Extravasation GuideTissue injury risk of antineoplastic extravasation

Epirubicin

Epirrubicina

Risk class

  • Vesicant

If it extravasates

Antidote

  • Dexrazoxane
  • Topical DMSO(if dexrazoxane is not available or is contraindicated – ref. ONS/ASCO 2025)

Compress

  • Cold
References

Risk class: VesicantONS/ASCO 2025 (Table 1, p. 385); ESMO-EONS 2012 (Table 1, p. vii167); JSCN/JSMO/JASPO 2024 (Table 2)

Antidote: dexrazoxaneONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (Table 5, p. vii173); JSCN/JSMO/JASPO 2024 (Table 1, CQ11)

Antidote: topical DMSOONS/ASCO 2025 (Table 4, p. 391); ESMO-EONS 2012 (Table 5, p. vii173)

Compress: coldONS/ASCO 2025 (text, p. 390); ESMO-EONS 2012 (Fig. 1, p. vii170)

Details by guideline

Risk class in extravasation

Specific antidote

  • ONS/ASCO 2025Dexrazoxane
    anthracycline therapy (doxorubicin, daunorubicin, epirubicin, idarubicin)
    Table 4, p. 391
  • ONS/ASCO 2025Dimethyl sulfoxide (DMSO), topical
    "when dexrazoxane is not available or is contraindicated"Anthracycline
    Table 4, p. 391
  • ESMO-EONS 2012Dexrazoxane
    Strength/level: III-BAnthracyclines
    Table 5, p. vii173
  • ESMO-EONS 2012Topical DMSO (99%)
    Strength/level: IV-BAnthracyclines
    Table 5, p. vii173
  • JSCN/JSMO/JASPO 2024Dexrazoxane
    Strength/level: Recommend (weak); Banthracycline cancer drug
    Table 1, CQ11

Compress

  • ONS/ASCO 2025Cold compress
    Strength/level: Conditional; very lowalkylating agents, anthracyclines, and antimetabolites
    text, p. 390
  • ESMO-EONS 2012Cold compress
    "Localize and neutralize"Anthracyclines; Antibiotics (Mitomycin / Dactinomycin); Alkylating agents
    Figure 1, p. vii170
Brand names (ANVISA, Brazil) · DCB (Brazil)

DCB (Brazil)epirrubicina (nº 3447)

Brand names (ANVISA, Brazil)BRECILA

General recommendations of the guidelines

  • ONS/ASCO 2025Recommendation 1 · Strong; very low

    Use antidotes, when one exists, for vesicants and irritants with vesicant properties, rather than no antidote.

    Table 3, p. 388
  • ONS/ASCO 2025Recommendation 3 · Conditional; very low

    Thermal compress (cold or warm depending on the agent) rather than no compress.

    Table 3, p. 388
  • ONS/ASCO 2025Recommendation 4 · Conditional; very low

    Compress for more than 24 hours rather than 24 hours or less.

    Table 3, p. 388
  • ONS/ASCO 2025Recommendation 5 · Conditional; very low

    Central line extravasation: surgical referral or escalation of care in addition to conservative management.

    Table 3, p. 388
  • JSCN/JSMO/JASPO 2024CQ10a · Recommend (weak)

    Cold compression (weak recommendation).

    Table 1, CQ10a
  • JSCN/JSMO/JASPO 2024CQ10b · Not recommend (weak); D

    Non-use of warm compresses (weak recommendation).

    Table 1, CQ10b

Vesicant antineoplastic drugs

AmrubicinBendamustineBusulfanCisplatin (≥0.5 mg/ml)DactinomycinDaunorubicinDocetaxelDoxorubicinIdarubicinLurbinectedinMechlorethamineMitomycin CMitoxantroneOxaliplatinPaclitaxelRanimustineTrabectedinVinblastineVincristineVindesineVinorelbine

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