Drug stability guidelines for a continuous infusion chemotherapy program

Recent technological advances in ambulatory infusion pumps, the development of safe long-term venous access devices, and the clinical advantages of the continuous infusion of chemotherapeutic agents have facilitated the delivery of ambulatory infusion chemotherapy. This method of therapy provides chemotherapeutic drug infusions over a period of several days, weeks, or months. Therefore, the antineoplastic drugs used must be chemically stable for the duration of the infusion. However, an extensive compilation of extended stability (greater than 24 hours) data of intravenous solutions containing antineoplastic drugs is lacking, and as such, pharmacy concerns have been significant. We have accumulated extended chemical stability data (greater than or equal to 90% of time zero concentration) based on literature surveys and manufacturer written correspondence. The accumulated data, presented herein, support the following minimum stability limits (in days) with regard to single and multiple drug admixtures stored in 60-ml polyvinylchloride (PVC) reservoir bags (Cormed, Medina, NY) at room temperature: cytarabine (8), cyclophosphamide (6), doxorubicin (14), epidoxorubicin (14), floxuridine (8), fluorouracil (14), methotrexate, mitomycin-C (14), cisplatin (14), thiotepa (7), vinblastine (8), methotrexate/fluorouracil (14), doxorubicin/vinblastine (8), doxorubicin/cyclophosphamide (7), fluorouracil/cyclophosphamide (7), and doxorubicin/vincristine (14).