Long-term stability of 5-fluorouracil stored in PVC bags and in ambulatory pump reservoirs

Long-term physicochemical stability of 5-fluorouracil at selected standardised rounded doses in polyolefin bags

BACKGROUND

Chemotherapy doses are usually prescribed on the basis of body surface area but dose banding is emerging as an efficient alternative. Dose banding presents the possibility of in-advance preparation in a Centralized Intravenous Admixture Service.

AIM OF THE STUDY

To evaluate the long-term stability of 5-fluorouracil at banded doses (700 mg and 800 mg) in polyolefin bags.

MATERIALS AND METHODS

Ten polyolefin bags were prepared under aseptic conditions and stored at 23 ± 2°C for 24 days. Five of them were composed of 14 mL 5-fluorocuracil (700 g) in 100 mL 0.9% sodium chloride solution and the five other of 16 mL 5-fluorouracil (800 mg) in 100 mL 0.9% sodium chloride solution. At defined times, physical stability parameters were assessed: optical densities, pH measurements, visual and microscopical inspections. Solutions concentrations were measured using high-performance liquid chromatography coupled with a photodiode array detector.

RESULTS

No change was observed on pH and optical density measurements during the study period. Visual and microscopical inspections remained free of colour change, precipitate, microagregate or crystal. The concentrations of 5-Fluorouracil in 800 mg bags remained stable for 24 days while the concentration in 700 mg bags showed a stability of at least 17 days.

CONCLUSION

Five-fluorouracil at banded doses of 700 and 800 mg in polyolefin bags is physicochemically stable for at least 17 days at 23 ± 2°C. These results support the possibility of in advance centralised preparation.

Stability of extemporaneously compounded 5-fluorouracil utilizing high performance liquid chromatography

The goal of the current study is to determine stability of compounded 5-fluorouracil (5-FU) in Intravia™ bags and CADD™ cassettes stored up to 15 days under refrigeration (2-8°C) and room temperature (25°C with 60% relative humidity), with four different concentrations (20 mg/mL, 30 mg/mL, 40 mg/mL, and 50 mg/mL) and two diluents (0.9% sodium chloride and 5% dextrose). A stability-indicating high-performance liquid chromatography (HPLC) method was developed to analyze the 5-FU concentrations. The stability of compounded 5-FU infusions was investigated using this method. Two samples from each storage condition were assessed for stability on days 0, 4, 7, 10, and 15 as per United States Pharmacopeia (USP) guidelines. The assay of 5-FU was done utilizing a calibrated stability-indicating HPLC method. The stability-indicating HPLC assay showed 5-FU completely degraded within 1 hour in basic conditions. No cloudiness or color change was observed during the stability study. Precipitation was observed in the CADD™ cassettes at day 15 in both storage conditions and at day 10 in a single room-temperature CADD™ cassette for 40 mg/mL in 5% dextrose (D5W). HPLC assay revealed the infusions in CADD™ cassettes retained greater than 90% of the initial concentrations of 5-FU for 15 days stored at room temperature (25°C and 60% relative humidity) and for 10 days at refrigeration (2-8°C). Intravia™ bags retained stability through 15 days for all the compounded 5-FU concentrations and both the storage conditions. 5-FU infusions in both CADD™ cassettes and Intravia™ bags were stable for extendable periods in multiple concentrations compared to recommended guidelines for hospital use.

Long-term physico-chemical stability of 5-fluorouracile at standardised rounded doses (SRD) in MyFuser® portable infusion pump

Management of chemotherapies is a strategic issue for european healthcare. Dose-banding enables to reduce waiting time of patients in day care units and drug wastage. The aim of this study was to assess the stability of 5-Fluorouracile (5-FU) at standardised rounded doses of 4 and 5 g in MyFuser® portable infusion pump for in-advance preparation. Ten MyFuser® (4 and 5 gr 5-FU added to NaCl 0.9%) were prepared under aseptic conditions and stored at room temperature (23 ± 2 °C) for 28 days then at 30 °C for three days. Physical stability tests were periodically performed: visual and microscopic inspection, pH measurements and optical densities. The concentration of solutions was measured by High Performance Liquid Chromatography/UV detector. Results confirm the stability of 5-FU at selected SRD of 4 g and 5 g with NaCl 0.9% in MyFuser® for at least 28 days at room temperature and three days at 30 °C, allowing in-advance preparation.

Preparation of intravenous chemotherapy bags: evaluation of a dose banding approach in an Italian oncology hospital

Introduction

Dose banding is an original approach that manages intravenous (IV) chemotherapy preparation by generating on a weekly basis a series of bags containing scaled dosages of the active agent. These predetermined, fixed dosage bags are intended to replace the traditional bags prepared daily that contain fully individualized dosages.

Methods

Three different scenarios were examined: (1) the current method of daily preparation of individualized bags at the hospital pharmacy; (2) the weekly preparation at the hospital pharmacy of non-individualized bags containing discrete, predefined doses covering an adequate range of doses (dose banding); (3) the use of commercial ready-to-use bags based on the same approach of dose banding. The objective of this study was to compare these three different approaches in terms of cost per patient. We considered five cancer drugs (gemcitabine, oxaliplatin, paclitaxel, trastuzumab and 5-fluorouracil) that were suitable for the dose ranging approach. Appropriate dose bands for these five agents were identified. Costs were estimated for each of the three approaches.

Results

A total of 13,490 fully individualized bags were studied, which corresponded to the real bags prepared at our institution for these five agents in 2018. Dose banding was predicted to determine savings ranging from €10,998 (-0.84%) for trastuzumab to €169,429.60 (-8.39%) for paclitaxel.

Conclusion

The introduction of dose banding can determine economic savings along with other advantages, such as improved work conditions, management reorganization and containment of waste. The pharmaceutical industry can hopefully support these experiences by producing ready-to-use bags in predetermined dosages.

Stability and compatibility of 5-fluorouracil infusions in the Braun Easypump®

Objective. The aim of this study was to determine the stability and compatibility of `high strength’ (50 mg/mL) and `normal strength’ (25 mg/mL) 5-fluorouracil (5-FU); the latter prepared from 50 mg/mL 5-FU in either 0.9% sodium chloride or 5% glucose diluents and filled into the Braun Easy-pumpÒ (also known as the Homepump Fresenius). Studies were conducted under storage (48C or 258C) and in-use (318C) conditions.

Methods. In the first study, the stability of 5-FU 50 mg/mL (undiluted) was determined in the EasypumpÒ at 258C and 318C over time intervals of 0, 1, 3, 5, 7, 14 and 21 days. In the second study, the stability of 25 mg/mL 5-FU diluted in 5% glucose and 0.9% sodium chloride for injection in the EasypumpÒ was determined after incubation at 48C for 0, 7 and 14 days and at 258C and 318C for 0, 1, 3, 5, 7, 14 and 21 days. For each time/temperature interval, the infusions were monitored for precipitation, colour change, pH, moisture loss, subvisual particulate levels (selected intervals) and chemical stability to assess for compatibility with the device.

Results. No significant changes in physical or chemical stability occurred in diluted solutions (25 mg/mL) over 14 days at 48C or 21 days at 258C and 318C or in the undiluted solutions (50 mg/mL) over 21 days at 258C and 318C, and 5-FU demonstrated suitable stability in the test devices.

Evaluation of sources to document extended shelf lives of compounded cytostatics

BACKGROUND

Due to the increasing demand for compounded cytostatics, future compounding of these drugs has to include automated production and improved logistics, and in both cases batch production for stockholding is needed. This set-up would also meet future staff shortages. Stockholding requires documentation of extended shelf lives in the range of minimum 1-3 months. Documentation is often provided by summary of product characteristics, data provided by the industry which is not included in the summary of product characteristics and data from literature.

OBJECTIVE

To evaluate the quality of the three main stability data sources used by hospital pharmacies when assessing extended shelf lives of compounded cytostatics.

METHODS

A total of 150 summary of product characteristics for fluorouracil, cyclophosphamid, oxaliplatin, cisplatin, doxorubicin, paclitaxel, vincristin, irinotecan, epirubicin, gemcitabin, docetaxel, carboplatin and cytarabin were examined regarding available information on how to handle the compounded product. A survey of literature for shelf lives for cyclophosphamide, fluorouracil, oxaliplatin and gemcitabine has been made. Dialogues with 14 suppliers of cytostatica have been conducted to clarify the possibility of expanding the fluorouracil information on shelf lives to include information on extended shelf lives of compounded products.

RESULTS

The analysis showed that often the information on shelf life stated in the summary of product characteristic is very short and sparse in basic information regarding the compounded product. The dialogues with the companies revealed that longer shelf lives will probably not be stated in the summary of product characteristic, and the literature review revealed very different stability data and uncertainty on the validity of the obtained data.

CONCLUSION

None of these data sources can be applied as documentation for extended shelf lives and it is crucial to document the extended stability yourself.

Long-term stability of 5-Fluorouracil in 0.9% sodium chloride after freezing, microwave thawing, and refrigeration

OBJECTIVE

To investigate the stability of 5-fluorouracil diluted in 0.9% sodium chloride (normal saline [NS]) after freezing, microwave thawing, and storage for 28 days at 5°C ± 3°C.

METHODS

Polyvinylchloride (PVC) infusion bags (n = 5) containing 5-fluorouracil 800 mg/100 mL were frozen for 79 days at -20°C. The bags were then thawed in a microwave oven and stored at 5°C ± 3°C for 28 days. The concentration of 5-fluorouracil was measured by high-performance liquid chromatography. Visual and microscopic inspections were performed and pH was measured periodically during storage. Solutions were considered stable if the lower limit of the 95% confidence interval of the concentration versus time profile remained greater than 90% of the initial concentration.

RESULTS

No colour change or precipitation was observed in any of the solutions. Slight changes in pH were observed during refrigeration. 5-Fluorouracil solutions were stable during storage at 5°C ± 3°C for 28 days, as indicated by the results of high-performance liquid chromatography.

CONCLUSION

5-Fluorouracil 8 mg/mL in NS may be prepared in advance, frozen and stored in PVC bags, and thawed before use. The solutions remained stable after freezing at -20°C for 79 days followed by storage at 5°C ± 3°C for up to 28 days.

Estimation of 5-fluorouracil-loaded ethylene-vinyl acetate stent coating based on percolation thresholds

The drug percolation thresholds of 5-fluorouracil-loaded ethylene-vinyl acetate stent coatings were estimated to characterize their drug release behavior and mechanical properties. The stent coatings were prepared using 5-fluorouracil (5-FU) as antitumor drug and ethylene-vinyl acetate (EVA) as matrix forming material in different ratios. In vitro release assays were carried out exposing only one side of coating to pH 6.5 PBS. Based on the release profiles, the drug percolation thresholds were estimated as 0.21 of total porosity (corresponding to ca. 32%, w/w of the drug), which is in approximately agreement with the atomic force microscopy (AFM) result. Based on the coating tensible break strength and tear break strength data, the mechanical percolation thresholds of drug were obtained as 39.7+/-0.3 and 37.5+/-1.4% (w/w) of drug content, respectively.

Characterization of 5-fluorouracil microspheres for colonic delivery

The purpose of this investigation was to prepare and evaluate the colon-specific microspheres of 5-fluorouracil for the treatment of colon cancer. Core microspheres of alginate were prepared by the modified emulsification method in liquid paraffin and by cross-linking with calcium chloride. The core microspheres were coated with Eudragit S-100 by the solvent evaporation technique to prevent drug release in the stomach and small intestine. The microspheres were characterized by shape, size, surface morphology, size distribution, incorporation efficiency, and in vitro drug release studies. The outer surfaces of the core and coated microspheres, which were spherical in shape, were rough and smooth, respectively. The size of the core microspheres ranged from 22 to 55 microm, and the size of the coated microspheres ranged from 103 to 185 microm. The core microspheres sustained the drug release for 10 hours. The release studies of coated microspheres were performed in a pH progression medium mimicking the conditions of the gastrointestinal tract. Release was sustained for up to 20 hours in formulations with core microspheres to a Eudragit S-100 coat ratio of 1:7, and there were no changes in the size, shape, drug content, differential scanning calorimetry thermogram, and in vitro drug release after storage at 40 degrees C/75% relative humidity for 6 months.