Totect

Resources

Guidelines support the use of TOTECT® (dexrazoxane) for injection

The MASCC Textbook of Cancer Supportive Care and Survivorship1
  • It is recommended that this treatment [TOTECT and Savene*] is available in every institution in which anthracyclines are administered.
  • Healthcare providers need to be well informed of current extravasation management recommendations and guidelines in order to most effectively treat patients receiving vesicant chemotherapy.
*The non-US equivalent of TOTECT
Infusion Nurses Society2
  • Daily intravenous (IV) infusion of dexrazoxane [TOTECT] over 3 days is the recommended antidote for anthracycline extravasation.
Oncology Nursing Society – Chemotherapy and Biotherapy Guidelines3
  • Vesicant Extravasation Management Guidelines – Dexrazoxane [TOTECT] is listed as the antidote for anthracyclines.
References:
1. Schulmeister L. Extravasation. In: Olver I (ed) The MASCC Textbook of Cancer Supportive Care and Survivorship, Springer, Berlin; 2011: 351-359. 2. Infusion Nurses Society 2016 Standards Infilitrations and Extravasations. 3. Schulmeister L. Safe Management of Chemotherapy: Infusion-Related Complications. Clin Journal of Oncol Nurs 2014;18(3):283-287.

INDICATION: TOTECT® (dexrazoxane) is indicated for the treatment of extravasation resulting from intravenous anthracycline chemotherapy.

IMPORTANT DOSAGE AND ADMINISTRATION INSTRUCTIONS
Vial contents must be reconstituted and diluted with 50 mL of 0.167 M sodium lactate injection solution and further mixed and diluted with the recommended dose in 1000 mL 0.9% Sodium Chloride before use. The TOTECT dose should be reduced by 50% in patients with creatinine clearance values < 40 mL/min.

IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS

None.

WARNINGS AND PRECAUTIONS
Myelosuppression: TOTECT is associated with leukopenia, neutropenia, and thrombocytopenia. Perform hematological monitoring during treatment with TOTECT and cytotoxic chemotherapy as the myelosuppression and cytotoxic potential may be additive to that of chemotherapy alone.

Anaphylactic/Hypersensitivity Reactions: Hypersensitivity reactions including anaphylactic reaction, angioedema, skin reactions, bronchospasm, respiratory distress, hypotension and loss of consciousness have occurred in patients treated with dexrazoxane products and anthracyclines. Previous history of allergy to dexrazoxane products should be carefully considered prior to administration. Consider permanent discontinuation in patients with severe hypersensitivity reactions.

Embryo-Fetal Toxicity: TOTECT can cause fetal harm when administered to a pregnant woman. Advise patients of potential risk and to use effective contraception during treatment and 6 months following the last dose of TOTECT. Use in patients with hepatic impairment is not recommended.

DRUG INTERACTIONS
TOTECT is not recommended for use with dimethyl sulfoxide (DMSO).

ADVERSE REACTIONS
In the clinical studies, TOTECT was administered to patients also receiving chemotherapeutic agents for cancer, and the adverse reaction profile reflects the combination of TOTECT, underlying disease, and already administered chemotherapy. The most common adverse reactions (≥15%) are nausea, fever, injection site pain, vomiting, and postoperative infection.

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