"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.
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 and 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.
Mechlorethamine
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.
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.
Taxanes
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.
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.
