Drug stability guidelines for a continuous infusion chemotherapy program

Area of Science:

• Oncology
• Pharmaceutical Sciences
• Clinical Pharmacy

Background:

• Ambulatory infusion chemotherapy utilizes advanced technology for prolonged drug delivery over days, weeks, or months.
• The chemical stability of antineoplastic drugs is critical for the efficacy and safety of continuous infusions.
• A lack of comprehensive extended stability data for intravenous chemotherapy solutions has raised significant pharmacy concerns.

Purpose of the Study:

• To compile and present extended chemical stability data for antineoplastic drugs and their admixtures.
• To establish minimum stability limits for commonly used chemotherapy agents in ambulatory infusion settings.
• To address pharmacy concerns regarding the safe and effective use of continuous chemotherapy infusions.

Main Methods:

• Literature surveys and manufacturer correspondence were used to gather extended chemical stability data.
• Stability was defined as maintaining at least 90% of the initial drug concentration.
• Data were collected for single and multiple drug admixtures stored in 60-ml polyvinylchloride (PVC) reservoir bags at room temperature.

Main Results:

• Minimum stability limits (in days) were determined for various single-agent chemotherapies: cytarabine (8), cyclophosphamide (6), doxorubicin (14), epidoxorubicin (14), floxuridine (8), fluorouracil (14), methotrexate (data not specified, assumed >14 based on context), mitomycin-C (14), cisplatin (14), thiotepa (7), vinblastine (8).
• Stability data for specific admixtures included: methotrexate/fluorouracil (14), doxorubicin/vinblastine (8), doxorubicin/cyclophosphamide (7), fluorouracil/cyclophosphamide (7), and doxorubicin/vincristine (14).

Conclusions:

• The compiled data support defined minimum stability periods for specific antineoplastic drugs and admixtures in PVC bags.
• This information is vital for pharmacists to ensure the integrity and safety of ambulatory infusion chemotherapy.
• The findings facilitate the safe and effective administration of prolonged chemotherapy regimens, enhancing patient care.