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DOSAGE AND ADMINISTRATION
The recommended dose and schedule of LEUSTATIN Injection for active Hairy Cell Leukemia is as a single course given by continuous infusion for 7 consecutive days at a dose of 0.09 mg/kg/day. Deviations from this dosage regimen are not advised. If the patient does not respond to the initial course of LEUSTATIN Injection for Hairy Cell Leukemia, it is unlikely that they will benefit from additional courses. Physicians should consider delaying or discontinuing the drug if neurotoxicity or renal toxicity occurs (see WARNINGS).
Specific risk factors predisposing to increased toxicity from LEUSTATIN have not been defined. In view of the known toxicities of agents of this class, it would be prudent to proceed carefully in patients with known or suspected renal insufficiency or severe bone marrow impairment of any etiology. Patients should be monitored closely for hematologic and non-hematologic toxicity (see WARNINGS and PRECAUTIONS).
Preparation and Administration of Intravenous Solutions
LEUSTATIN Injection must be diluted with the designated diluent prior to administration. Since the drug product does not contain any anti-microbial preservative or bacteriostatic agent, aseptic technique and proper environmental precautions must be observed in preparation of LEUSTATIN Injection solutions.
To prepare a single daily dose
LEUSTATIN Injection should be passed through a sterile 0.22μm disposable hydrophilic syringe filter prior to introduction into the infusion bag, prior to each daily infusion. Add the calculated dose (0.09 mg/kg or 0.09 mL/kg) of LEUSTATIN Injection through the sterile filter to an infusion bag containing 500 mL of 0.9% Sodium Chloride Injection, USP. Infuse continuously over 24 hours. Repeat daily for a total of 7 consecutive days. The use of 5% dextrose as a diluent is not recommended because of increased degradation of cladribine. Admixtures of LEUSTATIN Injection are chemically and physically stable for at least 24 hours at room temperature under normal room fluorescent light in Baxter Viaflex®† PVC infusion containers. Since limited compatibility data are available, adherence to the recommended diluents and infusion systems is advised.
|Dose of LEUSTATIN Injection||Recommended Diluent||Quantity of Diluent|
|24-hour infusion method||1(day) x 0.09 mg/kg||0.9% Sodium Chloride Injection, USP||500 mL|
To prepare a 7-day infusion
The 7-day infusion solution should only be prepared with Bacteriostatic 0.9% Sodium Chloride Injection, USP (0.9% benzyl alcohol preserved). In order to minimize the risk of microbial contamination, both LEUSTATIN Injection and the diluent should be passed through a sterile 0.22 μm disposable hydrophilic syringe filter as each solution is being introduced into the infusion reservoir. First add the calculated dose of LEUSTATIN Injection (7 days x 0.09 mg/kg or mL/kg) to the infusion reservoir through the sterile filter.
Then add a calculated amount of Bacteriostatic 0.9% Sodium Chloride Injection, USP (0.9% benzyl alcohol preserved) also through the filter to bring the total volume of the solution to 100 mL. After completing solution preparation, clamp off the line, disconnect and discard the filter. Aseptically aspirate air bubbles from the reservoir as necessary using the syringe and a dry second sterile filter or a sterile vent filter assembly. Reclamp the line and discard the syringe and filter assembly. Infuse continuously over 7 days. Solutions prepared with Bacteriostatic Sodium Chloride Injection for individuals weighing more than 85 kg may have reduced preservative effectiveness due to greater dilution of the benzyl alcohol preservative. Admixtures for the 7-day infusion have demonstrated acceptable chemical and physical stability for at least 7 days in the SIMS Deltec MEDICATION CASSETTE™ Reservoir‡.
|Dose of LEUSTATIN Injection||Recommended Diluent||Quantity of Diluent|
|7-day infusion method (use sterile 0.22μ filter when preparing infusion solution)||7 (days) x 0.09 mg/kg||Bacteriostatic 0.9% Sodium Chloride Injection, USP (0.9% benzyl alcohol)||q.s. to 100 mL|
Since limited compatibility data are available, adherence to the recommended diluents and infusion systems is advised. Solutions containing LEUSTATIN Injection should not be mixed with other intravenous drugs or additives or infused simultaneously via a common intravenous line, since compatibility testing has not been performed. Preparations containing benzyl alcohol should not be used in neonates (see WARNINGS).
Care must be taken to assure the sterility of prepared solutions. Once diluted, solutions of LEUSTATIN Injection should be administered promptly or stored in the refrigerator (2° to 8° C) for no more than 8 hours prior to start of administration. Vials of LEUSTATIN Injection are for single-use only. Any unused portion should be discarded in an appropriate manner (see Handling and Disposal).
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. A precipitate may occur during the exposure of LEUSTATIN Injection to low temperatures; it may be resolubilized by allowing the solution to warm naturally to room temperature and by shaking vigorously. DO NOT HEAT OR MICROWAVE.
Chemical Stability of Vials
When stored in refrigerated conditions between 2° to 8°C (36° to 46°F) protected from light, unopened vials of LEUSTATIN Injection are stable until the expiration date indicated on the package. Freezing does not adversely affect the solution. If freezing occurs, thaw naturally to room temperature. DO NOT heat or microwave. Once thawed, the vial of LEUSTATIN Injection is stable until expiry if refrigerated. DO NOT refreeze. Once diluted, solutions containing LEUSTATIN Injection should be administered promptly or stored in the refrigerator (2° to 8°C) for no more than 8 hours prior to administration.
Handling and Disposal
The potential hazards associated with cytotoxic agents are well established and proper precautions should be taken when handling, preparing, and administering LEUSTATIN Injection. The use of disposable gloves and protective garments is recommended. If LEUSTATIN Injection contacts the skin or mucous membranes, wash the involved surface immediately with copious amounts of water. Several guidelines on this subject have been published.2-8 There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate. Refer to your Institution's guidelines and all applicable state/local regulations for disposal of cytotoxic waste.
LEUSTATIN Injection is supplied as a sterile, preservative-free, isotonic solution containing 10 mg (1 mg/mL) of cladribine as 10 mL filled into a single-use clear flint glass 20 mL vial. LEUSTATIN Injection is supplied in 10 mL (1 mg/mL) single-use vials (NDC 59676-201-01) available in a treatment set (case) of seven vials.
Store refrigerated 2° to 8°C (36° to 46°F). Protect from light during storage.
2. Recommendations for the Safe Handling of Parenteral Antineoplastic Drugs. NIH Publication No. 83-2621. For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington, D. C. 20402.
3. AMA Council Report. Guidelines for Handling Parenteral Antineoplastics, JAMA, March 15 (1985).
4. National Study Commission on Cytotoxic Exposure--Recommendations for Handling Cytotoxic Agents. Available from Louis P. Jeffrey, Sc.D., Chairman, National Study Commission on Cytotoxic Exposure, Massachusetts College of Pharmacy and Allied Health Sciences, 179 Longwood Avenue, Boston, Massachusetts 02115.
5. Clinical Oncological Society of Australia: Guidelines and Recommendations for Safe Handling of Antineoplastic Agents, Med. J. Australia 1:425 (1983).
6. Jones RB, et al. Safe Handling of Chemotherapeutic Agents: A Report from the Mount Sinai Medical Center. Ca--A Cancer Journal for Clinicians, Sept/Oct. 258-263 (1983).
7. American Society of Hospital Pharmacists Technical Assistance Bulletin on Handling Cytotoxic Drugs in Hospitals. Am. J. Hosp. Pharm., 42:131 (1985).
8. OSHA Work-Practice Guidelines for Personnel Dealing with Cytotoxic (antineoplastic) Drugs. Am. J. Hosp. Pharm., 43:1193 (1986).
† Viaflex®containers, manufactured by Baxter Healthcare Corporation - Code No. 2B8013 (tested in 1991)
‡MEDICATION CASSETTE™ Reservoir, manufactured by SIMS Deltec, Inc. - Reorder No. 602100A (tested in 1991)
Centocor Ortho Biotech Products, L.P. Raritan, NJ 08869. Revised July 2012
Last reviewed on RxList: 8/9/2012
This monograph has been modified to include the generic and brand name in many instances.
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