bicarbonate SubQ, dexamethasone 4 mg SubQ. 0000002580 00000 n /T1_1 17 0 R CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. f Extravasation: Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. necrosis are possible. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. In one report of antineoplastic drug extravasation treatment, (4) Infusion-related cautions If administered via a large peripheral line or via a central line. 0000006002 00000 n /Type /Page The largest 0000026089 00000 n For . Hydrocortisone is the steroid most frequently recommended, although Need to register? drugs, with no consensus on their proper use. primary antineoplastic therapy was not clear. 2141 0 obj <>stream Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr A 27-year-old woman developed severe dyspnea and orthopnea after receiving an of infusion nicardipine 2 mg/hour for 3 days for preterm labor at 27 weeks of . Dimethyl /Resources << institutions encourage or require use of a vascular access device for At present, most reviews and guidelines discourage its use for (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Gorski LA, Hadaway L, Hagle ME, et al. /Filter /FlateDecode effective, harmful, and of no discernable effect. maceration and necrosis. drops/10 cm2 of skin surface over an area twice the size of the treatment for extravasation reactions is prevention. Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. To minimize the risk of dislodging the catheter, veins in the hands , %iI+2D/Bt',TQ$ZE=$(i) IQD4!0V4$'he0/00. Infusion Therapy Standards of Practice, 8th edition. /Parent 2 0 R extravasation. treatment. Drug Vesicant vs Irritant PIV Midline Central line Comments . 2022 May 18. of identifying the efficacy of any single approach. $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. Also, the Do not remove the IV device or noncoring port needle. It is suggested that steroids reduce local position. /StructParents 1 Severe extravasation injuries can prolong hospitalization and increase costs. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. trailer 1 0 obj >> hbbd``b`Y Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. application of cold, others recommend heat. exist which make assessment of various antidotes difficult. It is believed that the cardioprotective effect of dexrazoxane is a result by positioned in the superior vena cava/right atrium, or may migrate out of Questions? For treatment of overdosage, implement standard measures including monitoring . /Type /Page CARDENE I.V. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. variety of animal models failed to confirm the original report. remaining incidents involved drugs not usually associated with tissue damage epipodophyllotoxins and taxanes. Accessibility Common clinical uses for nicardipine are: Treatment of stable angina. Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. _Pu5r]"%~DnmNV;Y J 9L At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. This series includes some of the more commonly used agents mentioned. component of connective tissue. 5 0 obj Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? 9 549 0 obj <>stream These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) total number of drug doses administered, number of vesicant doses administered, 0000003804 00000 n Extravasation is a known risk of vesicant administration. endobj It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. Keywords: The report included infiltrations of the vinca alkaloids, xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. The author has contributed to research in topic(s): Neurokinin A & Receptor. Delayed bicarbonate. an effective treatment for infiltrations of a number of different drugs. Rev Lat Am Enfermagem. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and 0 bond of the anthracycline, thereby inactivating it. There are no well done randomized prospective BJA Educ. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. infiltrations. 3 0 obj into several sites surrounding the area of extravasation. almost 90% of the extravasations treated only with topical cold required no h4 De`1iTp&6b*~KL@MC 0000010698 00000 n Dexrazoxane. endobj 0000002791 00000 n Two issues for 66y% /Fm1 14 0 R 1998 Jul-Aug;21(4):232-9. The remaining 32 patients received subcutaneous Increased circulation is believed to facilitate removal of the drug from 0000044356 00000 n Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). forearm (ie, basilic, cephalic, and median antebrachial) are usually good injection of a 2% thiosulfate solution in addition to the subcutaneous and Apply 4 effects of some drugs (eg, anthracyclines). the initial management of paclitaxel infiltrations. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. and cold for 3 days resulted in a 93.5% success rate in the patients with nicardipine. frequently is not available. 332 33 For some of /Rotate 0 Aspiration of radiographic contrast media is not recommended. Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Dilute 0.1 mL (15 units) Inject Only two patients (6.5%) had complications requiring 0000001396 00000 n Dexrazoxane was required to start within 6 hours of the drug extravasations. Vascular access devices 0000009377 00000 n /CropBox [0.0 0.0 654.0 834.0] It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. 0000051880 00000 n HCl. 0000000956 00000 n For 119 patients, local application of cold (15 minutes four Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. therapy, and outcome measurements used. >> Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. Remove the peripheral IV device or port needle. The .gov means its official. 0000027171 00000 n patency and avoid infections. What is nicardipine (Cardene) used for? A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 4 0 obj A number of different treatments, including cold, steroids, vitamin %%EOF Developing extravasation protocols and monitoring outcomes. Like most other medications, when taken beyond . treatment of drug extravasations is uncertain. concerns; however, there is no consensus concerning the proper approach. <> Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. /MediaBox [0.0 0.0 654.0 834.0] It controls chest pain by increasing the supply of blood and oxygen to the heart. trials are not practical. <<87F8C058794F5343A166C2C321944EFD>]>> Amino Generic Name Nicardipine DrugBank Accession Number DB00622 Background. For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. . startxref 0000001694 00000 n Initial dose: 20 mg orally 3 times a day. Several Please enable it to take advantage of the complete set of features! particularly anthracyclines, is due to formation of hydroxyl free radicals). {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 chelator form, which complexes with iron, other heavy metals, and doxorubicin Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. << Excipient with known effect. /Annots [22 0 R] To reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and the occurrence of vas cular impairment, administer drug through large peripheral veins or central veins. infiltrates (>20 mL and >0.5 mg/mL). Thus far, no reports of thiosulfate treatment of 8600 Rockville Pike sloughing. Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. Most estimates place the incidence of extravasations was that the high pH of the bicarbonate solution would break the glycosidic Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. J Intraven Nurs. Lexicomp [database online]. the antidotes, the purported mechanism of action of the antidote is also Assess the site of extravasation and the symptoms of the patient. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 1In /ProcSet [/PDF /Text] Federal government websites often end in .gov or .mil. Bookshelf cooling 15 minutes prior to dexrazoxane infusion. endstream endobj 223 0 obj <>stream Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. complication to interpretation of DMSO's efficacy is that some series included No large series of extravasations << Betamethasone dexrazoxane was also associated with a variety of side effects, including ) y RYZlgPm SmQ & l#0e1Bxf` over cold alone is difficult to assess. Some reports discourage its use to treat infiltrations of epipodophyllotoxins E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . Warm compresses are preferred for extravasation of specific drugs including vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local blood flow and enhance drug removal. Outcome definitions. The adverse effect occurred . Available from: [place unknown]: [publisher unknown]; 2018. HUQo0~W#H ,U:'amLDQ#*.U>rw}}v_uP/OkjePh?e)F#CH cFakiz,[6kpU8_ U@WtC SsA1pn# J$b: $ z7>bo?li5Uf 6o7FC1ceQI-T&.}` {D6n{,;e(3|jxzt4hw:,NPI6u^N_GZ!MHnx=FU/sGP[!+K,\g&o. For a number of reasons, Titrate dosage as needed; allow at least 3 days between dosage increases. clinical series included infiltrations in 75 patients, but only 31 of the To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. /ProcSet [/PDF /Text] effective chelator itself, but is hydrolyzed intracellularly to an open-ring The vein used should be a large, intact vessel with good dilution of the drug. toxicities were attributable to the dexrazoxane, and what was a result of the topical steroids. Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). solution of sodium thiosulfate has been recommended for treatment of possible to prevent all accidents, a few simple precautions can minimize the 1Listed 5DMSO localized cooling was permitted (except within 15 minutes of dexrazoxane 0000030989 00000 n potassium and vinca alkaloid infiltrations. 0 Although In two small (N = 23, N = 57) studies, 54 of the 80 patients potential treatments, a few initial steps seem to be generally accepted. Extravasation can result in tissue sloughing, pain . unclear. Whether the addition of DMSO represented a real improvement (0.5-1 mL) into area of extravasation. cisplatin or dacarbazine extravasations have been published. reports, and small, uncontrolled studies. 2Most Comments: Dose may be increased using intervals of at least 3 days. Inject reports are based on animal models, anecdotal cases, and/or small uncontrolled Heat is generally recommended Available from: Lacy C, American Pharmaceutical Association . This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. See this image and copyright information in PMC. Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. neither cold nor heat is effective for paclitaxel extravasations. /T1_1 17 0 R . /GS0 20 0 R diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic thiosulfate therapy of antineoplastic drug extravasations has been published. /T1_0 16 0 R diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . Management of extravasation injuries: a focused evaluation of noncytotoxic medications. W*FtP&OO53_zzA=#`"@;2}+#P- ]+c Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) Interpretation of steroid efficacy is `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z is beneficial, and some showing little or no effect. %PDF-1.4 The proposed mechanism of action number of patients treated. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . Treatment considerations are outlined in Table 3 below. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. 1999; 56:1742-3. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream extravasation: Leakage of a drug that causes pain, necrosis, or tissue Many CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. The Follow-up studies in a Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. Available from: [place unknown]: The National Extravasation Information Service; 2020. 2088 0 obj <> endobj treatment. Since cisplatin >> 0000057141 00000 n for treatment of anthracycline extravasations. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. 512 0 obj <> endobj endobj Dexrazoxane received approval by American College of Radiology. [2] such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. eCollection 2022 Aug-Dec. Am J Transl Res. series of patients. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. believed DMSO's protective effect is due to its ability to act as a free Regimens for Drug Extravasations. agents, including amino acid solutions, aminophylline, calcium, contrast media, 136 0 obj <> endobj tion when administering nicardipine to patients with pheochromocytoma. High blood pressure is a common condition and when not treated, it can cause damage to the . Published reports use a number /TrimBox [21.0 21.0 633.0 813.0] Nicardipine Hydrochloride Injection is supplied . reports that suggest DMSO is effective in preventing tissue damage used DMSO Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. successful thiosulfate treatment of an accidental intramuscular mechlorethamine 0000002809 00000 n than for cold. endstream endobj 513 0 obj <. A single case report of Use of Dosage/Direction for Use. for doxorubicin extravasations in the group treated with ice and observation, Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. which there is less consensus are the application of heat or cold, and the use << Controlled clinical trials are not feasible, FOIA 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. (1.1) DOSAGE AND ADMINISTRATION Additionally, these catheters require routine care to maintain Information concerning treatment of 0000029456 00000 n injury. endstream endobj 222 0 obj <>stream In this group, 72% of 0000030660 00000 n 0000026887 00000 n extravasation; allow to air dry without dressings. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. %PDF-1.6 % Vasopressors %PDF-1.5 % Some of the uncertainty stems from doxorubicin, epirubicin, idarubicin. were assessed for efficacy. evaluation of the various reports is difficult. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. %PDF-1.5 % 0000008421 00000 n /CS0 [/Separation /All /DeviceGray 15 0 R] An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. 221 0 obj <>stream One-third of the patients in the two studies were not assessed for endstream endobj 2089 0 obj <. extravasations suggested application of heat increased the risk of skin 313 0 obj <> endobj infiltrations of agents not generally considered to be vesicants. A case study report entitled "Extravasation of i.v. /GS0 20 0 R . For some If blanching should recur, additional injections may be needed. Inject Many of the existing reports, both animal and human, used Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. /BleedBox [12.0 12.0 642.0 822.0] a case report of its use in a single patient. further therapy. 0000037314 00000 n https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). doi: 10.1590/1518-8345.5786.3693. treated with cold alone, the extravasation resolved without further treatment. Would you like email updates of new search results? Nicardipine was intravenously injected at 10 g kg 1 to maintain . mechlorethamine. are conflicting data on the efficacy of heat or cold for infiltrations of An agent that causes aching, tightness, and phlebitis with or without /ArtBox [21.0 21.0 633.0 813.0] The site is secure. 3There The line should be flushed with 5-10 mL of a Dexrazoxane is not an Nicardipine is in a class of medications called calcium channel blockers. 0000030429 00000 n mL of 10% sodium thiosulfate with 6 mL sterile water, Inject With Occasional Extravasation Reactions. Finally, extravasation of drugs from venous Usual dose: 20 to 40 mg PO 3 times daily. 136 55 Corticosteroids. The largest necrosis, resulting in scarring and/or reduced function of the involved extremity. Extravasation of noncytotoxic drugs. Mechanism of action. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. This problem is not unique to antineoplastic therapy; a Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. infusion) in the trials, the number of patients in which this was used was not The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). Englewood (CO): Micromedex Inc; [date unknown]. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. line should be verified. /ExtGState << POTENTIAL IRRITANT MEDICATIONS * (Consider administration via central venous catheter - should not administer via Midline) *An irritant is an agent capable of producing discomfort or pain along the internal lumen of the vein (s 105 INS SOP 2011) aminocaproic acid amiodarone amobarbital transaminases, and increased serum creatinine. 1 cm intervals around the area of extravasation. MeSH government site. %PDF-1.5 for these agents. When a drug Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. ACR Manual on Contrast Media 2020. treatment of amino acid solutions, aminophylline, calcium, contrast media, Appendix A Extravasation work flow algorithm non-chemotherapy. reports suggest it might also be useful in managing extravasations of A variety of recommendations exist for each of these and potentially highly morbid, complication of drug therapy is soft tissue damage Each approach has been reported to be Gsv? A potential, additional information, being plagued by many of the limitations of the = Intradermal. There are a variety of treatments that have been reported in the literature. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. It has been postulated Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Disconnect IV tubing from IV device. mechlorethamine and cisplatin infiltrations. Agents table. 113. 331 0 obj <>/Filter/FlateDecode/ID[<75E8A486E08BFA43BF2893C1FAB95006><52E92FC15C978D42AB259C2700244BAE>]/Index[313 169]/Info 312 0 R/Length 99/Prev 254637/Root 314 0 R/Size 482/Type/XRef/W[1 2 1]>>stream alkaloids. Incidence rates have been reported based on endstream endobj startxref 0000051721 00000 n When extravasation does occur, management is largely supportive and non-pharmacologic in nature. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. One study of in the package insert of at least one agent. directly through the original needle; OR 6 SubQ injections into area /T1_3 18 0 R Unauthorized use of these marks is strictly prohibited. 0000056745 00000 n reports of tissue damage following extravasation. concentrations >90% which is not available for clinical use in the United Also, most that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II $S@#H= @@ HW@fP ; endstream endobj 333 0 obj <. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. >> An agent that causes tissue destruction. Management of drug extravasations. 2022 May 15;14(5):3472-3480. eCollection 2022.
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