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Varicocele embolisation - patient information

Description
This factsheet explains what varicocele embolisation is, what the procedure involves and what the possible risks are.
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/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Varicocele-embolisation-3609-PIL.pdf

Radiologically inserted gastrostomy (RIG) tube - patient information

Description
This factsheet provides information about having a radiologically inserted gastrostomy (RIG) tube and what you can expect at your appointment.
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Radiologically-inserted-gastrostomy-RIG-tube-2305-PIL.pdf

Great saphenous vein harvesting for a coronary artery bypass graft (CABG) - patient information

Description
This factsheet explains what great saphenous vein harvesting is and what the procedure involves, so you know what to expect.
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Great-saphenous-vein-harvesting-for-a-coronary-artery-bypass-graft-CABG-3401-PIL.pdf

Having an ultrasound-guided tunnelled drain insertion - patient information

Description
This factsheet explains what an ultrasound-guided tunnelled drain insertion is, what the procedure involves and how to prepare for it.
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Having-an-ultrasound-guided-tunnelled-drain-insertion-3302-PIL.pdf

Angiogram and angioplasty - patient information

Description
Information about angiogram to assess the blood flow into your leg and angioplasty to improve the blood flow.
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Angiogram-and-angioplasty-1655-PIL.pdf

Bronchoscopy (surgical) - patient information

Description
This factsheet contains information about having a bronchoscopy (surgical).
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Bronchoscopy-surgical-3130-PIL.pdf

MyelomaPAD-Bortezomib(SC)DexamethasoneDoxorubicinVer1

Description
Chemotherapy Protocol MULTIPLE MYELOMA PAD (SC)-BORTEZOMIB (SC)-DEXAMETHASONE-DOXORUBICIN Regimen Multiple Myeloma – PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Indication Second or subsequent line treatment of transplant eligible multiple myeloma. Toxicity Drug Bortezomib Dexamethasone Doxorubicin Adverse Effect GI disturbances, peripheral neuropathy, hypotension, dizziness, blurred vision, headache, musculoskeletal pain, pyrexia Weight gain, GI disturbances, hyperglycaemia, CNS disturbances, cushingoid changes, glucose intolerance Cardiomyopathy, alopecia, urinary discolouration (red) The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring FBC prior to day 1. Days 4, 8, 11 are optional. LFTs and U&Es on day 1 Paraprotein or light chains every 3-6 weeks Regular monitoring of blood glucose is considered good practice Ensure adequate cardiac function before starting therapy. Baseline LVEF should be measured in patients with a history of cardiac problems, cardiac risk factors or in the elderly. Discontinue doxorubicin if cardiac failure develops Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1 (May 2016) Page 1 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Haematological Dose modifications for haematological toxicity in the table below are for general guidance only. Always refer to the responsible consultant as any dose reductions or delays will be dependent on clinical circumstances and treatment intent. Low counts can be a consequence of bone marrow infiltration as well as drug toxicity. Dose modifications based on haematological parameters apply to bortezomib and doxorubicin only. In the presence of cytopenias due to bone marrow involvement with myeloma, it is possible that the day 1 dose will go ahead even if the neutrophils are less than 1x109/L and platelets less than 75x109/L. Consider blood transfusion or erythropoietin if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Neutrophils (x109/L) 1 or greater and Platelets (x109/L) 75 or greater Dose (bortezomib and doxorubicin) 100% less than 1 or less than 75 Delay on a weekly basis until recovery If the neutrophil count is less than 1x109/L and platelets less than 75x109/L on day 1 of subsequent cycles (when previously greater than these levels) delay on a weekly basis until recovery and then decrease the bortezomib dose to 1mg/m2 and the doxorubicin dose to 6mg/m2 per day (24mg/m2 in total). If further toxicity occurs where neutrophils are less than 1x109/L and platelets less than 75x109/L on day 1, delay weekly until recovery and reduce the dose of bortezomib to 0.7mg/m2 and doxorubicin to 4.5mg/m2 per day (18mg/m2 in total). Neutrophils (x109/L) 0.75 or greater and less than 0.75 or Platelets (x109/L) 30 or greater less than 30 Dose (bortezomib and doxorubicin) 100% Delay on a weekly basis until recovery and reinitiate at a reduced dose Version 1 (May 2016) Page 2 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Hepatic Impairment Please note that the approach may be different where abnormal liver function tests are due to disease involvement. Drug Bortezomib Bilirubin μmol/L 1.5xULN or below greater than 1.5xULN AST/ALT units/L N/A N/A Dose (% of original dose) 100% Initiate treatment at 0.7mg/m2. The dose may be escalated to 1mg/m2 or reduced to 0.5mg/m2 in subsequent cycles based on patient tolerability. Doxorubicin less than 30 30-50 51-85 more than 85 and and/or 2-3xULN More than 3xULN N/A N/A 75% 50% 25% omit Renal Impairment Drug Bortezomib Creatinine Clearance (ml/min) greater than 20 20 and below Dose (% of original dose) 100% Clinical decision Doxorubicin less than 10 Consider dose reduction in severe renal failure Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Version 1 (May 2016) Page 3 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Bortezomib Neuropathic pain and/or peripheral neuropathy For patients experiencing NCI-CTC grade 1 neuropathy continue with full dose. For NCI-CTC grade 1 with pain or grade 2 neuropathy reduce the dose of bortezomib to 1mg/m2 or switch to a weekly bortezomib at the standard dose of 1.3mg/m2 For NCI-CTC grade 2 with pain or grade 3 neuropathy discontinue treatment until symptoms have resolved to NCI-CTC grade 1 or less then reinitiate bortezomib at a dose of 0.7mg/m2 For NCI-CTC grade 4 neuropathy and/or severe autonomic neuropathy discontinue bortezomib. Subcutaneous administration should also be considered as the incidence and severity of peripheral neuropathy has been shown to be less when bortezomib is given by this route. For any other NCI-CTC grade 3 non haematological toxicity bortezomib should be discontinued until symptoms have resolve to NCI-CTC grade 1 or below. On the first occurrence treatment may be reinitiated at a dose of 1mg/m2. Following second occurrence to dose should be further reduced to 0.7mg/m2 once symptoms have resolved. If the toxicity is not resolved or if it recurs at the lowest dose, discontinuation of bortezomib must be considered unless the benefit of treatment clearly outweighs the risk. Dexamethasone For patients who are elderly or unable to tolerate the standard dose of dexamethasone the dose given the day after bortezomib may be omitted or the dose reduced to avoid omission. Doxorubicin Discontinue doxorubicin if cardiac failure develops Regimen 21 day cycle continued to plateau plus two cycles (6 cycles will be set in Aria) Drug Bortezomib Dexamethasone Doxorubicin Dose 1.3mg/m2 40mg once a day 9mg/m2 Days 1, 4, 8, 11 1, 2, 3, 4 1, 2, 3, 4 Administration Subcutaneous injection Oral Intravenous infusion over 96 hours (36mg/m2 in total) via a portable infusion device Dose Information Bortezomib will be dose banded according to the agreed bands Dexamethasone is available as 2mg and 500mcg tablets Doxorubicin will be dose banded according to the agreed bands Version 1 (May 2016) Page 4 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin The maximum lifetime cumulative dose of doxorubicin is 450mg/m². However prior radiotherapy to mediastinal/pericardial area should receive a lifetime cumulative doxorubicin dose of no more than 400mg/m² Administration Information Extravasation Bortezomib – neutral Doxorubicin - vesicant Other At least 72 hours should elapse between consecutive doses of bortezomib. Dexamethasone should be taken in the morning, with or after food The doxorubicin dose can be administered as a daily intravenous bolus injection if there is no portable pump available Additional Therapy Anti-emetics 15-30 minutes prior to chemotherapy on day 1 - ondansetron 8mg oral or intravenous As take home medication - metoclopramide 10mg three times a day oral when required - ondansetron 8mg twice a day for 5 days starting on the evening of day 1 Consider allopurinol 300mg once a day for seven days for the first cycle only oral Anti-infective prophylaxis with; - aciclovir 400mg twice a day a day oral - co-trimoxazole 960mg once a day on Monday, Wednesday and Friday only Bisphosphonates in accordance with local policies Mouthwashes according to local or national policy on the treatment of mucositis Laxatives may be considered if ondansetron is taken for 5 days Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. Version 1 (May 2016) Page 5 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Coding Procurement – X71.5 Delivery – X72.3, X72.4 References 1. Oakervee HE et al. PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma. Br J Haem 2005; 129: 755-762. Version 1 (May 2016) Page 6 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin REGIMEN SUMMARY PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Cycle 1 Day 1 1. Ondansetron 8mg oral or intravenous 2. Bortezomib 1.3mg/m2 subcutaneous injection 3. Doxorubicin 36mg/m2 over 96 hours via a portable infusion device Day 4, 8, 11 4. Bortezomib 1.3mg/m2 subcutaneous injection Take Home Medicines (day 1 only) 5. Dexamethasone 40mg oral once a day in the morning on days on day 1, 2, 3, 4 Administration Instructions Take in the morning with or after food. 6. Metoclopramide 10mg oral up to three times a day when required for the relief of nausea Administration Instructions When required for the relief of nausea. Please supply 28 tablets or nearest original pack size 7. Ondansetron 8mg twice a day starting on the evening of day 1 for 5 days 8. Aciclovir 400mg twice times a day for 21 days Administration Instructions Please supply 21 days or an original pack if appropriate. 9. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 21 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 21 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 10. Allopurinol 300mg once a day for seven days oral Administration Instructions Take with or after food with plenty of water. Please supply 7 days. 11. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 21 days or nearest original pack size. Version 1 (May 2016) Page 7 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin Cycle 2, 3, 4, 5, 6 Day 1 12. Ondansetron 8mg oral or intravenous 13. Bortezomib 1.3mg/m2 subcutaneous injection 14. Doxorubicin 36mg/m2 over 96 hours via a portable infusion device Day 4, 8, 11 15. Bortezomib 1.3mg/m2 subcutaneous injection Take Home Medicines (day 1 only) 16. Dexamethasone 40mg oral once a day in the morning on days on day 1, 2, 3, 4 Administration Instructions Take in the morning with or after food. 17. Metoclopramide 10mg oral up to three times a day when required for the relief of nausea Administration Instructions When required for the relief of nausea. Please supply 28 tablets or nearest original pack size 18. Ondansetron 8mg twice a day starting on the evening of day 1 for 5 days 19. Aciclovir 400mg twice times a day for 21 days Administration Instructions Please supply 21 days or an original pack if appropriate. 20. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 21 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 21 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 21. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 21 days or nearest original pack size. Version 1 (May 2016) Page 8 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin DOCUMENT CONTROL Version Date Amendment Written By Approved By 1 May 2016 None Dr Deborah Wright Pharmacist Dr Mathew Jenner Consultant Haematologist Dr Helen Dignum Consultant Haematologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors that occur as a result of following these guidelines. Version 1 (May 2016) Page 9 of 9 Multiple Myeloma–PAD (SC)-Bortezomib (SC)-Dexamethasone-Doxorubicin
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Myeloma/MyelomaPAD-BortezomibSCDexamethasoneDoxorubicinVer1.pdf

MyelomaPAD-Bortezomib(IV)DexamethasoneDoxorubicinVer1

Description
Chemotherapy Protocol MULTIPLE MYELOMA PAD (IV)-BORTEZOMIB (IV)-DEXAMETHASONE-DOXORUBICIN Regimen Multiple Myeloma – PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Indication Second or subsequent line treatment of transplant eligible multiple myeloma. Toxicity Drug Bortezomib Dexamethasone Doxorubicin Adverse Effect GI disturbances, peripheral neuropathy, hypotension, dizziness, blurred vision, headache, musculoskeletal pain, pyrexia Weight gain, GI disturbances, hyperglycaemia, CNS disturbances, cushingoid changes, glucose intolerance Cardiomyopathy, alopecia, urinary discolouration (red) The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring FBC prior to day 1. Days 4, 8, 11 are optional. LFTs and U&Es on day 1 Paraprotein or light chains every 3-6 weeks Regular monitoring of blood glucose is considered good practice Ensure adequate cardiac function before starting therapy. Baseline LVEF should be measured in patients with a history of cardiac problems, cardiac risk factors or in the elderly. Discontinue doxorubicin if cardiac failure develops Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1 (May 2016) Page 1 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Haematological Dose modifications for haematological toxicity in the table below are for general guidance only. Always refer to the responsible consultant as any dose reductions or delays will be dependent on clinical circumstances and treatment intent. Low counts can be a consequence of bone marrow infiltration as well as drug toxicity. Dose modifications based on haematological parameters apply to bortezomib and doxorubicin only. In the presence of cytopenias due to bone marrow involvement with myeloma, it is possible that the day 1 dose will go ahead even if the neutrophils are less than 1x109/L and platelets less than 75x109/L. Consider blood transfusion or erythropoietin if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Neutrophils (x109/L) 1 or greater and Platelets (x109/L) 75 or greater Dose (bortezomib and doxorubicin) 100% less than 1 or less than 75 Delay on a weekly basis until recovery If the neutrophil count is less than 1x109/L and platelets less than 75x109/L on day 1 of subsequent cycles (when previously greater than these levels) delay on a weekly basis until recovery and then decrease the bortezomib dose to 1mg/m2 and the doxorubicin dose to 6mg/m2 per day (24mg/m2 in total). If further toxicity occurs where neutrophils are less than 1x109/L and platelets less than 75x109/L on day 1, delay weekly until recovery and reduce the dose of bortezomib to 0.7mg/m2 and doxorubicin to 4.5mg/m2 per day (18mg/m2 in total). Neutrophils (x109/L) 0.75 or greater and less than 0.75 or Platelets (x109/L) 30 or greater less than 30 Dose (bortezomib and doxorubicin) 100% Delay on a weekly basis until recovery and reinitiate at a reduced dose Version 1 (May 2016) Page 2 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Hepatic Impairment Please note that the approach may be different where abnormal liver function tests are due to disease involvement. Drug Bortezomib Bilirubin μmol/L 1.5xULN or below greater than 1.5xULN AST/ALT units/L N/A N/A Dose (% of original dose) 100% Initiate treatment at 0.7mg/m2. The dose may be escalated to 1mg/m2 or reduced to 0.5mg/m2 in subsequent cycles based on patient tolerability. Doxorubicin less than 30 30-50 51-85 more than 85 and and/or 2-3xULN More than 3xULN N/A N/A Renal Impairment Drug Bortezomib Creatinine Clearance (ml/min) greater than 20 20 and below 75% 50% 25% omit Dose (% of original dose) 100% Clinical decision Doxorubicin less than 10 Consider dose reduction in severe renal failure Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Version 1 (May 2016) Page 3 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Bortezomib Neuropathic pain and/or peripheral neuropathy For patients experiencing NCI-CTC grade 1 neuropathy continue with full dose. For NCI-CTC grade 1 with pain or grade 2 neuropathy reduce the dose of bortezomib to 1mg/m2 or switch to a weekly bortezomib at the standard dose of 1.3mg/m2 For NCI-CTC grade 2 with pain or grade 3 neuropathy discontinue treatment until symptoms have resolved to NCI-CTC grade 1 or less then reinitiate bortezomib at a dose of 0.7mg/m2 For NCI-CTC grade 4 neuropathy and/or severe autonomic neuropathy discontinue bortezomib. Subcutaneous administration should also be considered as the incidence and severity of peripheral neuropathy has been shown to be less when bortezomib is given by this route. For any other NCI-CTC grade 3 non haematological toxicity bortezomib should be discontinued until symptoms have resolve to NCI-CTC grade 1 or below. On the first occurrence treatment may be reinitiated at a dose of 1mg/m2. Following second occurrence to dose should be further reduced to 0.7mg/m2 once symptoms have resolved. If the toxicity is not resolved or if it recurs at the lowest dose, discontinuation of bortezomib must be considered unless the benefit of treatment clearly outweighs the risk. Dexamethasone For patients who are elderly or unable to tolerate the standard dose of dexamethasone the dose given the day after bortezomib may be omitted or the dose reduced to avoid omission. Doxorubicin Discontinue doxorubicin if cardiac failure develops Regimen 21 day cycle continued to plateau plus two cycles (6 cycles will be set in Aria) Drug Bortezomib Dexamethasone Doxorubicin Dose 1.3mg/m2 40mg once a day 9mg/m2 Days 1, 4, 8, 11 1, 2, 3, 4 1, 2, 3, 4 Administration Intravenous injection over 5 seconds Oral Intravenous infusion over 96 hours (36mg/m2 in total) via a portable infusion device Dose Information Bortezomib will be dose banded according to the agreed bands Dexamethasone is available as 2mg and 500mcg tablets Doxorubicin will be dose banded according to the agreed bands Version 1 (May 2016) Page 4 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin The maximum lifetime cumulative dose of doxorubicin is 450mg/m². However prior radiotherapy to mediastinal/pericardial area should receive a lifetime cumulative doxorubicin dose of no more than 400mg/m² Administration Information Extravasation Bortezomib – neutral Doxorubicin - vesicant Other At least 72 hours should elapse between consecutive doses of bortezomib. Dexamethasone should be taken in the morning, with or after food The doxorubicin dose can be administered as a daily intravenous bolus injection if there is no portable pump available Additional Therapy Anti-emetics 15-30 minutes prior to chemotherapy on day 1 - ondansetron 8mg oral or intravenous As take home medication - metoclopramide 10mg three times a day oral when required - ondansetron 8mg twice a day for 5 days starting on the evening of day 1 Consider allopurinol 300mg once a day for seven days for the first cycle only oral Anti-infective prophylaxis with; - aciclovir 400mg twice a day a day oral - co-trimoxazole 960mg once a day on Monday, Wednesday and Friday only Bisphosphonates in accordance with local policies Mouthwashes according to local or national policy on the treatment of mucositis Laxatives may be considered if ondansetron is taken for 5 days Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. Version 1 (May 2016) Page 5 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Coding Procurement – X71.5 Delivery – X72.4, X72.3 References 1. Oakervee HE et al. PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma. Br J Haem 2005; 129: 755-762. Version 1 (May 2016) Page 6 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin REGIMEN SUMMARY PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Cycle 1 Day 1 1. Ondansetron 8mg oral or intravenous 2. Bortezomib 1.3mg/m2 intravenous injection over 5 seconds 3. Doxorubicin 36mg/m2 over 96 hours via a portable infusion device Day 4, 8, 11 4. Bortezomib 1.3mg/m2 intravenous injection over 5 seconds Take Home Medicines (day 1 only) 5. Dexamethasone 40mg oral once a day in the morning on days on day 1, 2, 3, 4 Administration Instructions Take in the morning with or after food. 6. Metoclopramide 10mg oral up to three times a day when required for the relief of nausea Administration Instructions When required for the relief of nausea. Please supply 28 tablets or nearest original pack size 7. Ondansetron 8mg twice a day starting on the evening of day 1 for 5 days 8. Aciclovir 400mg twice times a day for 21 days Administration Instructions Please supply 21 days or an original pack if appropriate. 9. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 21 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 21 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 10. Allopurinol 300mg once a day for seven days oral Administration Instructions Take with or after food with plenty of water. Please supply 7 days. 11. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 21 days or nearest original pack size. Version 1 (May 2016) Page 7 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin Cycle 2, 3, 4, 5, 6 Day 1 12. Ondansetron 8mg oral or intravenous 13. Bortezomib 1.3mg/m2 intravenous injection over 5 seconds 14. Doxorubicin 36mg/m2 over 96 hours via a portable infusion device Day 4, 8, 11 15. Bortezomib 1.3mg/m2 intravenous injection over 5 seconds Take Home Medicines (day 1 only) 16. Dexamethasone 40mg oral once a day in the morning on days on day 1, 2, 3, 4 Administration Instructions Take in the morning with or after food. 17. Metoclopramide 10mg oral up to three times a day when required for the relief of nausea Administration Instructions When required for the relief of nausea. Please supply 28 tablets or nearest original pack size 18. Ondansetron 8mg twice a day starting on the evening of day 1 for 5 days 19. Aciclovir 400mg twice times a day for 21 days Administration Instructions Please supply 21 days or an original pack if appropriate. 20. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 21 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 21 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 21. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 21 days or nearest original pack size. Version 1 (May 2016) Page 8 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin DOCUMENT CONTROL Version Date Amendment Written By Approved By 1 May 2016 None Dr Deborah Wright Pharmacist Dr Mathew Jenner Consultant Haematologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors that occur as a result of following these guidelines. Version 1 (May 2016) Page 9 of 9 Multiple Myeloma–PAD (IV)-Bortezomib (IV)-Dexamethasone-Doxorubicin
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Myeloma/MyelomaPAD-BortezomibIVDexamethasoneDoxorubicinVer1.pdf

Electromagnetic navigational bronchoscopy (ENB) - patient information

Description
This factsheet explains what an electromagnetic navigational bronchoscopy (ENB) is.
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Electromagnetic-navigational-bronchoscopy-ENB-3120-PIL.pdf

Peptide receptor radionuclide therapy (PRRT) - patient information

Description
This factsheet explains what peptide receptor radionuclide therapy (PRRT) is, what the therapy involves, and what the possible benefits and risks are.
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Peptide-receptor-radionuclide-therapy-PRRT-3016-PIL.pdf
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