2.1 Cytotoxic drug-induced side
effects
DETOXIFYING DRUGS›UROPROTECTIVE DRUGS
Mesna
lINDICATIONS AND DOSE
Urothelial toxicity following oxazaphosphorine therapy
▶BY INTRAVENOUS INJECTION, OR BY CONTINUOUS
INTRAVENOUS INFUSION
▶Child:(consult local protocol)
Mucolytic in cystic fibrosis
▶BY INHALATION OF NEBULISED SOLUTION
▶Child: 3 – 6 mL twice daily, use a 20 % solutionlUNLICENSED USENot licensed for use in children.
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.arthralgia.
asthenia.chest pain.chills.concentration impaired.
conjunctivitis.constipation.cough.dehydration.
diarrhoea.dizziness.drowsiness.dry mouth.dyspnoea.
dysuria.fever.flatulence.flushing.gastrointestinal
discomfort.haemorrhage.headache.hyperhidrosis.
influenza like illness.laryngeal discomfort.
lymphadenopathy.malaise.myalgia.nasal congestion.
nausea.oral irritation.pain.palpitations.respiratory
disorders.sensation abnormal.skin reactions.sleep
disorders.syncope.vision disorders.vomiting
▶Frequency not knownAcute kidney injury.angioedema.
drug reaction with eosinophilia and systemic symptoms
(DRESS).hypotension.hypoxia.oedema.tachycardia.
ulcer.vulvovaginal rash
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of hypersensitivity to thiol-containing compounds.
lPREGNANCYNot known to be harmful. See alsoPregnancy
and reproductive functionin Cytotoxic drugs p. 531.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Mesna (Non-proprietary)
Mesna 100 mg per 1 mlMesna 1 g/ 10 ml solution for injection
ampoules| 15 ampouleP£ 441. 15
Mesna 400 mg/ 4 ml solution for injection ampoules| 5 ampouleP
£ 18. 90 | 15 ampouleP£ 201. 15
VITAMINS AND TRACE ELEMENTS›FOLATES
Folinic acid
lINDICATIONS AND DOSE
Reduction of methotrexate-induced toxicity
▶BY MOUTH, OR BY INTRAVENOUS INFUSION, OR BY
INTRAVENOUS INJECTION
▶Child:(consult local protocol)
Methotrexate overdose
▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶Child:(consult local protocol)
Megaloblastic anaemia due to folate deficiency
▶BY MOUTH
▶Child 1 month–11 years: 250 micrograms/kg once daily
▶Child 12–17 years: 15 mg once daily
Metabolic disorders leading to folate deficiency
▶BY MOUTH, OR BY INTRAVENOUS INFUSION
▶Child: 15 mg once daily, larger doses may be required in
older childrenPrevention of megaloblastic anaemia associated with
pyrimethamine and sulfadiazine treatment of congenital
toxoplasmosis
▶BY MOUTH
▶Neonate: 5 mg 3 times a week; increased if necessary up
to 20 mg 3 times a week, if the patient is neutropenic.▶Child 1–11 months: 10 mg 3 times a weekSODIOFOLIN®
As an antidote to methotrexate
▶BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶Child:(consult product literature)lUNLICENSED USEConsult product literature for licensing
status of individual preparations.
lCONTRA-INDICATIONSIntrathecal injection
lCAUTIONSAvoid simultaneous administration of
methotrexate.notindicated for pernicious anaemia or
other megaloblastic anaemias caused by vitamin B 12
deficiency
lINTERACTIONS→Appendix 1 : folates
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶UncommonFever
▶Rare or very rareAgitation (with high doses).depression
(with high doses).epilepsy exacerbated.gastrointestinal
disorder (with high doses).insomnia (with high doses).
urticaria
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶With intravenous useBone marrow failure.dehydration.
diarrhoea (with high doses).mucositis.nausea.oral
disorders.skin reactions.vomiting
▶Rare or very rare
▶With intravenous useSensitisation
▶Frequency not known
▶With intravenous useHyperammonaemia
lPREGNANCYNot known to be harmful; benefit outweighs
risk.
lBREAST FEEDINGPresence in milk unknown but benefit
outweighs risk.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Folinic acid (Non-proprietary)
Folinic acid (as Calcium folinate) 15 mgCalcium folinate 15 mg
tablets| 10 tabletP£ 49. 00 DT = £ 46. 92
▶Refolinon(Pfizer Ltd)
Folinic acid (as Calcium folinate) 15 mgRefolinon 15 mg tablets|
30 tabletP£ 85. 74
Solution for injection
▶Folinic acid (Non-proprietary)
Folinic acid (as Calcium folinate) 7.5 mg per 1 mlCalcium folinate
15 mg/ 2 ml solution for injection ampoules| 5 ampouleP£ 39. 00
DT = £ 39. 00 | 5 ampouleP£ 39. 00 DT = £ 39. 00 (Hospital only)
Folinic acid (as Calcium folinate) 10 mg per 1 mlCalcium folinate
300 mg/ 30 ml solution for injection vials| 1 vialP£ 100. 00
(Hospital only)
Calcium folinate 50 mg/ 5 ml solution for injection vials| 1 vialP
£ 20. 00 (Hospital only)
Calcium folinate 100 mg/ 10 ml solution for injection vials| 1 vialP
£ 37. 50 (Hospital only)
Folinic acid (as Disodium folinate) 50 mg per 1 mlDisodium
folinate 50 mg/ 1 ml solution for injection vials| 1 vialP£ 24. 70
Disodium folinate 200 mg/ 4 ml solution for injection vials| 1 vialP
£ 80. 40
▶Refolinon(Pfizer Ltd)
Folinic acid (as Calcium folinate) 3 mg per 1 mlRefolinon
30 mg/ 10 ml solution for injection ampoules| 5 ampouleP£ 23. 12
(Hospital only)BNFC 2018 – 2019 Cytotoxic drug-induced side effects 555
Immune system and malignant disease8