Improved tolerability of amifostine with rapid infusion and optimal patient preparation

Early studies of amifostine suggested a reduced frequency of nausea/vomiting and hypotension when the drug was given via shorter-duration, intravenous infusions. Data from subsequent clinical evaluations in the radioprotectant and cytoprotectant settings have supported this observation. Recent findings indicate that amifostine given preradiotherapy by rapid intravenous push (10 seconds) and prechemotherapy over 3 to 5 minutes is associated with reduced toxicity and improved tolerability without apparent loss of protective effects. In addition to reducing duration of infusion, steps that should be taken to improve amifostine tolerability include adequate pretreatment hydration, individualized antiemetic prophylaxis, and maintaining the patient in a supine or reclining position during and after amifostine treatment. Subcutaneous dosing is currently being assessed with the aim of improving ease of administration and potentially further improving tolerability. Semin Oncol 29 (suppl 19):9-13.