Chemo rounding - may round chemo DOWN to nearest vial if dose within ≤ 5% of ordered dose. Chemo doses will not be rounded up. (Approved 12/18)
High Alert Drug: Chemotherapeutic Agents - Parenteral
• Stored separately in pharmacy. • Pharmacist reviews literature in order to to verify calculations and dose prescribed. • Two pharmacists independently verify preparation. • No telephone orders. Pre-printed order sheet available. • Chemo is administered by specially trained RNs. • 2 RNs independently verify pump settings and drug on continuous infusions prior to administration. • IV sites are assessed every 2 hours. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes
CCU, OR, PACU, CCL, ED
PCU
2N (Tele)
1N (Tele), 3N (Tele)
Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N)
BirthPlace
SNF
ICS
OPS
cytotoxic agents (chemotherapy) IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only
Y (CCU only)
N
N
Y (1N only)
Y (1N only)
N
N
Y
N
Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)
Waste Requirements
mitoXANTRONE (Novantrone)
If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET
USP <800> Hazardous Drugs
Per Policy, these drugs have special handling requirements (any drug with an "AOR" is exempt from these requirements under normal circumstances).
generic (Brand) Route
Relative Risk Level
AOR?
NIOSH 2024 Table
MSHI?↑
Warnings
mitoXANTRONE (Novantrone) IV
Highest
N/A
1A↑
Yes
IARC‑2B↑
NIOSH Supplemental information (2016): N/A FDA Pregancy Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks;
Adult Extravasation Management
mitoXANTRONE (Novantrone)
Agent type:
Chemotherapeutic
Vesicant/Irritant:
Irritant with vesicant-like properties
Local Care:
Cold compress
Antidote:
Dexrazoxane or topical DMSO. Do not use in combination with each other due to decreased efficacy of dexrazoxane.
Antidote link(s):
Last updated: Jun. 18, 2025
Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug
Chemo doses will not be rounded up. (Approved 12/18)
• Pharmacist reviews literature in order to to verify calculations and dose prescribed.
• Two pharmacists independently verify preparation.
• No telephone orders. Pre-printed order sheet available.
• Chemo is administered by specially trained RNs.
• 2 RNs independently verify pump settings and drug on continuous infusions prior to administration.
• IV sites are assessed every 2 hours.
• Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only
(CCU only)
(1N only)
(1N only)
Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET