Chemotherapy Preparation and Dispensing Guidelines*

*These are guidelines which are intended for use by Palmetto Health Richland Pharmacy only.
Agent Reconstitution Dilution for Dispensing Auxiliary Information Ref

Aldesleukin 22 million unit vial IV infusion: Dilute in 50 mL D5W Exp: 48 hrs RT #11
(Proleukin, IL-2) Add 1.2 mL SWFI (18 million units/mL or 1.1 Dose < 57 MMU (< 70 mcg/mL) requires 0.1% Syringes exp 5 days REF #12
mg/mL) albumin (0.2 mL of 25% albumin to be added) TAV bag and add albumin
Dose = 57 – 82 MMU (70 – 100 mcg/mL) unstable first
Dose ≥ 82 MMU (≥ 100 mcg.mL) may be infused Do not filter
without albumin
Alemtuzumab Vial: 30mg/ml solution 1ml vial NS/D5W 100ml Exp. 8 hrs RT/REF
(Campath) Protect from light
Use 5µ filter
Asparaginase 10,000 unit vial IM: 10,000 units/mL in syringe Exp: 8 hrs RT/REF #1
(Elspar) IM: Add 1mL NS (10,000 units/mL) IV push: 2000 units/mL in syringe Do not shake vial
IV infusion: 50 mL NS only Not stable in D5W, Do not filter
Infuse 30 minutes or more With < 5 micron filter
Azacitidine 100MG vial Vigorously shake or roll vial until soln is clear Exp : 1 hr RT
(Vidaza) IV : Add 10ML SWFI (10MG/ML) Dilute in 50ml NS 8 hr REF #19
SubQ: Add 4ml SWFI (25mg/ml) SubQ: >4ml divide into 2 syringes

Bevacizumab Vial: 400mg/16ml (25mg/ml) NS 100ml Do Not Mix with Dextrose Solns Exp. 8 hrs REF
(Avastin) Infuse over : 1st -90min, 2nd-60min, 3rd-30min #19

15 unit vial SC,IM: 10 units/mL in syringe. Exp: 48 hrs RT #1

Bleomycin Add 1.5 mL SWFI (10 units/mL) IV push: 10 units/mL in syringe Exp: 2 weeks REF #12
(Blenoxane) IV infusion: 50 mL NS #18
Infuse over 10 minutes or more
Bortezomib Add 3.5ml NS to 3.5mg vial (1mg/1ml) IV push over 3-5 seconds Syringe Exp: 8 Hrs RT #18
(Velcade) 48 Hrs REF #19
Protect from light

CARBOplatin 50 mg, 150 mg, 450 mg vial, respectively IV infusion: Prepare as follows: Exp: 48 hrs RT in D5W #2
(Paraplatin) Add 5 mL, 15 mL, 45 mL SWFI (10 mg/mL) Dose < 400 mg: 100 mL D5W Exp: 5 days REF D5W #11
Dose ≥ 400 mg: 250 mL D5W Exp: 8 hrs RT in NS #18
Vial exp: 8 hrs Infuse over 15 minutes or more. +VP16 48 hrs RT
Avoid aluminum needles +Taxol in D5W/NS 24 hrs
Carmustine 100 mg vial Must be diluted IV infusion: Prepare as follows: Exp: 8 hrs RT #1
(BICNU) Add 3 mL Dehyd. Alcohol, then 27 mL SWFI Dose < 20 mg: 100 mL D5W or NS Exp: 24 hrs REF
(3.3 mg/mL) Dose = 20 – 100 mg: 250 mL D5W or NS NON-PVC container
Dose > 100 mg: 500 mL D5W or NS Protect from light
Infuse over 1 – 2 hrs IV push not recommended
Cetuximab Vial: (2mg/ml) Do Not Dilute Prime line with NS; attach .22µ filter Exp. 8 hr RT
(Erbitux) Flush with NS 12 hr REF #19

CISplatin 10mg, 50mg vials respectively IV infusion: Prepare as follows: Exp. 48 hrs RT #3
(Platinol) Add 10ml and 50ml SWFI (1mg/ml) Dose < 50mg: 250 ml NS DO NOT REFRIGERATE #18
Dose > 50mg: 500 ml NS Protect from light

Cladribine 10mg vial (1mg/1ml) IV infusion: 100-500ml NS Exp: 24 hrs RT #12

(2 CDA) Leustatin Infuse over 24 hours Dilute with NS only

Clofarabine D5W/NS Concentration 0.15mg-0.4mg/ml) Filter with 0.2µ before further dilution Exp. 24 hrs RT
(Clolar) Infuse over 2 hours

Cyclophosphamide Dilute with NS (BMS Vials) - IV push: 25 mg/mL in syringe Exp: 48 hrs RT #4
(Cytoxan) 500 mg, add 25 mL SWFI (20 mg/mL) IV infusion: Exp: 6 days REF D5W
1 gram, add 50 mL SWFI (20 mg/mL) Dose < 500 mg: 50 mL D5W or NS Exp: 2 weeks REF NS
2 gram, add 100mL SWFI (20 mg/mL) Dose = 500 – 1000 mg: 100 mL D5W or NS
Dose > 1000 mg: 250 mL D5W or NS
Vial exp: 24 hrs RT/ 6 days refrigerated
Infuse at 20 mg/min or less
Cytarabine For IV use reconstitute as follows: SC, IM: 100 mg/mL in syringe Exp: 48 hrs RT #5
(ARA-C) 100 mg: 2 mL SWFI (50mg/mL) IV push: 20 or 50 mg/mL in syringe. Exp: 14 days REF #18
For SC or IM use, reconstitute as follows: IV infusion:
100 mg: 1 mL SWFI (100 mg/mL) Dose < 1 gm: 100 mL D5W or NS Do not use BWFI for
500 mg: 5 mL SWFI (100 mg/mL) Dose 1 – 2 gm: 250 mL D5W or NS intrathecal or high-dose Ara-C
Dose > 2 gm: 500 mL D5W or NS
Vial exp: 48 hrs
Infuse over 1 hr or more
NOTE: Crystallization has occurred at concentrations
greater than 100 mg/mL unless further diluted. Do not
make syringes more concentrated than 100 mg/mL.

Dacarbazine 200 mg vial IV infusion: Prepare as follows: Exp: 24 hrs RT/REF #6

(DTIC) Add 19.7 mL SWFI (10 mg/mL) Dose < 100 mg: 100 mL D5W or NS + Doxorubicin 24 hrs RT/
Dose = 100 – 200 mg: 250 mL D5W or NS 5 days REF
Vial exp: 8 hrs RT/72 hrs refrigerated Dose > 200 mg: 500 mL D5W or NS
VESICANT
Infuse over 30 minutes or more Protect from light
Daclizumab NS 50ml Infuse over 15 minutes DO NOT SHAKE Exp. 4 hrs RT
(Zenapax) 24 hrs REF

Dactinomycin 0.5 mg vial IV push: 0.5 mg/mL in syringe Exp: 24 hrs RT/REF #6
(Cosmegen) Add 1.1 mL SWFI (0.5 mg/mL) IV infusion: 50 mL D5W or NS Avoid use of bacteriostatic
(Actinomycin D) diluent Discard vial after use
Infuse over 15 min or more Do not filter
 VESICANT
Daunorubicin 20 mg vial IV push: 5 mg/mL in syringe Exp: 48 hrs RT #7
(Cerubidine) Add 4 mL SWFI (5 mg/mL) IV infusion: 50 mL D5W or NS Exp: 14 days REF #18
Vial exp: 48 hrs REF 24 hrs RT VESICANT
Protect from light

Denileukin diftitox 300 mcg frozen vial (150 mcg/mL) IV over 15 minutes DO NOT SHAKE Exp. 6 hr RT;
(Ontak) Do Not Push Do not filter Keep vial frozen
Bring vials to RT (thaw 1 – 2 hrs RT) Dilute to at least 15 mcg/mL in NS. Withdraw Do not use glass
dose of Ontak and place in empty container, then
add required amount of NS.

Docetaxel 20 mg vial: Dilute 23.6 mg/0.59 mL vial with 1.83
(Taxotere) mL of diluent provided (10 mg/mL)
80 mg vial: Dilute 94.4 mg/2.36 mL with 7.33 mL
of diluent provided. (10 mg/mL)
IV infusion: Dilute in 250 mL of D5W or NS. Exp: 4hrs
Final conc = 0.3 – 0.9 mg/mL NON-PVC container
Infuse over 1 hour DO NOT SHAKE Non-DEHP administration set #12

Vial exp: 8 hrs RT/refrigerated

Doxorubicin Vial: 200mg multidose vial IV push: 2 mg/mL in syringe Exp: 48 hrs RT #7
(Adriamycin) (2 mg/mL) IV infusion: Exp: 14 days REF #5
If mixed with VP-16 & Doxorubicin-attach Dose < 50 mg: 50 mL D5W or NS No aluminum needles
extension set C25012 anti-siphon valve on the end Dose > 50 mg: 100 mL D5W or NS
of the non-dehp tubing Infuse over 15 minutes or more VESICANT
Protect from light

Epirubicin 50mg vial, 200mg vial IV Infusion: 50 mL D5W or NS over 3 – 5 min Exp: 8hrs RT in NS # 11
(Ellence) (2mg/mL) (D5W preferred) Exp: 48 hrs RT in D5W # 12
Must Dilute # 18

VESICANT

Etoposide 100 mg vial IV infusion only: Expiration dates vary as # 12

(VP-16) (20 mg/mL) Dose < 100 mg: 250 mL D5W or NS follows, all at RT - # 18
(Vepesid) Dose = 100 – 200 mg: 500 mL D5W or NS < 0.4 mg/mL: 48 hrs
If mixed with VP-16 & Doxorubicin-attach 0.6 mg/mL: 8 hrs
extension set C25012 anti-siphon valve on the end Infuse over at least 30 – 60 minutes > 0.6 mg/mL: 2 hrs
of the non-dehp tubing Non-PVC container and
tubing required
Fludarabine 50mg vial IV infusion: 50ml D5W or NS Exp: 48 hrs RT #15
(Fludara) Add 2 ml SWFI (25mg/ml) Infuse over 30 minutes #18

Fluorouracil 500 mg or 2500 mg vial (50 mg/mL) IV push: 50 mg/mL in syringe. Exp: 48 hrs RT #5
(5-FU) IV infusion: DO NOT REFRIGERATE # 10
Vial exp: 4 hours after initial entry Dose < 1200 mg: 50 mL D5W or NS. Infuse over at least 15 # 18
Dose 1200 – 2500 mg:100 mL D5W or NS minutes
Dose > 2500 mg:250 mL D5W or NS

Gemcitabine 200mg: 5ml of NS (pf) only IV use only. May be administered at Exp: 48 hrs. RT #12
(Gemzar) 1000mg: 25 ml of NS (pf) only Concentrations of 0.1mg/ml – 40mg/ml DO NOT REFRIGERATE #18
(38mg/ml) Infuse over 30 minutes (maximum=60minutes) Protect from light #20

Gemtuzumab 5 mg vial (20 mg size) IV Infusion only: 100 mL NS Exp: Use infusion # 12
(Mylotarg) Bring vials to RT. Add 5 mL SWFI (1 mg/mL) Infuse over 2 hrs; Use 1.2 micron filter immediately
Do Not Shake
Must be protected from
Vial exp: 8hrs REF direct/indirect sunlight and
unshielded fluorescent
lighting
Protect from light
Idarubicin 5 mg, 10 mg vials IV push: 1 mg/mL in syringe Exp: 24 hrs RT #9
(Idamycin) Add 5 mL and 10 mL NS respectively (1 mg/mL) IV infusion: 50 mL D5W or NS Avoid use of bacteriostatic # 12
Infuse over 15 minutes or more diluent
Vial exp: 72 hrs RT/ 7days refrigerated VESICANT
Protect from light
Ifosfamide 1 gram, 3 gram vial, respectively IV push: 50 mg/mL in syringe Exp: 48 hrs RT # 16
(Ifex) Add 20 mL, 60 mL BWFI/SWFI (50 mg/mL) IV infusion: Exp: 2 weeks REF # 18
Dose < 1 gram: 100 mL D5W or NS + Mesna in D5W 24 hrs RT
Dose 1 – 3 grams: 250 mL D5W or NS + Mesna in NS 48 hrs RT
Dose > 3 gram: 500 mL D5W or NS + Carboplatin 48 hrs RT
Infuse over at least 30 minutes + Cisplatin in NS 48 hrs RT
 + VP16 in NS 48 hrs RT
Irinotecan 100 mg vials D5W* Exp: 24 hrs RT # 12
(CPT-11) (20 mg/mL) NS Exp: 48 hrs REF in D5W
Final conc = 0.12 – 1.1 mg/mL Do not refrigerate NS
Infuse over 90 minutes or more dilutions
*Preferred diluent Protect from light
LIPOSOMAL 20 mg vials (2 mg/mL) IV infusion only Exp: 24 hrs # 12
Doxorubicin Doses ≤ 90mg in 250 mL D5W > 90mg in 500ml Do not filter # 19
(Doxil) Infuse over 60 min
# 12
Melphalan Conc = 5 mg/mL Infuse over 15-20min Exp: 1 hr
(Alkeran) Diluted to < 0.45 mg/mL in NS DO NOT REFRIGERATE

Methotrexate Various size vials IV push: 25 mg/mL in syringe Exp: 48 hrs RT (with or # 11
IV infusion: 500 – 1000 mg in 250 mL without NaHCO3) # 18

Protect from light

Mitomycin 5 mg, 20 mg vials, respectively IV push: 0.5 mg/mL in syringe Exp: 12 hrs RT # 11
(Mutamycin) Add 10 mL and 40 mL SWFI (0.5 mg/mL) IV infusion: 50 mL NS. Do NOT dilute in D5W
(Mitomycin C) VESICANT
Vial exp: 7 days RT/14 days refrigerated Infuse over 15 minutes or more Protect from light

Mitoxantrone 20 mg, 25 mg, & 30 mg vials (2 mg/mL) IV push not recommended Exp: 48 hrs RT # 17
(Novantrone) IV infusion: 50 mL D5W or NS Exp: 7 days REF # 18

Infuse in over 15 minutes or more

Oxaliplatin D5W 250ml-500ml DO NOT USE NS Infuse over 2 hrs Exp. 6hr RT / 24hr REF
(Eloxatin) Flush line with D5W prior to administration of any Folfox regimens: Y-SITE #19
concomitant meds WITH LEUCOVORIN

Paclitaxel 100 mg vial (6 mg/mL) Dilute to a conc = 0.3 – 1.2 mg/mL in D5W or NS Exp: 48 hrs RT # 13
(Taxol) Premeds- # 18
Attach in-line 0.2 µ filter (a) H2-antagonist: Tagamet 300 mg IV or Zantac NON-PVC container
50 mg IV
(b) Benadryl 50 mg IV
(c) Dexamethasone po 12 & 6 hrs before
administration. Infuse over 2-4 hrs

Paclitaxel Add 20ml NS (5mg/ml) Infuse over 30 minutes Exp: 8 hr RT #19

Protein Bound D5W/NS 0.3-1.2mg/ml Do Not Use in-line filter
 (Abraxane) SLOWLY INJECT OVER 1 MINUNITE 20ML NS
ONTO INSIDE WALL OF VIAL; LET SIT FOR
5MIN, SWIRL FOR 2 MIN

Peg-Asparagase Vial: 5ml (750units/ml) Give IM only Divide large doses into <2ml each Exp. 48hr RT
(Oncaspar)

Pemetrexed 500mg powder vial Dilute with 100ml pfNS give over 10min Exp. 24 hr REF #19
(Alimta) Reconstitute with 20ml NS (25mg/ml)

Rituximab 100 mg and 500 mg vials (10 mg/mL) Dilute to a final concentration = 1 mg/mL in D5W Exp: 24 hrs REF
(Rituxan) Keep refrigerated or NS Infusion rate: see package insert + additional 12 hrs RT # 11
Single dose vial
Topotecan 4 mg vial IV infusion: 100 mL D5W Exp: 24 hrs RT #12
(Hycamtin) Reconstitute with 4 mL SWFI (1mg/mL) Infuse over 30 minutes Exp: 7 days REF

Trastuzumab 440 mg multidose vial IV infusion: 250 mL NS Exp: 24 hrs RT # 11

(Herceptin) Add 20 mL BWFI (21 mg/mL) with provided diluent Infuse over 90 min for the first dose. If no DO NOT SHAKE # 12
reaction, other doses may be infused over 30 min.
Vial exp: 28 days refrigerated
VinBLASTine 10 mg vial IV push: 1 mg/mL in syringe Exp: 48 hrs RT # 14
(Velban) Add 10 mL BSNS (1 mg/mL) IV infusion: 50 mL Exp: 2 weeks REF # 18
Do NOT give IM, SQ, or IT VESICANT
****FATAL IF GIVEN INTRATHECALLY******* Protect from light

VinCRISTine Various size vials Dilute in 50 mL NS MINIBAG Exp: 48 hrs RT # 14

(Oncovin) (1 mg/mL) If mixed with VP-16 & Doxorubicin- Infuse over 15 minutes FATAL IF GIVEN # 18
attach extension set C25012 anti-siphon valve on *****MAX DOSE = 2 mg***** INTRATHECALLY
the end of the non-dehp tubing Check protocol if dose >2mg VESICANT
****FATAL IF GIVEN INTRATHECALLY******* Protect from light

Vinorelbine 50 mg vial (10 mg/mL) IV infusion: 50 – 100 mL D5W or NS Exp: 24 hrs RT/REF # 11
Tartrate Conc = 0.5 – 2 mg/mL
(Navelbine) Infuse over 6 – 10 minutes VESICANT
Protect from light

* All expiration dates apply to dilutions unless otherwise specified.

01/28/08 ALH.DOC

Reference list:
#1 McEvoy, GK (ed) American Hospital Formulary Service Drug Information 96, American Society of Health System Pharmacists, Bethesda, Maryland 1996.
#2 Sewell GJ. The stability of carboplatin in ambulatory continuous infusion regimens.Journal of Clinical Pharmacy and Therapeutics 12:427-432, 1987.
#3 Hrubisko M et al: Suitability of cisplatin solutions for 14-day continuous infusions by ambulatory pump, Cancer Chemotherapy and Pharmacology 29:252-255, 1992
#4 Kirk B et al: Chemical stability of cyclophosphamide in parenteral solutions British Journal of Parenteral Therapy p90-97 (May) 1984.
#5 Rochard EB et al: Stability of Fluorouracil, cytarabine, or doxorubicin hydrochloride in ethylenene vinyl acetate portable infusion pump reservoirs, American Journal of Hospital Pharmacy. 49:61
623 (March) 1992.
#6 Benvenuto JA et al: Stability and compatibility of antitumor agents in glass and plastic containers, American Journal of Hospital Pharmacy 38:1914-1918 (Dec) 1981.
#7 Wood MJ et al: Stability of doxorubicin, daunorubicin, and epirubicin, in plastic syringes and minibags. Journal of Clinical Pharmacy Therapeutics. 15: 279-289, 1990.
#8 Keller JH et al: Stability of Cancer Chemotherapeutic agents in a totally implanted drug delivery system. American Journal of Hospital Pharmacy 39: 1321-1323 (Aug) 1982.
#9 Beijnen JH et al: Stability of anthracycline antitumor agents in infusion fluids. Journal of Parenteral Science and Technology. 39:220 (Nov/Dec) 1985.
#10 Biondi L et al: Stability of 5-fluorouracil and flucytosine in parenteral solutions, Canadian Journal of Hospital Pharmacy. 39: 60-63 (June) 1986.
#11 Trissell Lawrence A. Handbook on Injectable Drugs. 13th ed, American Society of Health System Pharmacists. Bethesda, MD 2001.
#12 Manufacturer’s package insert (pertaining to specific drug referenced)
#13 Xu Q et al: Stability of paclitaxel in 5% dextrose injection or 0.9% sodium chloride injection at 4,22, or 32°C, American Journal of Hospital Pharmacy 51:3058-3060 (Dec) 1994.
#14 Beijnen JH et al: Stability of vinca alkaloid anticancer drugs in three commonly used infusion solutions, Journal of Parenteral Science and Technology. 43:84-87 (Mar/Apr) 1989.
#15 Flora KP et al: NCI Investigational Drugs Pharmaceutical Data. National Cancer Institute, Bethesda, Maryland, 1990.
#16 Trissel LA et al: Investigational drug information: ifosfamide, Drug Intelligence and Clinical Pharmacy 13:340-341, 1979.
#17 Trissel LA et al: NCI Investigational Drugs Pharmaceutical Data, National Cancer Institute, Bethesda, Maryland, 1986.
#18 USP 797 standards.
#19 Thompson Healthcare Series, Micromedex, 2008
#20 Drug Information Handbook for Oncology, 6th edition

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