Extravasation GuideTissue injury risk of antineoplastic extravasation

Paclitaxel

Risk class Guidelines differ

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

If it extravasates

Antidote

  • Hyaluronidase

Compress

  • Warm(when coadministering hyaluronidase – ref. ONS/ASCO 2025)
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)

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

Compress: warmONS/ASCO 2025 (text, p. 390-391); ESMO-EONS 2012 (Fig. 1, p. vii170)

Details by guideline

Risk class in extravasation

  • ONS/ASCO 2025Irritant with vesicant properties
    Antimicrotubule agents, taxanes
    Table 1, p. 385
  • ESMO-EONS 2012Vesicant
    Vesicants › Non-DNA-binding compounds › Taxanes
    Table 1, p. vii167
  • JSCN/JSMO/JASPO 2024Vesicant
    Classification according to the systematic review by JSMO/JASPO/JSCN.
    Table 2

Specific antidote

  • ONS/ASCO 2025Hyaluronidase
    Strength/level: Conditional; very lowRecommendation 2: "suggest the use of antidote"paclitaxel and docetaxel
    Table 4, p. 391
  • ESMO-EONS 2012Hyaluronidase
    Strength/level: V-CTaxanes
    Table 5, p. vii173

Compress

  • ONS/ASCO 2025Warm compress
    Strength/level: Conditional; very low"when coadministering hyaluronidase"paclitaxel, and docetaxel (when coadministering hyaluronidase)
    text, p. 390-391
  • ESMO-EONS 2012Warm compress
    "Disperse and dilute"Vinka alkaloids; Taxanes; Platin salts
    Figure 1, p. vii170
Brand names (ANVISA, Brazil) · DCB (Brazil)

DCB (Brazil)paclitaxel (nº 6786)

Brand names (ANVISA, Brazil)EVOTAXEL, MYLTOL, ONTAX, PANTIUM, POKLI, TAXILAN, TAXOL, TOXXEL

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 CMitoxantroneOxaliplatinRanimustineTrabectedinVinblastineVincristineVindesineVinorelbine

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