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Recommended treatment regimens for cytotoxic drug extravasations

Recommended treatment regimens for cytotoxic drug extravasations
Drug Treatment Route Frequency Duration
Vinca alkaloids (vinblastine, vincristine, vinorelbine) Heat Topical 15 to 20 minutes at least 4 times daily. 24 to 48 hours
Hyaluronidase Subcutaneously One-time dose: 1 mL (150 units) as 5 separate injections of 0.2 mL each, each injected subcutaneously into the extravasated site using a separate 25 gauge or smaller needle.
Etoposide Heat Topical 15 to 20 minutes at least 4 times daily. 24 to 48 hours
Anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin) Cold Topical 30 to 60 minutes, then every 15 minutes; discontinue at least 15 minutes prior to dexrazoxane therapy. Day 1 only
Dexrazoxane Over 1 to 2 hours IV in a large vein away from the extravasation area[1,2] 1000 mg/m2 within 6 hours, 1000 mg/m2 after 24 hours, and 500 mg/m2 after 48 hours.  
DMSO Topical For peripheral-line extravasations if dexrazoxane is unavailable or cannot be started within 6 hours: apply a few drops of 50% DMSO to the site using a sterile gauze pad every 8 hours. Allow to air dry; do not cover site. 7 days
Liposomal anthracyclines (daunorubicin, doxorubicin) Cold Topical 15 to 20 minutes at least 4 times daily. 24 hours
Mitomycin Cold Topical 15 to 20 minutes at least 4 times daily. 24 hours
DMSO Topical Apply a few drops of 50% DMSO to the site using a sterile gauze pad every 8 hours. Allow to air dry; do not cover site. 7 days
Taxanes (docetaxel, paclitaxel) Heat Topical 15 to 20 minutes at least 4 times daily. 24 hours
Hyaluronidase* Subcutaneously One-time dose: 1 mL (150 units) as 5 separate injections of 0.2 mL each, each injected subcutaneously into the extravasated site using a separate 25 gauge or smaller needle.  

Mechlorethamine

Bendamustine

Carboplatin

Cisplatin

Dacarbazine		 Cold Topical For 6 to 12 hours following sodium thiosulfate antidote injection. 6 to 12 hours
Sodium thiosulfateΔ Subcutaneously One-time dose: inject 2 mL of the 1/6 Molar solution for each mg of mechlorethamine suspected to have extravasated. Inject solution subcutaneously into the extravasation site using a 25 gauge or smaller needle.  
Oxaliplatin Corticosteroids Oral    
Heat Topical 15 to 20 minutes at least 4 times per day. 1 to 2 days. Exposure to cold may precipitate or worsen the acute neuropathy associated with oxaliplatin.
Other agents Cold Topical 15 to 20 minutes at least 4 times per day. 24 hours
IV: intravenous; DMSO: dimethylsulfoxide; EONS: European Oncology Nursing Society; ONS: Oncology Nursing Society.
* Use of hyaluronidase for taxane extravasation recommended in guidelines from the EONS but not ONS.
¶ Sodium thiosulfate recommendation from the ONS and EONS covers mechlorethamine extravasation only.
Δ Freshly prepared 1/6 Molar solution (approximately 4%; 4 mL 10% sodium thiosulfate + 6 mL sterile water); recommended in guidelines from the ONS and EONS.
References:
  1. Perez Fidalgo JA, Garcia Fabregat L, Cervantes A, et al. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 2012; 23:vii167.
  2. Polovich M, Whitford JM, Olsen M. Section V: Immediate complications of cytotoxic therapy. In: Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh 2009. p.105.
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