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List of Vesicant Chemotherapy
"Core Curriculum of Oncology Nursing" describes a vesicant chemotherapy as medication that can cause damage to cells and tissues if it leaks into subcutaneous tissue. This leaking is called extravasation. Extravasation of these medications typically happens during infusion of the chemotherapy and symptoms can take place up to 12 hours after infusion. Pain, swelling, and hypersensitivity reactions can occur. Extensive tissue death can occur. This type of cell death is considered an oncological emergency 2.
Antitumor Antibiotics
The book "Cancer Medicine" states that antitumor antibiotics can cause the worst tissue damage. Chemotherapy vesicants in this group include:
- doxorubicin
- daunorubicin
- mitomycin
- idarubicin
- epirubicin
- actinomycin
These types of vesicants continue to cause tissue death months after the extravasation occurs. Elevation of the arm and cold compresses are the initial treatment for this type of extravasation. Steroid injections and other medications may be helpful in preventing permanent or extensive damage.
- The book "Cancer Medicine" states that antitumor antibiotics can cause the worst tissue damage.
- Elevation of the arm and cold compresses are the initial treatment for this type of extravasation.
Mechlorethamine
Medications That Boost White Blood Cells
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This medication is derived from nitrogen mustard and is highly toxic. This medication can cause extensive damage according to "Cancer Medicine." Unlike antitumor antibiotics, mechloethamine does not continue to kill tissues weeks or months after administration. If extravasation occurs, the maker of this drug recommends ice packs and injections of isotonic sodium thiosulfate to the affected area.
- This medication is derived from nitrogen mustard and is highly toxic.
- Unlike antitumor antibiotics, mechloethamine does not continue to kill tissues weeks or months after administration.
Vinca Alkaloids
These chemotherapy agents are plant-based and are known vesicants. They do less damage than mustard and antitumor antibiotics but are still potentially dangerous. Vesicants in this category include vinblastine, vinorelbine and vincristine. Recommendations for treatment include warm compresses after leakage occurs and injections of a drug called hyaluronidase at the sight of the leak.
- These chemotherapy agents are plant-based and are known vesicants.
- Recommendations for treatment include warm compresses after leakage occurs and injections of a drug called hyaluronidase at the sight of the leak.
Taxanes
Medications That Could Cause Water Retention
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Taxanes are a class of chemotherapy that are also plant based. These medications include paclitaxel, docetaxel, and Abraxane. Taxane leaks are also treated with injections of hyaluronidase. Warm compresses are not recommended for taxanes. Some physicians will use cold compresses after the extravasation.
- Taxanes are a class of chemotherapy that are also plant based.
- Taxane leaks are also treated with injections of hyaluronidase.
Other Vesicant Chemotherapy
Many other chemotherapy drugs are considered vesicants. These include amsacrine, etoposide, streptozocin, oxaliplatin and ifosfamide. In addition, the "Core Curriculum for Oncology Nursing" lists cisplatin, dacarbazine, mitoxantrone and carmustine as vesicants when given in high doses.
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References
- Chemocare.com: Injection Site Reactions
- Cancer Medicine: Oncological Emergencies
- "Core Curriculum on Oncology Nursing"; Joanne Itano, Ph.D. & Karen Taoka, MSN; 2005
- Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol. 2012;23(Suppl 7):vii167-73. doi:10.1093/annonc/mds294
- Al-Benna S, O'Boyle C, Holley J. Extravasation injuries in adults. ISRN Dermatol. 2013;2013:856541. doi:10.1155/2013/856541
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Writer Bio
Christy Brogan is a nurse specializing in the fields of oncology, hospice and home care who has written educational materials for patients and students locally. She has been a clinical instructor teaching both patients and nursing students about health care issues. She graduated from Grand View College in 2005 with her Bachelor of Science in nursing.