***
Muscular toxicity from docetaxel in HIV-patient treated by ritonavir
C. Pichard, J. Jezequel, A. Pont, M. Bascoulergue, A. Oufella, V. Duperrin, A. Fabreguettes
CH Robert Ballanger, Seine-Saint-Denis, Aulnay sous Bois, France
Background: In hospital patients are treated in different care units for their cancer
and for their chronicles diseases. Interactions between their treatments can lead to iatrogenic consequences.
Purpose: To report a case of a docetaxel-ritonavir interaction in a HIV-patient with breast cancer
Material and Methods: Informations including HIV treatment have been obtained from patient clinical history. Chemotherapy treatments were obtained from CHIMIO.
Results: A 36-year-old HIV-positive woman was diagnosed with breast cancer in February 2010. The HIV-infection was diagnosed in 1996. Since 2007 eighth line treatment contains atazanavir (boosted with ritonavir), tenofovir and emtricitabine.
Neoadjuvant chemotherapy contains four cycles of Epirubicine-Cyclophosphamide followed by four cycles of docetaxel. Patient received four cycles of EC without important side effects. Three days after her first docetaxel cycle she was admitted to emergencies for muscular pains interesting her legs. Docetaxel-ritonavir interaction was supposed because docetaxel was metabolized by CYP450-3A4 and ritonavir inhibited CYP450-3A4.HIV treatment couldn’t be changed because infection was well controlled with viral load below the limit of detection. So docetaxel dose was reduced from 100mg/m² to 65mg/m². However seven days after the second cycle patient was again admitted for muscular pains. Docetaxel was definitely stopped. another possiblechoice was to use vinorelbine but review of literature has showed
vinorelbine is also metabolized by CYP450-3A4. Thereby patient received two more cycles of Epirubicine-Cyclophosphamide beforemastectomy.
Conclusion: This case report highlights severity of potential interaction between docetaxel and ritonavir. Concomitant administration of these medications may increase docetaxel blood concentration probably due to the inhibition of CYP450 by ritonavir. So docetaxel must be avoided in HIV-patient treated by ritonavir. While these interactions are well known to clinicians treating HIV, they are probably less obvious to the clinician prescribing chemotherapy. The optimal care for cancers requires that practitioners attend multidisciplinary meeting around the file of the
patient
Reference: 16th Congress of EAHP. 30 March - 01 April 2011. Viena. Austria
16 de janeiro de 2012
19 de dezembro de 2011
7 de dezembro de 2011
Cyclophosphamide 10-mg/mL Oral Liquid
Cyclophosphamide 10-mg/mL Oral Liquid
Loyd V. Allen, Jr, PhD
Professor Emeritus
College of Pharmacy, University of Oklahoma
Oklahoma City, Oklahoma
US Pharm. 2010;35(3):42-43.
Method of Preparation: Calculate the quantity of each ingredient for the amount to be prepared. Accurately weigh or measure each ingredient. Reconstitute the cyclophosphamide for injection with the 0.9% Sodium Chloride Injection. Place the mixture in an appropriate graduate, add sufficient Ora-Plus or simple syrup to final volume, and mix well.
Use: Cyclophosphamide oral liquid is used in the treatment of many adult and pediatric malignancies.
Packaging: Package in tight, light-resistant containers.
Labeling: Keep out of the reach of children. Shake well. Store in a refrigerator. Discard after 56 days.1,2
Stability: A beyond-use date of 56 days can be used for this preparation only when it is stored in a refrigerator.1,2 The reported stability study used the injection as the source of the drug.
Quality Control: Quality-control assessment can include weight/volume, pH, specific gravity, active drug assay, color, rheologic properties/pourability, physical observation, and physical stability (discoloration, foreign materials, gas formation, mold growth).3
Discussion: Cyclophosphamide is a widely used chemotherapeutic drug for treating a broad range of malignancies. It is used in the treatment of Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myeloma, leukemias, cutaneous T-cell lymphoma, neuroblastoma, ovarian cancer, retinoblastoma, breast cancer, small-cell lung cancer, sarcomas, and other diseases. A former method of preparing an oral liquid involved the use of Aromatic Elixir USP and had a reported stability of 14 days. However, Aromatic Elixir USP is no longer commercially available and takes time to prepare, so the current formula is presented with a beyond-use date of 56 days when it is stored in a refrigerator.1
It should be noted that storage at room temperature resulted in 10% degradation of the drug in 10.6 days in simple syrup and in 6.0 days in Ora-Plus. Therefore, this preparation must be refrigerated.
Cyclophosphamide (C7H15Cl2N2O2P.H2O, MW 279.10) is a nitrogen mustard derivative that is used as an antineoplastic and immunosuppressant. It occurs as a white, crystalline powder that liquefies upon the loss of its water of crystallization. Cyclophosphamide is soluble in water and in alcohol.1
0.9% Sodium Chloride Injection contains not less than 95.0% and not more than 105.0% of the labeled amount of sodium chloride in water for injection. It has a pH between 4.5 and 7.0, and it contains no added antimicrobial agents. Sodium chloride solutions are chemically and physically stable. They can be sterilized by filtration or autoclaving. Aqueous sodium chloride solutions will react to form precipitates with silver, lead, and mercury salts. When acidified sodium chloride solutions are mixed with strong oxidizing agents, chlorine can be liberated. Sodium chloride will decrease the solubility of some organic compounds; methylparaben is not as soluble in sodium chloride solutions as it is in water. Sodium chloride is soluble in water to the extent of 1 g in 2.8 mL water, and it is slightly soluble in alcohol (1 g in 250 mL of 95% ethanol).4
Ora-Plus is an oral suspending vehicle that accepts dilution of up to 50% or more with water, flavoring agents, or syrups and still retains its suspending properties. It has a pH of approximately 4.2 and an osmolality of about 230 mOsm/kg. Ora-Plus is a thixotropic vehicle with a viscosity of approximately 1,000 cps at 25˚C. It contains purified water, microcrystalline cellulose, sodium carboxymethylcellulose, xanthan gum, carrageenan, sodium phosphate, and citric acid as buffering agents; simethicone as an antifoaming agent; and potassium sorbate and methylparaben as preservatives.5
Syrup (simple syrup) is a clear, sweet vehicle used as a sweetening agent and as the base for many flavored and medicated syrups. It contains 85% w/v sucrose in water and has a specific gravity of not less than 1.30. Simple syrup is generally self-preserving as long as the sucrose concentration is maintained sufficiently high. Preferably, it is prepared without the use of heat, but it can be prepared by the use of boiling water. Simple syrup should be stored in tight containers, preferably in a cool place.1
REFERENCES
1. USP Pharmacists’ Pharmacopeia. Rockville, MD: US Pharmacopeial Convention, Inc; 2005:388,775-779,1433.
2. Kennedy R, Groepper D, Tagen M, et al. Stability of cyclophosphamide in extemporaneous oral suspensions. Ann Pharmacother. 2010;44:295-301.
3. Allen LV Jr. Standard operating procedure for performing physical quality assessment of oral and topical liquids. IJPC. 1999;3:146-147.
4. Maximilien JS. Sodium chloride. In: Rowe RC, Sheskey PJ, Quinn ME, eds. Handbook of Pharmaceutical Excipients. 6th ed. London, England: Pharmaceutical Press; 2009:637-640.
5. Ora-Plus (product information). Minneapolis, MN: Paddock Laboratories, Inc; 1992.
To comment on this article, contact rdavidson@uspharmacist.com.
Loyd V. Allen, Jr, PhD
Professor Emeritus
College of Pharmacy, University of Oklahoma
Oklahoma City, Oklahoma
US Pharm. 2010;35(3):42-43.
Method of Preparation: Calculate the quantity of each ingredient for the amount to be prepared. Accurately weigh or measure each ingredient. Reconstitute the cyclophosphamide for injection with the 0.9% Sodium Chloride Injection. Place the mixture in an appropriate graduate, add sufficient Ora-Plus or simple syrup to final volume, and mix well.
Use: Cyclophosphamide oral liquid is used in the treatment of many adult and pediatric malignancies.
Packaging: Package in tight, light-resistant containers.
Labeling: Keep out of the reach of children. Shake well. Store in a refrigerator. Discard after 56 days.1,2
Stability: A beyond-use date of 56 days can be used for this preparation only when it is stored in a refrigerator.1,2 The reported stability study used the injection as the source of the drug.
Quality Control: Quality-control assessment can include weight/volume, pH, specific gravity, active drug assay, color, rheologic properties/pourability, physical observation, and physical stability (discoloration, foreign materials, gas formation, mold growth).3
Discussion: Cyclophosphamide is a widely used chemotherapeutic drug for treating a broad range of malignancies. It is used in the treatment of Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myeloma, leukemias, cutaneous T-cell lymphoma, neuroblastoma, ovarian cancer, retinoblastoma, breast cancer, small-cell lung cancer, sarcomas, and other diseases. A former method of preparing an oral liquid involved the use of Aromatic Elixir USP and had a reported stability of 14 days. However, Aromatic Elixir USP is no longer commercially available and takes time to prepare, so the current formula is presented with a beyond-use date of 56 days when it is stored in a refrigerator.1
It should be noted that storage at room temperature resulted in 10% degradation of the drug in 10.6 days in simple syrup and in 6.0 days in Ora-Plus. Therefore, this preparation must be refrigerated.
Cyclophosphamide (C7H15Cl2N2O2P.H2O, MW 279.10) is a nitrogen mustard derivative that is used as an antineoplastic and immunosuppressant. It occurs as a white, crystalline powder that liquefies upon the loss of its water of crystallization. Cyclophosphamide is soluble in water and in alcohol.1
0.9% Sodium Chloride Injection contains not less than 95.0% and not more than 105.0% of the labeled amount of sodium chloride in water for injection. It has a pH between 4.5 and 7.0, and it contains no added antimicrobial agents. Sodium chloride solutions are chemically and physically stable. They can be sterilized by filtration or autoclaving. Aqueous sodium chloride solutions will react to form precipitates with silver, lead, and mercury salts. When acidified sodium chloride solutions are mixed with strong oxidizing agents, chlorine can be liberated. Sodium chloride will decrease the solubility of some organic compounds; methylparaben is not as soluble in sodium chloride solutions as it is in water. Sodium chloride is soluble in water to the extent of 1 g in 2.8 mL water, and it is slightly soluble in alcohol (1 g in 250 mL of 95% ethanol).4
Ora-Plus is an oral suspending vehicle that accepts dilution of up to 50% or more with water, flavoring agents, or syrups and still retains its suspending properties. It has a pH of approximately 4.2 and an osmolality of about 230 mOsm/kg. Ora-Plus is a thixotropic vehicle with a viscosity of approximately 1,000 cps at 25˚C. It contains purified water, microcrystalline cellulose, sodium carboxymethylcellulose, xanthan gum, carrageenan, sodium phosphate, and citric acid as buffering agents; simethicone as an antifoaming agent; and potassium sorbate and methylparaben as preservatives.5
Syrup (simple syrup) is a clear, sweet vehicle used as a sweetening agent and as the base for many flavored and medicated syrups. It contains 85% w/v sucrose in water and has a specific gravity of not less than 1.30. Simple syrup is generally self-preserving as long as the sucrose concentration is maintained sufficiently high. Preferably, it is prepared without the use of heat, but it can be prepared by the use of boiling water. Simple syrup should be stored in tight containers, preferably in a cool place.1
REFERENCES
1. USP Pharmacists’ Pharmacopeia. Rockville, MD: US Pharmacopeial Convention, Inc; 2005:388,775-779,1433.
2. Kennedy R, Groepper D, Tagen M, et al. Stability of cyclophosphamide in extemporaneous oral suspensions. Ann Pharmacother. 2010;44:295-301.
3. Allen LV Jr. Standard operating procedure for performing physical quality assessment of oral and topical liquids. IJPC. 1999;3:146-147.
4. Maximilien JS. Sodium chloride. In: Rowe RC, Sheskey PJ, Quinn ME, eds. Handbook of Pharmaceutical Excipients. 6th ed. London, England: Pharmaceutical Press; 2009:637-640.
5. Ora-Plus (product information). Minneapolis, MN: Paddock Laboratories, Inc; 1992.
To comment on this article, contact rdavidson@uspharmacist.com.
Look-alike, sound-alike drugs in oncology
Look-alike, sound-alike drugs in oncology
Laurel Kovacic, BSc (Pharm). External PharmD Program, University of Washington, Seattle, Washington, USA, laurelk@bccancer.bc.ca
Carole Chambers, BSc (Pharm) MBA
Cancer Services, Alberta Health Services, Calgary, Alberta, Canada
Abstract
Background. Medication errors with oncology drugs can place cancer patients at risk for adverse events or death. Look-alike, sound-alike (LASA) drug names may increase the risk for errors. Published lists of LASA drug names are generally a result of voluntarily reported medication incidents. This study performed a proactive review of the oncology drug formulary from the Cancer Services of the Alberta Health Services for LASA drug pairs.
Methods. The Levenshtein Distance and Bigram Similarity algorithms, same first and last letters, and Lexi-CompR on-line alerts were used to review the outpatient oncology formulary to identify potential LASA generic drug name pairs.
Results. Results indicate there are more potential LASA generic drug name pairs in the oncology formulary than are published in the literature. The risk detection methods used in this study identified unique and common LASA drug pairs. The Bigram Similarity algorithm identified 186 LASA drug pairs from 3320 possible pairs. The Levenshtein Distance algorithm, same first and last letters, and Lexi-CompR methods identified 42, 75, and 38 LASA drug pairs, respectively. Five generic LASA drug pairs were identified in common by all four of the risk determination methods.
Discussion. LASA drug pairs identified by three or four methods were considered to provide the highest risk for errors. A step-wise approach to risk reduction, dependent on the number of detection methods identifying a pair, is presented.
Conclusion. For specialty areas of practice, a proactive system of reviewing LASA drug name pairs may be warranted for increasing medication safety.
Reference: J Oncol Pharm Practice (2011) 17: 104— 118.
Laurel Kovacic, BSc (Pharm). External PharmD Program, University of Washington, Seattle, Washington, USA, laurelk@bccancer.bc.ca
Carole Chambers, BSc (Pharm) MBA
Cancer Services, Alberta Health Services, Calgary, Alberta, Canada
Abstract
Background. Medication errors with oncology drugs can place cancer patients at risk for adverse events or death. Look-alike, sound-alike (LASA) drug names may increase the risk for errors. Published lists of LASA drug names are generally a result of voluntarily reported medication incidents. This study performed a proactive review of the oncology drug formulary from the Cancer Services of the Alberta Health Services for LASA drug pairs.
Methods. The Levenshtein Distance and Bigram Similarity algorithms, same first and last letters, and Lexi-CompR on-line alerts were used to review the outpatient oncology formulary to identify potential LASA generic drug name pairs.
Results. Results indicate there are more potential LASA generic drug name pairs in the oncology formulary than are published in the literature. The risk detection methods used in this study identified unique and common LASA drug pairs. The Bigram Similarity algorithm identified 186 LASA drug pairs from 3320 possible pairs. The Levenshtein Distance algorithm, same first and last letters, and Lexi-CompR methods identified 42, 75, and 38 LASA drug pairs, respectively. Five generic LASA drug pairs were identified in common by all four of the risk determination methods.
Discussion. LASA drug pairs identified by three or four methods were considered to provide the highest risk for errors. A step-wise approach to risk reduction, dependent on the number of detection methods identifying a pair, is presented.
Conclusion. For specialty areas of practice, a proactive system of reviewing LASA drug name pairs may be warranted for increasing medication safety.
Reference: J Oncol Pharm Practice (2011) 17: 104— 118.
26 de novembro de 2011
Livro Manual de Drogas Injetáveis
2ª Edição 2012Livraria e Editora Medfarma
ISBN: 978-85-89248-07-5
Nº de páginas: 412
Formato: 16 x 23 cm
Capa dura
De forma prática e concisa o Manual de Drogas Injetáveis apresenta importantes informações a médicos, enfermeiros e farmacêuticos que atuam em Unidade Central de Misturas Intravenosas, tais como: Descrição do produto, nome comercial, posologia, alertas, reconstituição, concentração após a reconstituição, vias de administração, diluentes, volume final para infusão, compatibilidade, incompatibilidade e estabilidade de medicamentos injetáveis para 175 medicamentos: pH dos produtos farmacêuticos: capítulo com cálculos e fórmulas, capítulo sobre administração de medicamentos injetáveis e capítulo com lista de abreviaturas e siglas. A descrição de cada medicamento está de acordo com a nova norma da ANVISA, com o Sistema Fechado, a RDC 45.
Conteúdo
Sumário
Nota
Agradecimentos
Prefácio
Apresentação
Introdução
Lista de abreviaturas e siglas
Cálculos e fórmulas
Informações básicas
Reconstituição de pós injetáveis
Misturas intravenosas
Cálculos e fórmulas
Cálculos de velocidade de infusão
Cálculo do gotejamento
Método prático
Infusão em gotas
Infusão em microgotas
Cálculo para infusão intravenosa do medicamento
Cálculo da velocidade de gotejamento com equipo de bureta
Cálculo de mL/h para uso em bomba de infusão contínua (BIC)
Cálculo da concentração do medicamento
Cálculo da concentração do medicamento em porcentagem
Cálculo da concentração do medicamento na forma diluída
Cálculo da dose para medicamentos em g/mL, mg/mL ou mcg/mL
Cálculo de mL/h para uso em BIC em gotas/min
Resumo de cálculo para gotejamento
Unidades de medida
Questões para autoavaliação
Respostas do teste
Administração de medicamentos injetáveis
Introdução
Terapia intravenosa
Injeção intravenosa direta
Infusão intravenosa intermitente
Infusão intravenosa contínua 40
Injeção intramuscular
Injeção subcutânea
Injeção subcutânea contínua
Via intra-arterial
Via intratecal
Via intraperitoneal
Outras vias
Equipos para infusão
Sistema fechado de infusão
Bombas de infusão
Medicamentos Injetáveis: Monografias
ACETILCISTEÍNA
ACICLOVIR
ÁCIDO AMINOCAPRÓICO
ÁCIDO ASCÓRBICO
ÁCIDO TRANEXÂMICO
ADENOSINA
ALBUMINA HUMANA
ALFAINTERFERONA 2b RECOMBINANTE
ALFENTANILA
ALPROSTADIL
ALTEPLASE
AMICACINA
AMINOFILINA
AMIODARONA
AMOXICILINA + CLAVULANATO DE POTÁSSIO
AMPICILINA
AMPICILINA + SULBACTAM
AMRINONA
ANFOTERICINA B
ANFOTERICINA B COMPLEXO LIPÍDICO
ANFOTERICINA B LIPOSSOMAL
ANIDULAFUNGINA
ATRACÚRIO
ATROPINA
AZITROMICINA
BENZILPENICILINA POTÁSSICA
BICARBONATO DE SÓDIO
BROMOPRIDA
BUPIVACAÍNA
CALCITRIOL
CASPOFUNGINA
CEFAZOLINA
CEFEPIMA
CEFOTAXIMA
CEFTAROLINA
CEFTAZIDIMA
CEFTRIAXONA
CEFUROXIMA
CETAMINA
CETOPROFENO
CETOROLACO DE TROMETAMOL
CIPROFLOXACINO
CISATRACÚRIO
CLARITROMICINA
CLINDAMICINA
CLONIDINA
CLORETO DE POTÁSSIO
CLORETO DE SÓDIO
COMPLEXO VITAMÍNICO B
CLORPROMAZINA
DALTEPARINA
DANTROLENO
DAPTOMICINA
DESFERROXAMINA
DESLANOSÍDEO
DESMOPRESSINA
DEXAMETASONA
DEXMEDOTIMIDINA
DIAZEPAM
DICLOFENACO DE SÓDIO
DILTIAZEM
DIMENIDRINATO
DIPIRONA
DOBUTAMINA
DOLASETRONA
DOPAMINA
DORIPENEM
DROPERIDOL
EFEDRINA
ENOXAPARINA
EPINEFRINA
ERTAPENEM
ESCOPOLAMINA
ESMOLOL
ESOMEPRAZOL
ESTREPTOMICINA
ESTREPTOQUINASE
ETILEFRINA
ETOMIDATO
FENILEFRINA
FENITOÍNA
FENOBARBITAL
FENTANILA
FITOMENADIONA
FLUCONAZOL
FLUMAZENIL
FOSFATO DE POTÁSSIO
FUROSEMIDA
GENTAMICINA
GLICOSE
GLUCAGON
GLUCONATO DE CÁLCIO
GRANISETRONA
HALOPERIDOL
HEPARINA
HIDRALAZINA
HIDROCORTISONA
IBUPROFENO
IMIPENEM + CILASTATINA
IMUNOGLOBULINA ANTITETÂNICA
IMUNOGLOBULINA ANTITIMÓCITO
IMUNOGLOBULINA HUMANA ENDOVENOSA
INDOMETACINA
INSULINA HUMANA REGULAR
LANSOPRAZOL
LEVOBUPIVACAÍNA
LEVOFLOXACINO
LIDOCAÍNA
LINEZOLIDA
MANITOL
MEROPENEM
METADONA
METARAMINOL
METILPREDNISOLONA
METOCLOPRAMIDA
METOPROLOL
METRONIDAZOL
MICAFUNGINA
MIDAZOLAM
MILRINONA
MONONITRATO DE ISOSSORBIDA
MORFINA
NALBUFINA
NALOXONA
NEOSTIGMINA
NIMODIPINO
NITROGLICERINA
NITROPRUSSIATO DE SÓDIO
NOREPINEFRINA
OCITOCINA
OCTREOTIDA
OMEPRAZOL
ONDANSETRONA
OXACILINA
PALONOSETRONA
PANCURÔNIO
PANTOPRAZOL
PARECOXIBE SÓDICO
PENTOXIFILINA
PETIDINA
PIPERACILINA + TAZOBACTAM
POLIMIXINA B
PROMETAZINA
PROPOFOL
PROPRANOLOL
PROTAMINA
RANITIDINA
REMIFENTANILA
ROCURÔNIO
ROPIVACAÍNA
SACARATO DE HIDRÓXIDO FÉRRICO
SALBUTAMOL
SOMATOSTATINA
SUFENTANILA
SUGAMADEX
SULFAMETOXAZOL + TRIMETOPRIMA
SULFATO DE MAGNÉSIO
SUXAMETÔNIO
TEICOPLANINA
TENOXICAM
TERBUTALINA
TICARCILINA + CLAVULANATO DE POTÁSSIO
TIGECICLINA
TIOPENTAL
TIROFIBANA
TRAMADOL
TREPROSTINIL
TROPISETRONA
VANCOMICINA
VASOPRESSINA
VECURÔNIO
VERAPAMIL
VORICONAZOL
ZIDOVUDINA
31 de outubro de 2011
Hypomagnesemia in patients treated with cetuximab
***
Hypomagnesemia in patients treated with cetuximab
F. Moreno Ramos, G. Casado Abad, S. Hernandez Garrido, E. Codes Cid, M.A. Tacoronte Fonturbel, A. Sierra Muñoz, A. Herrero Ambrosio
Hospital Universitario La Paz, Pharmacy, Madrid, Spain
Background:Cetuximab is a chimeric monoclonal antibody that inhibits the epidermal-growth-factor receptor (EGFR). EGF stimulates Mg2+ Henle´s loop reabsorption and in the renal distal convoluted tubule. Preliminary evidence suggests that magnesium wasting occurs in patients who are treated with cetuximab for colorectal cancer.
Methods: Prospective study in a cohort of 46 patients with colorectal cancer treated with cetuximab, between April and August 2008. We collected serum magnesium levels from the patients’ clinical report, chemotherapy protocols, maintenance cetuximab
dosage, and oral or intravenous magnesium replacement doses if necessary. Data from 24 patients were not available because the doctor did not request the analitical magnesium levels.
Results: 22 patients were evaluated, 12 men (54, 5%) and 10 women (45, 5%). In 17 patients serum magnesium levels remained below the normal limits (1, 8-2, 40 mg/dl), of which, 12 received oral magnesium and 2 were treated also with intravenous magnesium sulphate because of their low serum magnesium levels (1 mg/dl and 1, 4 mg/dl respectively). 5 patients remained within normal magnesium levels, and one did not received oral magnesium. The cetuximab dosage was maintained during this period.
Conclusions: Careful monitoring of serum magnesium is recomended during treatment, because symptoms of hypomagnesaemia can easily remain unrecognised. Our study suggests that oral magnesium substitution in patients with hypomagnesaemia is not efficient raising the magnesium to normal levels; however it controls magnesium levels avoiding a great decreasement in serum magnesium levels being effective for the maintenance of stable concentrations.
Reference: EAHP Congress Barcelona 2009
Hypomagnesemia in patients treated with cetuximab
F. Moreno Ramos, G. Casado Abad, S. Hernandez Garrido, E. Codes Cid, M.A. Tacoronte Fonturbel, A. Sierra Muñoz, A. Herrero Ambrosio
Hospital Universitario La Paz, Pharmacy, Madrid, Spain
Background:Cetuximab is a chimeric monoclonal antibody that inhibits the epidermal-growth-factor receptor (EGFR). EGF stimulates Mg2+ Henle´s loop reabsorption and in the renal distal convoluted tubule. Preliminary evidence suggests that magnesium wasting occurs in patients who are treated with cetuximab for colorectal cancer.
Methods: Prospective study in a cohort of 46 patients with colorectal cancer treated with cetuximab, between April and August 2008. We collected serum magnesium levels from the patients’ clinical report, chemotherapy protocols, maintenance cetuximab
dosage, and oral or intravenous magnesium replacement doses if necessary. Data from 24 patients were not available because the doctor did not request the analitical magnesium levels.
Results: 22 patients were evaluated, 12 men (54, 5%) and 10 women (45, 5%). In 17 patients serum magnesium levels remained below the normal limits (1, 8-2, 40 mg/dl), of which, 12 received oral magnesium and 2 were treated also with intravenous magnesium sulphate because of their low serum magnesium levels (1 mg/dl and 1, 4 mg/dl respectively). 5 patients remained within normal magnesium levels, and one did not received oral magnesium. The cetuximab dosage was maintained during this period.
Conclusions: Careful monitoring of serum magnesium is recomended during treatment, because symptoms of hypomagnesaemia can easily remain unrecognised. Our study suggests that oral magnesium substitution in patients with hypomagnesaemia is not efficient raising the magnesium to normal levels; however it controls magnesium levels avoiding a great decreasement in serum magnesium levels being effective for the maintenance of stable concentrations.
Reference: EAHP Congress Barcelona 2009
7 de setembro de 2011
Ciclofosfamida: estabilidade e compatibilidade
***
Compatibilidade na administração em Y: ácido folínico, alopurinol, amifostina, amicacina, aztreonam, bicarbonato de sódio, bleomicina, cefazolina, cefepima, cefota-xima, cefoxitina, cefuroxima, clindamicina, cisplatino, cimetidina, cladribina, clorpro-mazina, dexametasona, dacarbazina, doxorrubicina, doxorrubicina lipossomal, droperidol, difenidramina, etoposido, filgrastima, fludarabina, fluoruracila, furosemida, gatifloxacina, gemcitabina, granisetrona, hidromorfona, heparina, hidroxizina, idarrubicina, folinato de cálcio, linezolida, lorazepam, melfalano, metilprednisolona, mesna, metotrexato, metoclopramida, metronidazol, mitomicina, morfina, nafcilina, ondansetrona, oxacilina, paclitaxel, palonosetrona, penicilina G potássica, piperacilina, piperacilina + tazobactama, proclorperazina, propofol, prometazina, ranitidina, sargramostima, solução de aminoácidos, sulfametoxazol + trimetoprima, teniposido, ticarcilina dissódica, ticarcilina + clavulanato, tiotepa, topotecano, tobramicina, vinorelbina, vancomicina, vimblastina, vincristina.
Incompatibilidade na administração em Y: anfotericina B colesteril sulfato.
Compatibilidade em seringa de polipropileno: ácido folínico, bleomicina, cisplatino, doxapram, doxorrubicina, droperdiol, fluoruracila, furosemida, heparina, folinato de cálcio, metotraxato, metoclopramida, mitomicina, vimblastina, vincristina.
Estabilidade da solução diluída: em área classificada para reconstituição de soluções de drogas citostáticas. Diluída em soro fisiológico 0,9% nas concentrações de 2 a 20 mg/mL é estável para 24 h na temperatura ambiente e 7 dias sob refrigeração em bolsa plástica Viaflex®. Para uso injetável.
Referência: Souza GB. Oncohematologia: Manual de Diluição, Administração e Estabilidade de Medicamentos Citostáticos 1ª edição, 2010. 256 páginas, Editora Atheneu: Rio de Janeiro.RJ
Compatibilidade na administração em Y: ácido folínico, alopurinol, amifostina, amicacina, aztreonam, bicarbonato de sódio, bleomicina, cefazolina, cefepima, cefota-xima, cefoxitina, cefuroxima, clindamicina, cisplatino, cimetidina, cladribina, clorpro-mazina, dexametasona, dacarbazina, doxorrubicina, doxorrubicina lipossomal, droperidol, difenidramina, etoposido, filgrastima, fludarabina, fluoruracila, furosemida, gatifloxacina, gemcitabina, granisetrona, hidromorfona, heparina, hidroxizina, idarrubicina, folinato de cálcio, linezolida, lorazepam, melfalano, metilprednisolona, mesna, metotrexato, metoclopramida, metronidazol, mitomicina, morfina, nafcilina, ondansetrona, oxacilina, paclitaxel, palonosetrona, penicilina G potássica, piperacilina, piperacilina + tazobactama, proclorperazina, propofol, prometazina, ranitidina, sargramostima, solução de aminoácidos, sulfametoxazol + trimetoprima, teniposido, ticarcilina dissódica, ticarcilina + clavulanato, tiotepa, topotecano, tobramicina, vinorelbina, vancomicina, vimblastina, vincristina.
Incompatibilidade na administração em Y: anfotericina B colesteril sulfato.
Compatibilidade em seringa de polipropileno: ácido folínico, bleomicina, cisplatino, doxapram, doxorrubicina, droperdiol, fluoruracila, furosemida, heparina, folinato de cálcio, metotraxato, metoclopramida, mitomicina, vimblastina, vincristina.
Estabilidade da solução diluída: em área classificada para reconstituição de soluções de drogas citostáticas. Diluída em soro fisiológico 0,9% nas concentrações de 2 a 20 mg/mL é estável para 24 h na temperatura ambiente e 7 dias sob refrigeração em bolsa plástica Viaflex®. Para uso injetável.
Referência: Souza GB. Oncohematologia: Manual de Diluição, Administração e Estabilidade de Medicamentos Citostáticos 1ª edição, 2010. 256 páginas, Editora Atheneu: Rio de Janeiro.RJ
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