A A AText only | Accessibility | Privacy and cookies

Browse site A to Z

Search results

Go To Simple Search

Having an endoscopy procedure under General AnaestheticPropofol sedation-diabetes - patient information

Description
Factsheet about the special preparation you will need to follow before an endoscopic procedure if you have diabetes
Url
/Media/UHS-website-2019/Patientinformation/Endoscopy/Having-an-endoscopy-procedure-under-GeneralAnaesthetic-Propofol-sedation-diabetes-3506-PIL.pdf

Gemcitabine-Vinorelbine Ver1.1

Description
Chemotherapy Protocol LYMPHOMA GEMCITABINE-VINORELBINE Regimen Lymphoma – Gemcitabine-Vinorelbine Indication Relapsed or refractor
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lymphoma/Gemcitabine-Vinorelbine-Ver1.1.pdf

InP DoxorubicinIfosfamideVer1

Description
Chemotherapy Protocol SARCOMA DOXORUBICIN-IFOSFAMIDE In-Patient Regimen Regimen Sarcoma – InP-Doxorubicin - Ifosfamide Indication Soft tissue sarcoma WHO performance status 0,1, 2 Toxicity Drug Doxorubicin Ifosfamide Adverse Effect Cardiotoxicity, asthenia, paresthesia, alopecia Haemorrragic cystitis, encephalopathy, nephrotoxicity The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs FBC, LFTs and U&Es (including uric acid, albumin, calcium, magnesium, bicarbonate and phosphate) prior to day one of treatment Urine dip test for protein every four hours the day of and the day after ifosfamide administration EDTA or calculated creatinine clearance prior to each cycle Fluid balance monitoring every four hours the day of and the day after ifosfamide administration. Urine output should be maintained above 100ml/hour Ensure adequate cardiac function before starting therapy. Baseline ECG and LVEF should be measured in patients with a history of cardiac problems 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. Version 1 (February 2016) Page 1 of 7 Sarcoma-InP-Doxorubicin-fosfamide 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. 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 Consider blood transfusion or erythropoietin if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Prior to cycle 1 the following criteria must be met; Criteria Neutrophil Platelets Eligible Level equal to or more than 1x109/L equal to or more than 100x109/L Day 1 Neutrophils (x109/L) 1 or greater 100% Dose Modifications 0.5 - 1 less than 0.5 Platelets (x109/L) Delay until recovery to 1x109/L or greater then continue at full dose Delay until recovery to 1x109/L or greater then continue at 75% of the original dose Dose Modifications 100 or greater 50 - 99 less than 50 100% Delay until recovery to 100x109/L or greater then continue at full dose Delay until recovery to 100x109/L or greater then continue at 75% of the original dose Hepatic Impairment Doses recommended below are for initial dosing. If the first dose of doxorubicin is well tolerated with minimal toxicity and no increase in bilirubin or liver enzymes the dose may be increased from 75% to 100% and from 50% to 75% at the next cycle (and from 75% to 100% on subsequent cycles where appropriate.) Version 1 (February 2016) Page 2 of 7 Sarcoma-InP-Doxorubicin-fosfamide Drug Ifosfamide Bilirubin (μmol/L) more than 20 or AST/ALT (units/L) more than 2,5xULN or ALP more than 2.5xULN Dose (%of original dose) Not recommended Doxorubicin less than *30 *30-50 51-85 more than 85 and 2-3xULN and/or More than 3xULN N/A N/A 75% 50% 25% omit Renal Impairment Drug Ifosfamide Creatinine Clearance (ml/min) more than 60 40-59 Less than 40 Dose (% of original dose) 100% 70% or consider using cyclophosphamide at a dose of 1500mg/m2 Clinical decision, consider using cyclophosphamide at a dose of 1500mg/m2 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. For all other non-haematological NCI-CTC grade 3 and above toxicities delay treatment until the adverse effect has resolved to NCI-CTC grade 1 or below. The dose should then be reduced to 75% of the original dose or discontinued as appropriate. Doxorubicin Discontinue doxorubicin if cardiac failure develops Ifosfamide In the case of a NCI-CTC grade 1 neurological toxicity to ifosfamide, consider reducing the dose of ifosfamide for the next cycle. If a NCI-CTC grade 2 neurologic toxicity appears or neurologic toxicity worsens despite dose reduction consider stopping the ifosfamide. Version 1 (February 2016) Page 3 of 7 Sarcoma-InP-Doxorubicin-fosfamide In the case of NCI-CTC grade 3 or 4 mucositis/GI toxicity reduce dose to 80% on first occurrence and to 60% on second occurrence. In the case of NCI-CTC grade 3 or 4 neutropenic sepsis reduce dose to 80% on first occurrence and to 60% on second occurrence. In the case of delayed recovery of greater than 6 days, reduce dose to 80% on first occurrence and to 60% on second occurrence. Risk factors for CNS toxicity include a low albumin, renal impairment, prior administration of cisplatin, poor performance status, CNS tumour, bulky pelvic disease, concomitant psychotropic drugs and younger age. Methylene blue 50mg four times a day intravenous infusion in 100ml sodium chloride 0.9% over 30 minutes can be used to prevent or treat ifosfamide induced encephalopathy. Regimen 21 day cycle for 6 cycles The dose of doxorubicin in some regimens is 25mg/m2. Check with the relevant consultant before prescribing. Drug Doxorubicin Mesna Ifosfamide Mesna Mesna Dose 20mg/m2 600mg/m2 3000mg/m2 3000mg/m2 1800mg/m2 Days 1, 2, 3 1, 2, 3 1, 2, 3 1, 2, 3 1, 2, 3 Administration Intravenous bolus Intravenous bolus in 100ml sodium chloride 0.9% over 15 minutes Intravenous infusion in 1000ml sodium chloride 0.9% over 240 minutes (the ifosfamide and mesna are in the same bag) Intravenous infusion in 1000ml sodium chloride 0.9% over 12 hours Dose Information Ifosfamide will be dose banded according to the CSCCN agreed bands Mesna will be dose banded according to the CSCCN agreed bands. Doxorubicin will be dose banded according to the CSCCN agreed bands 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. Also consider previous anthracycline exposure. Version 1 (February 2016) Page 4 of 7 Sarcoma-InP-Doxorubicin-fosfamide Administration Information Extravasation Doxorubicin – vesicant Ifosfamide – neutral Additional Therapy This is an inpatient regimen please ensure all supportive and take home medicines are prescribed on the inpatient chart or general electronic prescribing system. Antiemetics Starting 15-30 minutes prior to chemotherapy - dexamethasone 4mg twice a day for 5 days oral or intravenous - metoclopramide 10mg three times a day for 5 days then when required oral or intravenous - ondansetron 8mg twice a day for 5 days oral or intravenous Growth factors according to local formulary choice. For example: - filgrastim or bioequivalent 30 million units once a day from day 6 subcutaneous - lenograstim or bioequivalent 33.6 million units once a day from day 6 subcutaneous - pegfilgrastim or bioequivalent 6mg once only on day 4 subcutaneous Ciprofloxacin 500mg twice a day for 7 days starting on day 8 of the cycle The final dose of mesna on day 3 may be replaced with oral mesna at a dose of 1200mg/m2 (rounded upwards to the nearest 400mg tablet) at 0, 2 and 6 hours after the end of the ifosfamide infusion. Mouthwashes according to local or national policy on the treatment of mucositis 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. Coding Procurement – X70.4 Delivery – not relevant References 1. Judson I, Verweij J, Gelderblom H et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for the first line treatments of advanced or metastatic soft tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol 2014; 15 (4): 415-423. Version 1 (February 2016) Page 5 of 7 Sarcoma-InP-Doxorubicin-fosfamide REGIMEN SUMMARY InP-Doxorubicin-Ifosfamide Day 1 Other than those listed below, supportive medication for this regimen will not appear in Aria as prescribed agents. The administration instructions for each warning describes the agents which must be prescribed on the in-patient chart or general electronic prescribing system Day 1, 2, 3 1. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day day for 5 days oral or intravenous 2. Metoclopramide 10mg three times a day for 5 days oral or intravenous 3. Ondansetron 8mg twice a day for 5 days oral or intravenous 4. Ciprofloxacin 500mg twice a day days 8-15 oral 5. Growth factor according to local formulary choice. For example; - filgrastim or bioequivalent 30 million units once a day for 7 days from day 6 subcutaneous - lenograstim or bioequivalent 33.6 million units once a day for 7 days from day 6 subcutaneous - pegfilgrastim or bioequivalent 6mg once only on day 4 subcutaneous 6. Consider gastric protection 7. Consider mouthwashes 2. Doxorubicin 20mg/m2 intravenous bolus 3. Mesna 600mg/m2 intravenous bolus in 100ml sodium chloride 0.9% over 15 minutes 4. Ifosfamide 3000mg/m2 and mesna 3000mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over 240 minutes 5. Mesna 1800mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over 720 minutes Administration Instructions On day 3 of the cycle (after the last of the ifosfamide infusions) this may be substituted by oral mesna at a dose of 1200mg/m2 rounded upwards to the nearest 400mg tablet given 0, 2 and 6 hours after the end of the ifosfamide infusion. Version 1 (February 2016) Page 6 of 7 Sarcoma-InP-Doxorubicin-fosfamide Version Date 1 February 2016 DOCUMENT CONTROL Amendment Written By Approved By None Dr Deborah Wright Pharmacist Dr Nicola Keay Consultant Medical Oncologist 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 which occur as a result of following these guidelines. Version 1 (February 2016) Page 7 of 7 Sarcoma-InP-Doxorubicin-fosfamide
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Sarcoma/InPDoxorubicinIfosfamideVer1.pdf

Bevacizumab-Irinotecan Ver 1.1

Description
Chemotherapy Protocol COLORECTAL CANCER BEVACIZUMAB-IRINOTECAN This protocol may require funding Regimen Colorectal Cancer – Bevacizumab-Irinot
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Bevacizumab-IrinotecanVer11.pdf

InP (RICE) Carboplatin Etoposide Ifosfamide Rituximab

Description
Chemotherapy Protocol LYMPHOMA CARBOPLATIN-ETOPOSIDE-IFOSFAMIDE-RITUXIMAB (RICE) Inpatient Regimen Regimen • Lymphoma – InP-RICE-Carboplatin-E
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lymphoma/InP-RICE-Carboplatin-Etoposide-Ifosfamide-Rituximab.pdf

O-CVP-Cyclophosphamide-Obinutuzumab-Prednisolone-Vincristine

Description
Chemotherapy Protocol Non-Hodgkin Lymphoma Cyclophosphamide-Obinutuzumab-Prednisolone-Vincristine Regimen (O-CVP) • NHL – O-CVP-Cyclophosphamide
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lymphoma/O-CVP-Cyclophosphamide-Obinutuzumab-Prednisolone-Vincristine.pdf

Gemcitabine

Description
Chemotherapy Protocol PANCREATIC CANCER GEMCITABINE Regimen  Pancreatic Cancer – Gemcitabine Indication  Adjuvant
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Pancreas/Gemcitabine.pdf

ColorectalTrifluridineTipiricilVer1

Description
Chemotherapy Protocol Regimen COLORECTAL CANCER TRIFLURIDINE-TIPIRACIL  Colorectal Cancer – Trifluridine-Tipiracil Indication  Triflu
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/ColorectalTrifluridineTipiricilVer1.pdf

Carboplatin (AUC4.5) Gemcitabine

Description
Chemotherapy Protocol BLADDER CARBOPLATIN (AUC4.5)-GEMCITABINE Regimen  Bladder-Carboplatin-Gemcitabine Indication 
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Bladdercancer/Carboplatin-AUC4.5-Gemcitabine.pdf

Carboplatin(AUC2)-Paclitaxel (7 day)

Description
A chemotherapy protocol on Carboplatin (AUC2) Paclitaxel.
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Cervical-cancer/CarboplatinAUC2-Paclitaxel7day.pdf
191 to 200 of 865
Previous … 18 19 20 21 22 … Next