Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
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J Oncol Pharm Pract · Mar 2009
ReviewEvaluation of osmolality and pH of various concentrations of methotrexate, cytarabine, and thiotepa prepared in normal saline, sterile water for injection, and lactated Ringer's solution for intrathecal administration.
Neurotoxicity of intrathecal (IT) chemotherapy has been variously attributed to the preservatives, volume, osmolality, and pH of the preparations. There has been little evaluation of how different drug concentrations or diluents can affect the osmolality and pH of the final solution. We conducted a three-part study: survey of cancer centers regarding the drug concentrations and diluent used in preparing IT chemotherapy; review of the literature on common practice of preparing IT chemotherapy; evaluation of the pH and osmolality of commonly used chemotherapy preparations for IT. ⋯ There is limited published literature on the potential impact of diluent and drug concentration on the pH and osmolality of IT chemotherapy preparation. Most cancer centers conventionally prepare IT chemotherapy with 5 mL of preservative diluent normal saline, irrespective of the specific drug or dose used. The conventional practice means that most methotrexate preparations are likely to have comparable pH and osmolality to CSF. In contrast, cytarabine preparations may show significantly higher pH than the CSF, while thiotepa preparations generally have lower osmolality than the CSF.
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J Oncol Pharm Pract · Mar 2009
ReviewDasatinib dosing strategies in Philadelphia chromosome-positive leukemia.
Imatinib resistance has emerged as a significant clinical issue in the treatment of chronic myelogenous leukemia (CML) and Philadelphia chromosome positive acute lymphocytic leukemia (Ph+ ALL). Imatinib intolerance is also a concern. Dasatinib is approved for the treatment of patients with imatinib-resistant or -intolerant CML or Ph+ ALL and has helped address these concerns. Here, we review the clinical profile of dasatinib and discuss dosing strategies to manage these adverse events. ⋯ The safety profile of dasatinib is manageable. A 100 mg once-daily dose is now approved for use in patients with CP CML. A dose of 70 mg twice daily remains the recommended dosage for use in patients with advanced phase CML or Ph+ ALL.
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J Oncol Pharm Pract · Mar 2009
Comparative Study Controlled Clinical TrialStress-related mucosal bleeding in critically ill oncology patients.
To determine the incidence of stress-related mucosal bleeding (SRMB) in a critically ill oncology population receiving stress ulcer prophylaxis (SUP) with either a histamine-2 receptor antagonist (H2RA) or proton pump inhibitor (PPI). ⋯ The incidence of SRMB among high-risk critically ill oncology patients receiving SUP appears low; further, large-scale trials are needed to confirm this finding.