Antidotes: mechanism of action
The four specific antidotes named by the guidelines. For each one, the mechanism and the drugs in this guide for which a guideline cites it.
Dexrazoxane
Cardioprotective agent used to reduce anthracycline cardiotoxicity. It binds free and bound iron and decreases anthracycline–iron complexes, which generate toxic free radicals. The exact mechanism of tissue protection in extravasation is unknown; a possible action is topoisomerase II inhibition.
Based on ONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (text, p. vii171)Cited for
Topical DMSO
Dimethyl sulfoxide: an organosulfur solvent that scavenges free radicals and increases skin permeability, helping absorption and dispersion of the extravasated drug. Topical use.
Based on ONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (text, p. vii170)Cited for
Hyaluronidase
Enzyme (endoglycosidase) that breaks down hyaluronic acid in connective tissue. This increases tissue permeability and favors dispersion and absorption of the extravasated drug. Given subcutaneously around the area.
Based on ONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (text, p. vii171)Cited for
Sodium thiosulfate
Hypothesis: thiosulfate acts as a target for alkylation and thereby neutralizes some alkylating agents with vesicant properties (mechlorethamine; high-concentration cisplatin). Given subcutaneously.
Based on ONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (Table 5, p. vii173)