Quicklinks table - extravasation management

Evidence in the area of extravasation management for antineoplastic agents is extremely limited. Recommendations regarding the treatment of antineoplastic agent extravasation are based on animal models, case reports and a limited number of small uncontrolled studies, and are often conflicting. eviQ has reviewed all the available literature and attempted to provide some guidance in this area.

Drug name	Class/clinical procedure	Warm or cold compress	Antidote
Alemtuzumab	Non-irritant (neutral)	Not indicated	Not indicated
Amsacrine	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hours	Dimethyl sulfoxide (DMSO 99% solution)
Arsenic trioxide	Non-irritant (neutral)	Not indicated	Not indicated
Asparaginase (L-aspariginase)	Non-irritant (neutral)	Not indicated	Not indicated
Azacitidine	Non-irritant (neutral) (this does not preclude subcutaneous therapy)	Not indicated	Not indicated
Bendamustine	Irritant	Cold compress (initial for comfort measures)	Not indicated
Bevacizumab	Non-irritant (neutral)	Not indicated	Not indicated
Bleomycin	Non-irritant (neutral)	Not indicated	Not indicated
Bortezomib	Irritant (this does not preclude subcutaneous therapy)	Cold compress (initial for comfort measures)	Not indicated
Brentuximab	Non-irritant (neutral)	Not indicated	Not indicated
Busulfan	Irritant	Cold compress (initial for comfort measures)	Not indicated
Cabazitaxel	Irritant*	Cold compress (initial for comfort measures)	Not indicated
Calcium leucovorin	Non-irritant (neutral)	Not indicated	Not indicated
Carboplatin	Irritant	Cold compress (initial for comfort measures)	Not indicated
Carmustine	Irritant	Cold compress (initial for comfort measures)	Not indicated
Cetuximab	Non-irritant (neutral)	Not indicated	Not indicated
Cisplatin <0.5 mg/mL	Irritant	Cold compress (initial for comfort measures)	Not indicated
Cisplatin >0.5 mg/mL	Vesicant (treated as an irritant with vesicant properties)	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hours	No recommended antidote
Cladribine	Non-irritant (neutral)	Not indicated	Not indicated
Cyclophosphamide	Non-irritant (neutral)	Not indicated	Not indicated
Cytarabine	Non-irritant (neutral)	Not indicated	Not indicated
Dacarbazine	Irritant	Cold compress (initial for comfort measures) (Phlebitis and pain not to be confused with extravasation)	Not indicated
Dactinomycin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Daunorubicin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Docetaxel	Irritant with vesicant properties	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	No recommended antidote
Doxorubicin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Doxorubicin liposomal	Irritant with vesicant properties*	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	No recommended antidote Do not use DMSO 99% solution
Epirubicin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Eribulin mesilate	Non-irritant (neutral)	Not indicated	Not indicated
Etoposide	Irritant	Cold compress (initial for comfort measures)	Not indicated
Etoposide phosphate	Irritant*	Cold compress (initial for comfort measures)	Not indicated
Fludarabine	Non-irritant (neutral)	Not indicated	Not indicated
Fluorouracil	Irritant	Cold compress (initial for comfort measures)	Not indicated
Fotemustine	Irritant	Cold compress (initial for comfort measures)	Not indicated
Ganciclovir	Non-irritant (neutral)	Not indicated	Not indicated
Gemcitabine	Irritant	Cold compress (initial for comfort measures) (phlebitis and pain not to be confused with extravasation)	Not indicated
Idarubicin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Ifosfamide	Irritant	Cold compress (initial for comfort measures)	Not indicated
Ipilimumab	Non-irritant (neutral)	Not indicated	Not indicated
Irinotecan	Irritant	Cold compress (initial for comfort measures)	Not indicated
Melphalan	Irritant with vesicant properties	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	No recommended antidote
Mesna	Non-irritant (neutral)	Not indicated	Not indicated
Methotrexate	Non-irritant (neutral)	Not indicated	Not indicated
Mitomycin	Vesicant	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	Dimethyl sulfoxide (DMSO 99% solution)
Mitozantrone	Irritant with vesicant properties	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	No recommended antidote
Nivolumab	Non-irritant (neutral)	Not indicated	Not indicated
Obinutuzumab	Non-irritant (neutral)	Not indicated	Not indicated
Ofatumumab	Non-irritant (neutral)	Not indicated	Not indicated
Oxaliplatin	Irritant with vesicant properties	No warm or cold compress recommended	No recommended antidote
Paclitaxel	Irritant with vesicant properties	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	There have been some clinical reports of positive outcomes with using hyaluronidase. If hyaluronidase is administered no compress is recommended.
Paclitaxel nab (Abraxane®)	Irritant with vesicant properties	Cold compress apply 15 to 20 minutes FOUR times daily for 48 hour	No recommended antidote
Panitumumab	Non-irritant (neutral)	Not indicated	Not indicated
Pembrolizumab	Non-irritant (neutral)	Not indicated	Not indicated
Pemetrexed	Non-irritant (neutral)	Not indicated	Not indicated
Pertuzumab	Non-irritant (neutral)	Not indicated	Not indicated
Raltitrexed	Non-irritant (neutral)	Not indicated	Not indicated
Rituximab	Non-irritant (neutral)	Not indicated	Not indicated
Teniposide	Irritant	Cold compress (initial for comfort measures)	Not indicated
Thiotepa	Non-irritant (neutral)	Not indicated	Not indicated
Topotecan	Irritant	Cold compress (initial for comfort measures)	Not indicated
Trastuzumab (Herceptin®)	Non-irritant (neutral)	Not indicated	Not indicated
Trastuzumab emtansine (Kadcyla®)	Irritant	Not indicated	Not indicated
Vinblastine	Vesicant	Warm compress apply 15 to 20 minutes FOUR times daily for 48 hour	Hyaluronidase
Vincristine	Vesicant	Warm compress apply 15 to 20 minutes FOUR times daily for 48 hour	Hyaluronidase
Vindesine	Vesicant	Warm compress apply 15 to 20 minutes FOUR times daily for 48 hour	Hyaluronidase
Vinflunine	Vesicant	Warm compress apply 15 to 20 minutes FOUR times daily for 48 hour	Hyaluronidase
Vinorelbine	Vesicant	Warm compress apply 15 to 20 minutes FOUR times daily for 48 hour	Hyaluronidase

 * The classification of these drugs is based upon limited evidence and has been extrapolated from drugs within the same class.
This table is not an exhaustive list of antineoplastic agents used in the clinical setting. There are other drugs in use which have not yet been classified and for which the risk of extravasation injury is not known. For investigational drugs, information on extravasation management may be available from the trial sponsor or the clinical trials pharmacist.
Please read the extravasation management document for a comprehensive list of references used to develop this table.