What Is An Extravasation?

Extravasation is the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue, instead of the venous system1,2

Anthracycline extravasation

  • Anthracyclines are vesicant chemotherapy agents that may cause severe and irreversible tissue damage when accidental extravasation occurs.3,4
  • Examples of commonly used anthracyclines include: epirubicin, doxorubicin, and daunorubicin.
  • Anthracyclines bind to the nuclear DNA of cells, causing cell death.5
  • The dead cells release bound anthracycline creating a continuing cycle of tissue damage as the anthracycline is recirculated in the tissue.6
  • While believed to be under-reported, anthracycline extravasation is estimated to occur in 0.1% to 1% of all patients receiving treatment.7


1. Fidalgo JAP, Garcia LG, Cervantes A et al. Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines. Ann Oncol 2012; 23 (suppl 7): vii167-vii173. 2. Roe H. Anthracycline extravasations: prevention and management. Br J Nurs 2011; 20(17): S16, S18-22. 3. Schulmeister L. Extravasation management: clinical update. Semin Oncol Nurs 2011; 27(1): 82-90. 4. Vidall C, Roe H, Dougherty L, et al. Dexrazoxane: a management option for anthracycline extravasations. Br J Nurs. 2013; 22(17): S6 -12. 5. Binaschi M, Farinosi R, Borgnetto, ME et. al. In vivo site specificity and human isoenzyme selectivity of two topoisomerase II-poisoning anthracyclines. Cancer Res 2000; 60(14): 3770–3776. 6. Wickham R. Vesicant extravasation from an implanted venous access port. Oncology (Williston Park) 2009; 23(4) Suppl Nurse Ed: 34-8. 7. Fontaine C, Noens L, and Pierre P. Savene (dexrazoxane) use in clinical practice. Support Care Cancer. 2012; 20(5): 1109-12.

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

Reconstitute and further dilute Totect before use [see Prescribing Information- Dosage and Administration]. The Totect dose should be reduced by 50% in patients with creatinine clearance values < 40 mL/min.



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.

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

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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