ADRIM – DOXORUBICIN HYDROCHLORIDE INJECTION USP 2MG/ML

FRESENIUS KABI (SINGAPORE) PTE LTD

FRESENIUS KABI (SINGAPORE) PTE LTD

Therapeutic

Prescription Only

INJECTION, SOLUTION

**DOSAGE AND ADMINISTRATION** Care in the administration of ADRIM will reduce the chance of perivenous infiltration. It may also decrease the chance of local reactions such as urticaria and erythematous streaking. The recommended dosage schedule is 60–75 mg/m2 as a single intravenous injection administered at 21-day intervals. The lower dose should be given to patients with inadequate marrow reserves due to old age, or prior therapy, or neoplastic marrow infiltration. An alternative dose schedule is 30 mg/m2 on each of three successive days repeated every 4 weeks. The adult dosage regimens may be suitable for paediatric cases. The recommended lifetime cumulative dose limit is 550 mg doxorubicin/m2 body surface area. ADRIM has been administered as an intra-arterial infusion for 1–3 days at doses of 45–100 mg/m2. It is recommended that the total cumulative dose of doxorubicin for adults aged 70 or older be restricted to 450 mg/m2 body surface area. Doxorubicin dosage must be reduced if hepatic function is impaired according to the following table:  ADRIM Injection is supplied as 10 mg and 50 mg doxorubicin hydrochloride in 5 and 25 mL vials, respectively (doxorubicin concentration 2 mg/mL). ADRIM Injection must be handled with care. If contact with the skin occurs, wash thoroughly with soap and water. The product contains no antimicrobial preservative. The single-dose vials should be used in one patient on one occasion only. Discard any residue. The solution is to be stored under refrigeration (2°C to 8°C) and should be protected from sunlight and retained in the carton until time of use. Administration Visually inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. Discard if the solution is discolored, cloudy, or contains particulate matter. It is recommended that ADRIM be slowly administered into the tubing of a freely running intravenous infusion of Sodium Chloride Injection U.S.P. or 5% Glucose Injection U.S.P. The tubing should be attached to a butterfly needle inserted preferably into a large vein. The rate of administration is dependent on the size of the vein and the dosage. However, the dose should be administered in not less than 3–5 minutes. A direct push injection is not recommended due to the risk of extravasation, which may occur even in the presence of adequate blood return upon needle aspiration. **Management of Suspected Extravasation** Discontinue doxorubicin HCl for burning or stinging sensation or other evidence indicating perivenous infiltration or extravasation. Manage confirmed or suspected extravasation as follows: - Do not remove the needle until attempts are made to aspirate extravasated fluid. - Do not flush the line. - Avoid applying pressure to the site. - Apply ice to the site intermittently for 15 min 4 times a day for 3 days. - If the extravasation is in an extremity, elevate the extremity. Until specific compatibility data are available, it is not recommended that ADRIM be mixed with other drugs. Contact with alkaline solutions should be avoided since this can lead to hydrolysis of doxorubicin. ADRIM should not be mixed with heparin due to chemical incompatibility that may lead to precipitation. Doxorubicin should not be mixed with fluorouracil (e.g., in the same IV infusion bag or at the Y-site of an IV infusion line) since it has been reported that these drugs are incompatible to the extent that a precipitate might form. If concomitant therapy with doxorubicin and fluorouracil is required, it is recommended that the IV line be flushed between the administration of these drugs. ADRIM has been used in combination with other approved chemotherapeutic agents. Though evidence is available that at least in some types of neoplastic disease combination chemotherapy is superior to single agents, the benefits and risks of such therapy have not yet been fully elucidated. **Intravesical Administration** The following procedure is recommended: 1. The bladder should be catheterised and emptied. 2. Dilute ADRIM to a final concentration of 80 mg in 100 mL of normal saline and instill via the catheter into the bladder. 3. The catheter should be removed and the patient instructed to be on one side. At 15-minute intervals the patient should alternate to the opposite side over a 1-hour period. 4. The patient should be requested not to urinate for 1 hour, after which the bladder should be emptied of solution. 5. The procedure should be repeated at monthly intervals. **Protective Measures** The following protective recommendations are given due to the toxic nature of this substance: - Personnel should be trained in good technique for reconstitution and handling. - Pregnant staff should be excluded from working with this drug. - Personnel handling doxorubicin should wear protective clothing: goggles, gowns and disposable gloves and masks. - A designated area should be defined for reconstitution (preferably under a laminar flow system). The work surface should be protected by disposable, plastic-backed, absorbent paper. - All items used for reconstitution, administration or cleaning, including gloves, should be placed in high-risk waste-disposal bags for high-temperature incineration. - Spillage or leakage should be treated with dilute sodium hypochlorite (1% available chlorine) solution, preferably by soaking, and then water. - All cleaning materials should be disposed of as indicated previously. - In case of skin contact, thoroughly wash the affected area with soap and water or sodium bicarbonate solution. However, do not abrade the skin by using a scrub brush. - In case of contact with the eye(s), hold back the eyelid(s) and flush the affected eye(s) with copious amounts of water for at least 15 minutes. Then seek medical evaluation by a physician. - Always wash hands after removing gloves.