40 mL shake well148 0.5 mg/mL148 48 h F, RT13,148 (PFL)148 syringe13 4 h RT140 14 d F, 48 h RT13,148 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 37/77 Slide 38: 0.02-0.04 mg/mL148 NS, D5W, sodium lactate148 Mitomycin 5 mg 20 mg (BMS) (RT)(PFL) no preservative149 SWI 5 mg: 10 mL 20 mg: 40 mL shake well149 0.02–0.04 mg/mL NS, D5W, sodium lactate149 0.5 mg/mL149 48 h F, RT13,149 (PFL)149 syringe11 3 h RT: D5W 12 h RT: NS 24 h RT: sodium lactate148 14 d F, 48 h RT11,21 - cytotoxic7 12 h RT: NS 3h: D5W 24 h: sodium lactate149 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 38/77 Slide 39: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Mitoxantrone 20 mg/10 mL 25 mg/12.5 mL (Hospira) (RT)(PFL) no preservative150 Mitoxantrone 20 mg/10 mL (Novopharm) (RT)(PFL) no preservative151 Mitoxantrone 20 mg/10 mL (Pharmaceutical Partners of Canada) (RT) no preservative153 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A 2 mg/mL150 discard unused portion150 0.2-0.6 mg/mL150 NS, D5W150 > 50 mL150 NS: 24 h F, RT150 *(PFL)150 - cytotoxic7 N/A 2 mg/mL151 discard unused portion151 NS, D5W151 > 50 mL151 NS, D5W2 > 50 mL153 24 h RT151 (PFL)152 24 h RT153 - cytotoxic7 N/A 2 mg/mL153 discard unused portion153 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 39/77 Slide 40: Octreotide 50 mcg/mL; 100 mcg/mL; 500 mcg/mL (Novopharm) (F)(PFL) no preservative multidose vials (5mL): 200 µg/mL (F)(PFL) 154 preservative 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 24 h RT18 - noncytotoxic10 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 40/77 Slide 41: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Octreotide (Sandostatin) 50 mcg/1 mL 100 mcg/1 mL 500 mcg/1 mL (Novartis) (F)(PFL) no preservative18 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 record time of reconstitution 10 mg: 5 mg/mL 20 mg: 10 mg/mL 30 mg: 15 mg/mL18 discard unused portion18 deep intragluteal administration only18 use within 4 h of initial reconstitution18,13 - noncytotoxic10 - do NOT shake BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 41/77 Slide 42: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Oxaliplatin 50 mg/10 mL 100 mg/20 mL 200 mg/40 mL (Sanofi-Aventis) (RT)(PFL) no preservative157 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 chloridecontaining 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 - cytotoxic7 - do NOT use aluminumcontaining needle, syringe or tubing157 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 42/77 Slide 43: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Oxaliplatin 50 mg 100 mg (Sigmacon) (RT) no preservative160 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes SWI, D5W: 50 mg: 10 mL 100 mg: 20 mL do NOT use NS or other chloridecontaining solution160 do NOT use aluminumcontaining needle and syringe160 5 mg/mL160 24 h F160 500 mL D5W do NOT use NS or other chloridecontaining solutions (degrades)160 do NOT use aluminum-containing needle and syringe160 24 h F, 6 h RT160 - cytotoxic7 - do NOT use aluminumcontaining needle, syringe or tubing160 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 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 - cytotoxic7 - use non-PVC bag and tubing with inline filter162 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 43/77 Slide 44: 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 44/77 Slide 45: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Paclitaxel, nab 100 mg paclitaxel and approximately 900 mg human albumin (Abraxis Oncology) (RT)(PFL) no preservative167 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 N/A 5 mg/mL167 8 h F, PFL167 in empty sterile PVC or nonPVC infusion bag167,168 8 h RT167 - cytotoxic167 - do NOT filter167 - non-PVC tubing is NOT needed - the use of an inline filter is not recommended168 Pamidronate 30 mg/10 mL 60 mg/10 mL 90 mg/10 mL (Hospira) (RT) no preservative169 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 45/77 Slide 46: 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 46/77 Slide 47: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Panitumumab 100 mg/5 mL 200 mg/10 mL 400 mg/20 mL (Amgen) (F)(PFL) do not shake no preservative173 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 - cytotoxic7 Pemetrexed 100 mg 500 mg (Eli Lilly) (RT) no preservative175 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 syringe177 24 h F, RT175 Porfimer 15 mg 75 mg (Axcan) (RT)(PFL) no preservative177 6.6 mL D5W 31.8 mL D5W177 record time of reconstitution 2.5 mg/mL177 24 h F (PFL)177 use within 4 h of initial reconstitution13,178 (PFL)177 - noncytotoxic7 - avoid contact with skin and eyes; protect exposed area from light177 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 47/77 Slide 48: Raltitrexed 2 mg (AstraZeneca) (F, RT)(PFL) no preservative179 Raltitrexed 2 mg (Hospira) (F, RT)(PFL) no preservative180 4 mL SWI179 0.5 mg/mL179 24 h F, RT179 50–250 mL NS, D5W179 24 h F, RT179 - cytotoxic7 4 mL SWI180 0.5 mg/mL180 24 h F, RT180 50–250 mL NS, D5W180 24 h F, RT180 - cytotoxic3 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 48/77 Slide 49: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Rituximab 100 mg/10 mL 500 mg/50 mL (Roche) (F)(PFL) no preservative181 Streptozocin 1g (Pfizer) (F)(PFL) no preservative182 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 9.5mL NS, SWI, D5W182 100 mg/mL182 48 h F,182 24 h RT syringe182 50-500 mLNS, D5W, SWI182 48 h F, 24 h RT182 48 h F, 24 h RT182 - cytotoxic7 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 49/77 Slide 50: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Temozolomide 100 mg (Schering) (F) do not dilute183 do not shake183 no preservative183 Temsirolimus 30 mg/1.2 mL (Wyeth) (F)(PFL)184,185 no preservative186 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 41 mL SWI183 2.5 mg/mL183 14 h F, RT183 empty 250 mL PVC bag183 14 h RT183 - cytotoxic{3 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 - cytotoxic7 - do NOT refrigerate18 - use non-PVC bag and tubing18 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 50/77 Slide 51: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Thiotepa 15 mg (Bedford) (F)(PFL) no preservative187 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 1.5 mL SWI187 filter through 0.22 micron filter187 record time of reconstitution 10 mg/mL187 8 h F187 50 mL NS187 use within 4 h of initial 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 51/77 Slide 52: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Thiotepa IT injection: 15 mg (Bedford) (F)(PFL) no preservative187 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 preservative free NS191 use within 4 h of initial 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 52/77 Slide 53: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Tocilizumab 80 mg/4 mL 200mg/10 mL 400 mg/20 mL (Genentech) (F)(PFL) no preservative193 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 53/77 Slide 54: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Topotecan 4 mg (GSK) (RT)(PFL) no preservative195,196 Topotecan 4 mg (GSK) (RT)(PFL) single use no preservative198 Trastuzumab 440 mg (Roche) (F) preservative199 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 4 mL SWI198 1 mg/mL198 24 h F, RT198 0.020 – 0.5 mg/mL198 24 h F, RT198 cytotoxic3 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 54/77 Slide 55: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Treosulfan 1g 5g (medac) (RT) no preservative200 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 polytetrafluoroethyl ene filters200 - may require vigorous shaking to reconstitute200 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 55/77 Slide 56: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Vinblastine 10 mg/10 mL (Hospira) (F)(PFL) no preservative154 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 56/77 Slide 57*: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Vincristine 2 mg/2 mL 5 mg/5 mL (Hospira) (F)(PFL) no preservative207 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A 1 mg/mL207 8 h F, RT207 50 mLNS, D5W207 24 h F, 6 h RT,207 *(PFL)207 - cytotoxic7 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205 - cytotoxic7 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205 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 mLNS, D5W208 72 h F, 24 h RT65 (PFL)208 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 57/77 Slide 58*: BC CANCER AGENCY CHEMOTHERAPY PREPARATION AND STABILITY CHART DRUG & STRENGTH (Storage Prior to Use, Manufacturer, Preservative Status) Vinorelbine 10 mg/1 mL 50 mg/5 mL (GSK) (F)(PFL) no preservative209 Reconstitute With: To Give: Vial Stability Product Product Stability Special Precautions/Notes N/A 10 mg/mL209 discard unused portion209 syringe: 1.5 – 3.0 mg/mL in NS or D5W209 24 h F, RT209 - cytotoxic7 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205 0.5 – 2.0 mg/mL209 50 mLNS, D5W, ½NS, D5½NS, Ringer’s, Ringer’s Lactate209 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, RT209 24 h F, RT210 - cytotoxic7 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 58/77 Slide 59: 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 0.5 – 2.0 mg/mL210 50 mL* NS, D5W, ½NS, D5½NS, Ringer’s, Ringer’s Lactate210 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, RT210 24 h F, RT211 - cytotoxic3 - label with: WARNING: FOR INTRAVENOUS USE ONLY – FATAL IF GIVEN BY OTHER ROUTES204,205 0.5-2.0 mg/mL211 NS, D5W, ½NS, D5½NS, Ringer’s, Ringer’s Lactate211 24 h F, RT211 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 59/77 Slide 60: BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 60/77 Slide 61: * 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 BC Cancer Agency Chemotherapy Preparation and Stability Chart© version 2.00 Activation Date: 2 March 2006 Revised Date: 1 July 2010 61/77 Slide 62: References 1. Novartis Pharmaceuticals Canada Inc. PROLEUKIN® product monograph. Dorval, Quebec; 6 July 2006. 2. McEvoy GK, editor. AHFS 2008 Drug Information. Bethesda, Maryland: American Society of Health-System Pharmacists, Inc. p. 917-925. 3. National Institute for Occupational Safety and Health (NIOSH). Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings. Cincinnati, Ohio: NIOSH - Publications Dissemination; September 2004. p. 31-40. 4. Rui Paiva. Personal communication. 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