Extravasation GuideTissue injury risk of antineoplastic extravasation

Mitoxantrone

Mitoxantrona

Risk class Guidelines differ

  • Irritant with vesicant propertiesref. ONS/ASCO 2025
  • Vesicantref. ESMO-EONS 2012, JSCN/JSMO/JASPO 2024
  • Irritantref. ESMO-EONS 2012

If it extravasates

Antidote

References

Risk class: Irritant with vesicant propertiesONS/ASCO 2025 (Table 1, p. 385)

Risk class: VesicantESMO-EONS 2012 (Table 1, p. vii167); JSCN/JSMO/JASPO 2024 (Table 2)

Risk class: IrritantESMO-EONS 2012 (Table 1, p. vii167)

Antidote: topical DMSOONS/ASCO 2025 (Table 4, p. 391)

Details by guideline

Risk class in extravasation

  • ONS/ASCO 2025Irritant with vesicant properties
    Topoisomerase II inhibitor
    Table 1, p. 385
  • ESMO-EONS 2012Vesicant
    Vesicants › DNA-binding compounds › Others (antibiotics)Single case reports describe both irritant and vesicant properties.
    Table 1, p. vii167
  • ESMO-EONS 2012Irritant
    Irritants › Anthracyclines (other)
    Table 1, p. vii167
  • JSCN/JSMO/JASPO 2024Vesicant
    Classification according to the systematic review by JSMO/JASPO/JSCN.
    Table 2

Specific antidote

  • ONS/ASCO 2025Dimethyl sulfoxide (DMSO), topical
    Mitomycin C; Mitoxantrone
    Table 4, p. 391
Brand names (ANVISA, Brazil) · DCB (Brazil)

DCB (Brazil)mitoxantrona (nº 6022)

Brand names (ANVISA, Brazil)EVOMIXAN

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)DactinomycinDaunorubicinDocetaxelDoxorubicinEpirubicinIdarubicinLurbinectedinMechlorethamineMitomycin COxaliplatinPaclitaxelRanimustineTrabectedinVinblastineVincristineVindesineVinorelbine

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