Marquette General Health System Pharmacy and …

1 Marquette General Health System Pharmacy and Therapeutics Committee medication Guideline Intravenous Medications Requiring Filtration Type of IV Filter Recommended Drug Preparation Administration Comments References Chemotherapeutic Agents: Asparaginase (Elspar ) Not required 5 micron filter needle Gelatinous fibers may develop on standing 1, 2, 3. Cladribine (Leustatin ) micron filter Not required Recommend using a micron filter to prepare a 7- 1, 2, 3. (see comment) day infusion only. It is not necessary to use a micron filter for preparation of single daily dose. Do not use D5W as a diluent as it increases cladribine degradation. Cytarabine intrathecal micron filter Not required Daunorubicin (Cerubidine ) Not required Use a micron 2.

2 Filter Etoposide (Vepesid ) Not required micron in-line Incidence of precipitation with conc. > 1, 2, 3. filter Methotrexate intrathecal micron filter Not required Paclitaxel (Taxol ) Not required micron in-line Recommend using the NON-DEHP IV tubing with the 1, 2, 3. filter built-in micron in-line filter during administration. Thiotepa (Thioplex ) micron filter Not required May undergo polymerization forming insoluble polymeric 1, 2, 3. derivatives. Coagulation Factors: Human Factor VIII (Humate P Filter needle Not required Use one filter needle per vial. 1, 2. (Provided). Recombinant Factor VII 5 micron filter needle Not required Use one filter needle per vial.)

3 1, 2. (Recombinate ) (Provided). Factor IX complex (Profilnine 20 micron filter Not required Use one filter per vial. 1,2. SD) (Provided). Recombinant Factor IX One filter spike Not required Use one filter needle per vial. 1, 2. (BeneFixTM) (Provided). Recombinant Antihemophilic One filter spike Not required Use one filter spike per vial 2. Factor (Advate ) (provided). Recombinant Factor VIIa Not required Not Required 2. (Novoseven ). Miscellaneous Agents: Amiodarone (Cordarone ) Not required micron in-line May precipitate when diluted 1, 2, 3. filter Amphotericin B Desoxycholate Not required May use an in-line 2. (Amphocin ) filter not less than 1.

4 Micron Amphotericin B Lipid Complex 5 micron filter needle Do not use an in-line Each filter needle may be used to filter contents of up to 1, 2, 4. (Abelcet (Provided) filter 4 vials. Flush IV line w/ D5W before and after amphotericin infusion. Amphotericin B Liposome 5 micron filter needle May use an in-line Use only one filter per vial of AmBisome per 1, 2. (AmBisome (Provided) filter not less than 1 manufacturer. Flush IV line w/ D5W before and after micron amphotericin infusion. Antithymocyte globulin, horse Not required to 1 micron in- Slight granular or flaky deposits may develop during 4,5. (ATGAM ) line filter storage Cyclosporine (Sandimmune ) Not required Use a or micron filter Epoprostenol (Flolan ) Not required micron in-line 2.))

5 Filter Infliximab (Remicade ) Not required In-line filter, low 2,5. protein binding (pore size of microns or less). Mannitol (Osmitrol ) Not required 5 micron in-line filter Incidence of crystallization w/ concentration > 20%. 1, 2, 3, 5, 6. Recommend using a 5 micron filter needle for administration of concentrated solutions equal to or greater than 20%. Pentobarbital (Nembutal ) Not required micron in-line May precipitate when diluted. When diluted use a 3. filter micron in-line filter during administration. Document created: 08/12. Marquette General Health System Revised: None Marquette General Hospital Cross Reference: None Marquette , MI 49855.

6 This is a confidential professional/peer review and quality assessment document of Marquette General Health System of Marquette , MI. It is protected from disclosure pursuant to the provisions of MCL , MCL , MCL 21515, MCL , MCL , MCL , and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited. Marquette General Health System Pharmacy and Therapeutics Committee medication Guideline Intravenous Medications Requiring Filtration Phenobarbital (Luminal ) Not required micron in-line When diluted use a micron in-line filter during 3. filter administration. May precipitate depending on the concentration and pH.

7 Phenytoin (Dilantin ) Not required micron in-line Phenytoin is preferably administered by direct IV 1, 2, 3. filter (see comment) injection. A filter is not required for undiluted phenytoin. The rate of IV injection should be < 50mg/min. If dilution is needed, mix phenytoin with NS and use micron in-line filter during administration. Phenytoin may precipitate due to the drug's low solubility and at low pH. Solution from glass amp 5 micron filter needle Not required Use filter needle to withdraw from amp. Change needle 8. before administering to a patient or admixing. Total Parenteral Nutrition: Without lipids Not required micron in-line 1, 7.

8 Filter With lipids Not required micron in-line 1, 7. filter Lipid alone Not required micron in-line 7. filter References: 1. AJHP 55:1313-4, 6/98. 2. Package insert 3. Trissel, 10th edition 4. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook 14th edition 2006. 5. Micromedex Healthcare Series Web site. Accessed August 10, 2012. 6. Drugs to be used with a filter for preparation and/or administration. Hospital Pharmacy . 2007;42:378-382. 7. AJIC 24:262-93, 1996. 8. AJHP 50:1561, 8/93. Basic properties of filtration during drug preparation/administration: 5 micron filter removes large particles, including glass from ampules.

9 Micron filter removes fungi and other particulate contamination. micron filter is designed for sterilization and bacteria retention. Document created: 08/12. Marquette General Health System Revised: None Marquette General Hospital Cross Reference: None Marquette , MI 49855. This is a confidential professional/peer review and quality assessment document of Marquette General Health System of Marquette , MI. It is protected from disclosure pursuant to the provisions of MCL , MCL , MCL 21515, MCL , MCL , MCL , and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited.