• Each vial (1.3 mg) should be reconstituted with 1.2 ml of SWI.
• During reconstitution, USP should be directed at the side of the vial and the contents gently swirled to avoid excess foaming. Do not shake.
• Addition of BSWI or NS may promote aggregation and these solutions should not be used.
• For IV administration, dilute further in 50 mL bag of D5W; infuse over 15 minutes.
• Final concentration of drug should be 30 - 70µg/mL.
• Drug delivery is more consistent when diluted in PVC container rather than non PVC container.
• In-line filter should not be used when administering aldesleukin.
• Do not freeze.

Recommended premedication:

• Antipyretics such as acetaminophen or NSAID’s
• Meperidine to control rigors
• H2-blockers for GI irritation or bleeding
• Antiemetics and anti-diarrheals should be given as indicated
• Consider antibiotic prophylaxis in patients with indwelling intravenous lines
• For subcutaneous self-administration (or administered by home caregiver); drug available by retail prescription

• See the Product Monograph for full details of preparation and administration.
• Full resuscitation facilities and experienced personnel should be available.
• Do not administer as an intravenous push or bolus. Although not approved by Health Canada, alemtuzumab has been given subcutaneously in Phase II studies.
• Mix in 100mL IV bag (5% Dextrose or Normal Saline). Gently invert the bag to mix the solution.  Infuse the admixture over 2 hours.
• Other drug substances should not be added or simultaneously infused through the same intravenous line.

• Oral self-administration; drug available by retail prescription.

• Mix in 100mL minibag; Infuse over 15 minutes.
• Patient must be supine during infusion; measure blood pressure throughout infusion.

• Dilute only with supplied lactic acid diluent.
• Dilute further with 500mL bag (5% Dextrose; do not dilute with Normal Saline); Infuse over 60-90 minutes.
• Incompatible with any solution containing chloride ions.
• For i.v. infusion only.

• Oral self-administration; drug available by outpatient prescription.
• Missed dose should be taken as soon as possible, but only if there is at least 12 hours before the next dose is due.

• Prescribed dose should be swallowed whole, once daily with or without food.
• Store at room temperature.

• Use normal saline for reconstitution and further dilution as directed.  Swirl vial gently to prevent foaming.  Final concentration should be approximately 1 mg/mL.
  
• Infuse IV over 15 minutes.
  
• Incompatible with any solutions containing divalent cations (e.g. Ca, Mg), including Lactated Ringer’s and Hartman’s solution.
  
• Unopened vials should be refrigerated (2-8°C).

• Reconstitute with Sterile Water for Injection – do not shake.
• Given as an IM injection (preferred route).
• If given intravenously then dilute further in 100mL minibag or slow push through side arm of free flowing IV (5% Dextrose, Normal Saline, or 2/3:1/3); Infuse over at least 30 minutes.

• For subcutaneous use only
• Discard if the drug contains large particles or agglomerates.
• Before injection, ensure contents of syringe are at room temperature. Contents of the syringe must be re-suspended immediately prior to administration, by vigorously rolling the syringe between the palms until a uniform cloudy suspension is achieved.
• Rotate injection sites; possible sites include the upper arm, thigh or abdomen.
• Do not inject into sites which are red, bruised, tender, or hardened.
• Doses greater than 4 mL should be injected into at least 2 separate sites.
• New injections should be given at least 2.5 cm from the previous site.
• If a dose is missed, it should not be given at the same time as the next dose, but should be added to the end of the current dosing cycle.

• Handle as infectious material – contains live mycobacteria. Check the expiry date of the product carefully. Store between 2 and 8oC.
• Reconstitute with sterile non-preserved diluent provided and dilute further to a total volume of 50ml with sterile saline. Do not use filters. Use immediately after reconstitution.
• Do not expose to direct sunlight and minimize exposure to any light.
• For intravesical use only. Instillation into the bladder (through an indwelling catheter) and hold in the bladder for as long as possible up to 2 hours. The patient should lie prone for the first 15 minutes following instillation, with frequent body positioning afterwards to coat inner surface of bladder.
• The patient should not have any fluid intake for 4 hours before the instillation, or during the time (2 hours) while BCG remains in the bladder.
• From 2 to 6 hours after treatment, patients should void in a seated position to avoid splashing of urine.
• Unless contraindicated, patients should increase fluid intake for several hours after BCG instillation to flush the bladder
• All urine voided for 6 hours after instillation should be disinfected with an equal, undiluted volume of hypochlorite (bleach) solution for 15 minutes before flushing.

• Bevacizumab infusions should not be administered or mixed with Dextrose solutions.
• Mix in 100 mL bag NS. (Dilution should be 1.4 -16.5 mg/mL)
• Do not shake
• Should not be mixed or diluted with other drugs.
• Refrigerate; Do not freeze.
• Infused over 90 minutes as loading dose, if tolerated next infusion can be given over 60 minutes; can thereafter be given over 30 minutes as maintenance dose
• Alternative infusion rates have been described by Reidy et al., but this is not approved by Health Canada
• DO NOT ADMINISTER AS AN IV PUSH OR BOLUS

• Outpatient prescription for home administration.
• May be taken with or without food.

• If the patient is known to have hypersensitivity to other drugs, the first dose may be preceded by 1mg test dose given in sidearm of running IV and 30 minutes observation for hypersensitivity.
• Reconstitute in 1-5mls sterile water for injection. Bacteriostatic water for injection or normal saline for injection.
• Full dose mixed in 50mL minibag (NS); Infuse over 10-15 minutes.
• May be given by direct IV push over 5-10 minutes, followed by a Saline flush, if no IV line has been set up.
• For intrapleural administration, infuse 50-100mls, via an indwelling thoracostomy tube after drainage. Frequent repositioning of patient. Drain after 4 hours.

• Administered as a 3- to 5-second IV push followed by a standard saline flush; no central line is required.

• Subcutaneous injection of depot in Cancer Centre or physician's office; nasal spray and subcutaneous injection supplied by outpatient prescription.
• Subcutaneous:   Rotate injection sites
• Solution for SC injection:  Store at room temperature.  May be kept up to 14 days after the first opening when stored at room temperature.
• Intranasal solution:  Store at room temperature.  May be kept up to 5 weeks after the first opening when stored at room temperature.
• DEPOT formulation for SC injection:  

• Store at room temperature.
• Implant rods should be kept horizontal before injection.  
• Before the injection, a local anesthetic may be used if needed.
• Inject SC into the lateral abdominal wall

• Protect from light

• Oral self-administration; drug available by retail prescription.
• Diluted solution for infusion; compatible with D5W or NS.
• Final concentration of busulfan should be approximately > 0.5 mg/mL.
• Stable for 8 hours in NS or D5W at room temperature; stable for 12 hours in NS if refrigerated

• Oral self-administration; drug available by retail prescription.
• Clinical studies performed with capecitabine administered 30 minutes after food. Administering capecitabine on an empty stomach may result in slightly higher exposure and thus toxicity.

• Mix in 50mL to 250mL bag (D5W or NS); Infuse over 15 to 60 minutes.
• Incompatible with sets, needles or syringes containing aluminum - leads to precipitation and loss of potency.

• Reconstitute with the supplied diluent.
• Mix in 250-500mL polyolefin bag/glass bottle (D5W, NS, or 2/3:1/3)- Use non-PVC tubing.
• Infuse over 60 minutes or longer (faster infusion, if tolerated).
• Extra IV fluid (up to 750mL) may be run at same time by piggyback, to reduce vein irritation.
• May be mixed in 500mL bag (NS) and infused through main IV line, with an additional 250 mL NS co-infused through a piggyback line (more IV fluid if ordered by physician).
• Should be protected from light and must be refrigerated (2-8°C).

• Do not shake or further dilute the solution.
• DO NOT ADMINISTER AS AN IV PUSH OR BOLUS.
• Using appropriate aseptic technique, transfer undiluted solution into an empty Viaflex bag or an empty syringe, if using a syringe pump.
• Administer the undiluted solution via a low protein binding 0.22-micrometer in-line filter. Piggybacking to the patient’s infusion line, infuse initial loading dose over 2 hours, and maintenance dose over 1 hour or at maximum rate 10mg/min. (May require to infuse at slower rate in those who experienced infusion reactions).
• Prime administration line with drug solution before infusion and may use NS to flush line at the end of infusion.
• A 1-hour observation period is recommended following each cetuximab infusion. Longer observation periods may be required in those who experienced infusion reactions.
• Should not be mixed or diluted with other drugs.
• Discard any unused portion left in a vial 12 hours under refrigeration or 8 hours at room temperature, as the product contains no preservatives.

• Ensure good urinary output during chemotherapy visit; Patient should void at least once during chemotherapy visit.
• Blood pressure should be taken before and after chemotherapy.
• Additional hydration may be ordered for hypovolemic patients.
• Hydration and diuresis for patients with pre-existing renal, cardiac, or diabetic history at discretion of physician.
• Oral hydration with 8 glasses of fluid per day (for 1-2 days) is strongly encouraged; if nausea and vomiting prevent oral hydration, the patient may need to return for more IV hydration.

• Prehydration:
  • 250mL NS; Infuse over 30 minutes, or
  • 500mL NS over 60 minutes
• Infusion:
  • Infuse in 100-250mL bag (NS) over 15-60 minutes
  • May add 10G Mannitol with Cisplatin
• Post-hydration:
  • 100-250mL NS, or
  • 500mL NS with10Meq KCL

• Prehydration:
  • 500-1000mL NS with 10 Meq KCL over 2 hours;
  • May add 20-40mg of Furosemide or 10G Mannitol
  • May add 20-40mg Furosemide
• Infusion:
  • in 250-500mL NS over 60 minutes
  • Give 50G Mannitol (concurrently with Cisplatin or split with pre and post hydration) unless Furosemide given with prehydration.
• Post-hydration:
  • 1000mL NS with 20Meq KCL (2g Magnesium Sulfate may also be added) over 1 hour
  • May give magnisium glucoheptonate (100mg/ml) 30ml PO QID x 4 days
• For inpatient administration: May prehydrate with 1-2L (NS, 2/3:1/3) over 8-12 hours; post-hydrate with 1-1.5L of IV fluid

• Oral self-administration; drug available by retail prescription.

• Continuous infusion; can be given by ambulatory infusion with CADD pump – benzyl alcohol diluent should be used.
• May mix in 250-500mL NS and administer over 2 hours each day.
• Do not mix with D5W (results in increased degradation of cladribine).
• Do not admix with other drugs.
• Protect from light and store at 2-8°C.

• Oral hydration is strongly encouraged; for PO cyclophosphamide: 8-10 (8oz) glasses of fluid per day; for IV cyclophosphamide: 2-3 L of fluid/day; poorly hydrated patients may need more IV hydration. Inadequate total hydration may result in dose-related hemorrhagic cystitis. Patients should be encouraged to empty their bladder frequently to minimise dwell times.
• Consider usage of mesna with high dose therapy of cyclophosphamide (>1g/m²).
• Smaller doses (<500mg) may be given by direct IV push, followed by a Normal Saline flush, if no IV line has been set up.
• Larger doses of drug should be given with larger total fluid volumes to the patient; patients receiving doses >1000mg should receive at least 500-750mL total fluid, either as oral or IV hydration.
  May mix doses ≤1000mg in 100mL minibag (Normal Saline); Infuse over 15 minutes.
• Doses >1000mg may be mixed in 250mL minibag Normal Saline; Infuse over 30 minutes.
• Doses >2000mg may be mixed in 250-500mL bag (Normal Saline); Infuse over 30-60 minutes.
• High dose (2000 mg/m2 or greater) may be mixed in 1000 mL NS; infuse IV over 1 to 4 hours
• Use 0.9% sodium chloride to reconstitute cyclophosphamide
• Do not reconstitute or dilute with benzyl alcohol-containing solutions (ie. Bacteriostatic sodium chloride), since it may catalyse the decomposition of cyclophosphamide or cause toxicity in infants
• Avoid the use of aluminium-containing preparation and administration equipment, since darkening of aluminium and gas production have been reported
• Oral tablets should be administered as a single dose in the morning, with or without food.

• Oral tablets should be administered as a single dose in the morning with or without food.

• Drug available by outpatient prescription.
• Avoid alcohol intake during treatment.
• Tablets: Oral self-administration; take after meals

• 300 mg as intramuscular injection every week; in orchiectomized patients: 300 mg IM every 2 weeks

• May be given as IM or SC injection.
• Do not use benzyl alcohol diluent with high dose cytarabine.
• May be mixed in 50-100mL minibag (Normal Saline – preferred, or 5% Dextrose); Infuse over approximately 15 – 60 minutes.
• Larger doses may be mixed in 250mL bag (Normal Saline – preferred, or 5% dextrose); Infuse IV over 1-3 hours.
• May be given by direct IV push, followed by a Normal Saline flush, if no IV line has been set up.
• Continuous infusion using CADD infusion pump, or similar device; Infuse through central venous access device.
• Incompatible with heparin, insulin, methotrexate, fluorouracil, penicillin and methylprednisolone.
• May be given as Intrathecal injection; mix in unpreserved diluent (DO NOT USE BENZYL ALCOHOL DILUENT) using strict aseptic technique.

• May be given by slow infusion through sidearm of free-flowing IV (5% Dextrose or Normal Saline).
• May be mixed in 250-500 mL bag (Normal Saline) and infused through main IV line or central venous access device, with an additional 250 mL Normal Saline run at the same time by piggyback, to reduce vein irritation (more IV fluid if ordered by physician).
• Infuse over 30 to 120 minutes.
• Keep dacarbazine vials refrigerated; protect from light.

• Slow push through sidearm of free flowing IV (5% Dextrose or Normal Saline).
• May be mixed in 50 mL minibag (Normal Saline or D5W); Infuse over 10-15 minutes.
• May be filtered out by in-line cellulose ester membrane filters; do not use these filters.
• Reconstitute dactinomycin by adding 1.1 mL of sterile water for injection (without preservative) using aseptic precautions.  Precipitation occurs if sterile water containing preservatives is used.
• Dactinomycin is extremely corrosive to soft tissue, irritating to the eyes and mucous membranes; precautions for materials of this nature should be observed.
• Protect from light.

• Refrigerate (2-8°C) but do not freeze. Protect from exposure to light. Do not shake.
• Subcutaneous self-administration (or administered by home caregiver); drug available by retail prescription.
• Do not administer by intravenous infusion or mix with other drugs.
• Available as single-dose vial of 15, 25, 40, 60, 100, 200, 325, or 500 µg darbepoetin alfa per vial, containing polysorbate 80 as stabilizer.
• Available as pre-filled syringe of 10, 15, 20, 30, 40, 50, 60, 80, 100, 130, 150, 200, 250, 300, 400 or 500 µg darbepoetin alfa, containing polysorbate 80 as stabilizer.

• Prescribed dose should be administered orally, swallowed whole with or without food, at frequency as prescribed.
• Antacid should be avoided, and if taken should be taken up to 2 hours before or 2 hours after the administration of dasatinib.
• Grapefruit and grapefruit juice must be avoided.
• Store at 250C.

• Slow push through sidearm of free flowing IV (D5W, NS or 2/3:1/3); Give 4mg(2mL) per minute.
• May be mixed in 50mL minibag (D5W, NS); Infuse through sidearm of free flowing IV over 10-15 minutes.
• Slow down injection rate if erythematous streaking occurs.
• Do not use if solution turns blue or purple.

• Oral self-administration; drug available by retail prescription

• Use standard cytotoxic handling and preparation procedures for dexrazoxane.
• Should be reconstituted with the diluent provided, Sodium Lactate.
  
• Should be given within 30 minutes before anthracycline administration.
  
• May be given undiluted as an IV bolus or as a rapid IV drip infusion (from an empty viaflex bag) ; infused over 15 minutes.
  
• Do not admix with other drugs.
• The diluted solution is only stable for 6 hours under refrigeration.

• Oral self-administration; drug available by retail prescription.

• ALWAYS premedicate with Dexamethasone.
• Mix in 250mL D5W or NS to a maximum concentration of 0.3 to 0.74 mg/mL; Infuse through main IV line over 1 hour. May use a larger infusion vehicle volume for higher doses, so that the maximum concentration is not exceeded.
• Use non-PVC equipment.
• To minimize hypersensitivity reactions, docetaxel infusion should be started at a slow rate, then increased incrementally to planned rate e.g. infuse at an 8 hourly rate for 5 minutes, then at a 4 hourly rate for 5 minutes , then at a 2 hourly rate for 5 minutes, then finally, resume at the 1 hourly infusion rate.

• Slow push through sidearm of free flowing IV (5% Dextrose, Normal Saline or 2/3-1/3).  Depending on the dose volume and vein condition, administer the dose between 3 to 10 minutes to minimize thrombosis risk or perivenous extravasation. 
• Doses <100mg may be mixed in 50mL-1000mL minibag (Normal Saline, 5% dextrose), doses >100mg may be mixed in 100-1000mL minibag. Infuse through sidearm of free flowing IV (dilution volume and infusion duration depend on chemotherapy protocol).
• Do not admix with other drugs unless data are available; precipitates with fluorouracil and heparin.
• Slow down injection rate if erythematous streaking or facial flushing occurs.
• If any signs or symptoms of extravasation occur, the injection or infusion should be immediately terminated and restarted in another vein.  Any known or suspected extravasation should be managed promptly.
• PROTECT FROM LIGHT.

• May be diluted in NS for continuous infusion via central venous access device over 24hr ;Continuous infusion using an ambulatory infusion pump for periods over 1 day via central venous access device
• Stable at room temperature for 7 days in NS at concentrations: doxorubicin 1.4 to 2.37 mg/ml and vincristine 0.033 to 0.05 mg/ml

• For dose < 90mg, dilute drug in 250mL D5W
• For dose = 90mg, dilute drug in 500mL D5W
• To minimize the risk of infusion reactions, the initial dose is administered at a rate no greater than 1 mg/minute. If no infusion reaction is observed, subsequent infusions may be administered over a 60-minute and 30-minutes period for ovarian cancer patients and Kaposi’s sarcoma patients, respectively.
• Avoid Extravasation
• Do not administer as a bolus injection or undiluted solution
• Pegylated liposomal doxorubicin must not be given by the intramuscular or subcutaneous route.

• Slow push through sidearm of free flowing IV (5% Dextrose, Normal Saline or 2/3-1/3).  Doses of 100-120mg/m2 should be infused over 15-20 minutes.  For lower dose volumes, the infusion time may be proportionally decreased to no less than 3-5 minutes.
• Doses <100mg may be mixed in 50mL minibag (5% Dextrose), doses >100mg may be mixed in 100mL minibag (5% Dextrose); Infuse through sidearm of free flowing IV over 10-20 minutes.
• Do not admix with other drugs.  Incompatible with heparin.
• Slow down injection rate if erythematous streaking or facial flushing occurs.
• If any signs or symptoms of extravasation occur, the injection or infusion should be immediately terminated and restarted in another vein.  Any known or suspected extravasation should be managed promptly.
• Keep refrigerated. PROTECT FROM LIGHT.

• Refrigerate (2-8°C); do not freeze. Protect from exposure to light. Do not shake.
• Subcutaneous self-administration (or administered by home caregiver); drug available by retail prescription.
• Do not administer by intravenous infusion or mix with other drugs.
• The maximum volume per injection site should be 1 mL. For larger volumes, use more than one injection site. The injections should be given in the limbs or the anterior abdominal wall.
  
• Multi-dose vials of 20 000 IU epoetin per mL contain human serum albumin (0.25%) as stabilizer and benzyl alcohol (0.9%) as preservative.
• Pre-filled syringes (1000, 2000, 3000, 4000, 5000, 6000, 7000, 8000, 9000, 10 000, 20 000, 30 000, or 40 000 IU) and single-use vials (1000, 2000, 4000, 10000, or 40000 IU) of epoetin are human serum albumin free, containing glycine and polysorbate 80 as stabilizers and no preservative.
  
  

• Oral self-administration; drug available by retail prescription.
• Should be administered at least one hour before or two hours after meal.

• Oral self-administration; drug available by outpatient prescription.
  
• Capsules should not be opened.
  
• Capsules should be taken on an empty stomach (1 hour before or 2 hours after a meal).
  
• Must not be taken with milk, milk products or drugs that contain calcium, magnesium or other polyvalent ions which may impair the absorption of estramustine
  

• Maximum diluted concentration of 0.4 mg/mL
• All premixed bag(s) should be attached to (0.22 micron) in-line filter.
• Precipitation is unpredictable, depending on concentration, time after dilution, presence of crystallization nuclei, agitation, contact with incompatible surfaces and other factors.
• Monitor solutions for precipitation before and during administration.
• Dilute doses < or = 100 mg in 250 mL NS or D5W, doses >100 mg to < or = 200 mg in 500 mL, and doses >200 mg in 1000 mL
• The use of non-PVC containers and tubing is recommended due to the potential for polysorbate 80 leaching of diethylhexyl phthalate (DEHP), from polyvinyl chloride (PVC) containers and tubing into etoposide IV solution.
• Larger volumes may be used for prehydration for Cisplatin or Ifosfamide dose.
• Infuse over 30 to 60 minutes; Adjust rate if blood pressure drops. Etoposide should not be given by rapid i.v. injection.
• May observe patient for 30 minutes after dose, to watch for hypotension.
• Acrylic or ABS (a polymer composed of acrylonitrile. butadiene and styrene) infusion devices may crack if exposed to undiluted etoposide.

• Oral self-administration; drug available by retail prescription.
• Capsules should be taken on empty stomach.

• Take dose at the same time each day, preferably in the morning.
• Take Everolimus on an empty stomach or after a light fat-free meal.
• Avoid grapefruit or grapefruit products.
• Swallow whole with a glass of water; do not crush or chew.
• Store in original package at room temperature; protect from light.

• Oral self-administration; drug available by retail prescription.

• Oral self-administration; drug available by retail prescription. Tablets should be swallowed whole with water, and should not be broken, crushed or chewed.
• In clinical investigation, pharmacokinetic parameters after oral administration were not significantly affected by concomitant food intake.
• Intravenous : Mix in 50mL minibag (Normal Saline or Dextrose 5%); Give over 30 minutes. Do not admix with other drugs.

• Slow push through sidearm of free flowing IV (D5W, NS, or 2/3:1/3).
• May be given by direct IV push, followed by a NS flush, if no IV line has been set up.
• May be mixed in 50ml minibag (NS or D5W); infuse over 15 min.

• Continuous infusion using CADD infusion pump, or similar device.
• Infuse through central venous access device, if available
• Infuse through patent peripheral venous catheter, if infusion for only 3-5 days; Inspect peripheral infusion sites daily and replace if evidence of irritation or extravasation.
• Protect from light.
• Incompatible with doxorubicin, epirubicin, diazepam, methotrexate and cytarabine; line must be flushed prior to administration of these agents.

• Oral self-administration; drug available by retail prescription

• Oral self-administration; drug available by outpatient prescription

• Prescribed dose should be swallowed whole, once daily with or without food.
• Store at room temperature.

• Usenormal saline for reconstitution and further dilution as directed. Swirl vial gently to prevent foaming.  Final concentration should beapproximately 1 mg/mL.
  
• Infuse IV over 15 minutes.
  
• Incompatiblewith any solutions containing divalent cations (e.g. Ca, Mg), includingLactated Ringer’s and Hartman’s solution.
• Unopened vials should be refrigerated (2-8°C).

• Drug supplied by retail prescription
• Intramuscular injection in Cancer Centre or physician's office

• Oral self-administration; drub available by retail prescription.
• May be administered with or without food.

• Mix drug in 250mL (NS); Infuse over 30 minutes through free-flowing IV.
• May further dilute with normal saline to concentrations as low as 0.1mg/mL.
• Stability data done by Trissel et al. has shown that the reconstituted solution is stable for 35 days at room temperature, but may crystallize upon refrigeration.
• Diluted solution at concentrations of 0.1 to 10mg/mL in D5W or NS is stable for 35 days at room temperature or refrigerated temperature.

• Should be administered orally with a large glass of water to reduce gastric irritation. Doses <800mg should be given once daily with a meal and total daily doses of 800mg should be given as 400mg twice daily.
• May be dispersed in water or apple juice if unable to swallow.
• Must avoid grapefruit or grapefruit juice.

• Subcutaneous injection of depot in Cancer Centre or physician’s office; drug supplied by retail prescription.
  
• A local anesthetic, such as 1 mL of lidocaine 1% without epinephrine, may be used if the patient finds the injection uncomfortable
  

• Oral self-administration; drug available by retail prescription.

• Oral self-administration; drug available by outpatient prescription.
  
• If patient is unable to swallow capsules, may empty the capsule contents into a glass of water and take orally immediately.  Some inert material used as vehicle in the capsule may not dissolve and float on the surface.
  
• To minimize the risk of exposure, always wash hands before and after handling hydroxyurea.  Always wear impervious gloves when handling hydroxyurea capsules or packaging.
  
• Do not allow the drug powder to contact the skin and mucous membranes.  Avoid inhaling the powder when opening the capsules. 
  

• should be administered in a setting where full resuscitation facilities are immediately available, and under the close supervision of someone experienced and capable of dealing with severe infusion-related reactions.
• DO NOT administer as an IV push or bolus.
• Do not admix with other drugs.
• Administer rituximab through a dedicated line.
• Step 1: Administer intravenously at an initial rate of 50 mg/h. In the absence of hypersensitivity or infusion-related events, escalate in 50 mg/h increments every 30 minutes, to a maximal infusion rate of 400 mg/h. If hypersensitivity or an infusion-related event develops, the infusion should be temporarily slowed or interrupted. The infusion can continue at one-half the previous rate if symptoms improve.
• Step 2: Administer intravenously at an initial rate of 100 mg/h (50 mg/h if infusion- related events were documented during the first rituximab administration) and increase by 100 mg/h increments at 30-minute intervals, to a maximum of 400 mg/h, as tolerated.

• Should be handled and prepared by a qualified specialist, consistent with institutional good radiation safety practices and patient management procedures.  Follow appropriate precautions to minimize radiation exposure to patients and to medical personnel.
• Follow procedures carefully as provided by the manufacturer including tests for radiochemical purity.
  

• Precautions should be taken to avoid extravasation. A free-flowing intravenous line should be established prior to 90Y ibritumomab tiuxetan injection. Close monitoring for evidence of extravasation during the injection of 90Y ibritumomab tiuxetan is required. If any signs or symptoms of extravasation occur, the infusion should be immediately terminated and restarted in another vein.
• Administer within 4 hours of step 2 rituximab.
• A 0.22-micrometer low-protein-binding membrane filter should be in-line between the syringe and the infusion port prior to injection of 90Y- ibritumomab tiuxetan.
• After injection, the line should be flushed with at least 10 mL of Normal Saline.

Intravenous:

• Slow push through sidearm of free flowing IV (D5W, NS or 2/3:1/3); Give over 10-15 minutes.
• Direct IV push not recommended due to risk of extravasation.
• Slow down injection rate if erythematous streaking or facial flushing occurs.
• Diluents containing bacteriostatic agents are not recommended.
• When admixed with heparin, precipitation may occur.
  

Oral dosage form has been discontinued by the manufacturer.

• Bolus dose of Mesna before Ifosfamide infusion; Mesna admixed in Ifosfamide solution; followed by 2 doses of Mesna by IV bolus or PO, see Mesna.
• May mix doses < or = 2000mg in 100mL bag (NS); Infuse over 30-60 minutes.
• May mix doses >2000mg in 500-1000mL bag (NS); Infuse over 2-4hours.
• May be admixed with Mesna solution, when Mesna given by an infusion started before Ifosfamide.
• Oral hydration is strongly encouraged; poorly hydrated patients may need more IV hydration.
• Inadequate total hydration may result in dose-related hemorrhagic cystitis.

• May be diluted in larger volumes for continuous infusion over 6-24 hours; May be infused using a CADD ambulatory infusion pump over longer periods.

• (see Gleevec)

• Subcutaneous self-administration (or administered by home caregiver); drug available by retail prescription.
• For IV administration mix in 100mL bag of NS; Infuse over 30 minutes.
• May give acetaminophen 500mg-1000mg 30min prior administration to alleviate Flu-like symptoms.
• Avoid IM use with thrombocytopenia.

• Mix in 500mL bag (D5W) in a concentration range between 0.12 to 3 mg/mL; infuse IV over 90 minutes
• Do not refrigerate admixtures in NS (may result in precipitation)
• Freezing irinotecan and admixtures of irinotecan may result in precipitation of the drug and should be avoided.
• Do not admix with other drugs
• Protect from light
• Prior to the initial irinotecan treatment, patients should be given a sufficient supply of loperamide and instructed on its appropriate use.
• Avoid grapefruit juice or products during irinotecan treatment.

• Oral self-administration; drug available by retail prescription
• Avoid grapefruit and grapefruit juice while on lapatinib treatment
• Take the daily dose at least 1 hour before, or at least 1 hour after a low-fat meal
• Missed doses should not be replaced; dosing should resume with the next scheduled daily dose

• Oral self-administration; missed doses (≥12 hours late) should be skipped.
• Capsules should not be broken or chewed; swallowed whole, preferably with water, either with or without food.
• Available as 5 mg, 10 mg, 15 mg,  and 25 mg capsules.
• Note: Females who could become pregnant, or who plan to become pregnant can handle lenalidomide capsules if they are using latex gloves.

• Oral self-administration; drug available by outpatient prescription.

• Doses <100mg may be given by IV push through sidearm of free flowing IV (5% Dextrose, Normal Saline or 2/3-1/3), the injection must not exceed 160mg/min of leucovorin (due to calcium content).
• May be mixed in 50mL Normal Saline or 5% Dextrose minibag (doses up to 500mg) or 100mL minibag (doses >500mg) or in 100mL fluid in graduated administration set (5% Dextrose, Normal Saline or 2/3-1/3); Give over 15 minutes.
• Continuous infusion using CADD pump or similar device.
• Cryodesiccated powder reconstituted with Bacteriostatic Water for Injection containing benzyl alcohol should only be used at doses below 10 mg/m2
• Leucovorin should not be mixed in the same infusion as 5-fluorouracil as a precipitate may form.
• Keep refrigerated; protect from light.

• Oral self-administration; drug available by retail prescription.

• Outpatient prescription; administer in Cancer Centre or physician’s office
• Vary injection site
• For long-acting preparations, reconstitute with supplied diluent immediately before injection as directed (see product monograph).  
• Lupron® 5mg/mL injection:
• For Subcutaneous use only
• Keep refrigerated
• Lupron Depot® 7.5mg, 22.5mg and 30mg:
• For Intramuscular use only.  
• Store at room temperature
• Eligard® 7.5mg, 22.5mg, 30mg, and 45mg:
• For Subcutaneous use only.  Choose an injection site on the abdomen, upper buttocks, or anywhere with adequate amounts of subcutaneous tissue.  
• Keep refrigerated, or may be stored at room temperature in original packaging for a period of 8 weeks before administration.  
• Allow product to reach room temperature before using. 

• Oral self-administration; drug available by retail prescription.

• Mix in 100mL empty minibag with D5W in a 1:1 ratio with the volume of the drug dose; infuse over 1 hour.

• Follow manufacturer's instrucions for reconstitution.
• Dilute drug in 250-500mL NS or D5W. (May dilute drug maximally up to 50 times.)
• Infuse over 1 hour.
• Avoid extravasations.
• Do not administer as a bolus injection or undiluted solution.
• Liposomal doxorubicin must not be given by the intramuscular or subcutaneous route.

• For dose < 90mg, dilute drug in 250mL D5W.
• For dose = 90mg, dilute drug in 500mL D5W.
• To minimize the risk of infusion reactions, the initial dose is administered at a rate no greater than 1 mg/minute. If no infusion reaction is observed, subsequent infusions may be administered over a 60-minute and 30-minutes period for ovarian cancer patients and Kaposi’s sarcoma patients, respectively.
• Avoid Extravasation.
• Do not administer as a bolus injection or undiluted solution.
• Pegylated liposomal doxorubicin must not be given by the intramuscular or subcutaneous route.

• Oral self-administration; drug available by retail prescription.

• Solution should be prepared immediately prior to administration.
• Slow push through sidearm of free flowing IV (NS); Give 1mg/1mL per minute.

• Oral self-administration; drug available by retail prescription.
• Depot formulation for intramuscular injections available.
• Medroxyprogesterone is not for i.v. use.

• Oral self-administration; drug available by retail prescription.

• Oral self-administration; drug available by retail prescription.
• Take on an empty stomach.

• Slow push through sidearm of free flowing IV (Normal Saline).
• For reconstitution, rapid addition of the supplied diluent to the drug vial followed by immediate vigorous shaking is important for proper dissolution.
• May dilute in Normal Saline to a concentration between 0.1 to 0.45 mg/mL; Infuse over 15-30 minutes.
• Should be administered within 50 minutes of reconstitution. Reconstituted product is stable for 2 hours at 30 ^o C. Precipitate forms if refrigerated.

• Oral self-administration; drug available by retail prescription.

• May be diluted in 50-100mL of diluent (D5W, NS, or 2/3-1/3), at 1mg/mL or greater, and given over a 15-30 minutes.
• May be diluted in larger volumes for continuous infusion over 3-24 hours; May be infused using a CADD ambulatory infusion pump over longer periods.
• May be given as IV push through side arm of free-flowing IV.
• May be infused concurrently with ifosfamide and cyclophosphamide
• Incompatible in solution with cisplatin or carboplatin.
• IV solution may be given PO; may be mixed with juice, cola or milk to mask unpleasant taste.

• Preserved formulation contains benzyl alcohol and should not be used for intrathecal intraventricular or high dose treatment.
• Do not admix with araC, 5FU, prednisolone, KCI or other drugs unless compatibility are available.
• Slow push through sidearm of free flowing IV (D5W, NS or 2/3:1/3).
• May be given by IM or direct IV push, followed by a NS IV flush, if no IV line has been set up.
• Doses from >100mg may be mixed in 50-100mL minibag (NS); Infuse over 30-60 minutes.
• Doses from 250-500mg may be mixed in 500mL bag (NS); Infuse over 1-2 hours.
• Doses from >500mg may be mixed in 1000mL bag (NS); Infuse over 2-4 hours.
• May be given as Intrathecal injection; use unpreserved solution or mix in unpreserved diluent using strict aseptic technique.

• Hydrate with NS at 100-125mL/hour, starting 6 to 12 hours before Methotrexate; measure urine output (>60 mL/hour).
• Alkalinize urine, starting 6-12 hours before Methotrexate, with Sodium Bicarbonate 50mmol in alternating litres of IV hydration fluid (or in each litre); maintain urine pH > 7.0 (may also give Sodium Bicarbonate 100mg/m ^² PO q6h).
• Continue hydration and alkalinization for 24 hours after completion of Methotrexate infusion.
• Leucovorin rescue to start 24 hours after Methotrexate dosing finished; continue until serum levels drop below toxic range (<0.05µmol/L).

• Oral self-administration; drug available by retail prescription.

• Slow push through sidearm of free flowing IV (NS)

• Slow push through sidearm of free flowing IV (NS); Give 1.5mg/3mL per minute.
• Doses may be mixed in 50mL minibag (NS); Infuse through sidearm of free flowing IV over 10-30 minutes.

• Oral self-administration; drug available by retail prescription.
• Should not be taken with a fatty meal.
• Consider steroid replacement.

• Doses may be mixed in 100mL minibag (NS); Infuse through sidearm of free flowing IV over 10-15 minutes.
• Slow push through sidearm of free flowing IV; Give 4mg/m ² mL per minute.
• Mitoxantrone should not be mixed in the same infusion with heparin since a precipitate may form.
• Do not admix with other drugs.
• Do not freeze.

• Infuse intravenously over 30 minutes. Slower infusion rates may increase the likelihood of infusion-related reactions.
• After reconstitution, no further dilution is necessary.
• DEHP-free containers or administration sets may be used but are not required.
• Do not admix with other drugs.
• Inline filters are NOT recommended.

• Oral self-administration; drug available by outpatient prescription
  
• Take tablet(s) before breakfast.
  Avoid alcoholic beverages during treatment
  

• Nilotinib must be taken on an empty stomach, at least 1 hour before and 2 hours after food.  Avoid grapefruit or grapefruit juice.
• Swallow whole with a glass of water.
• Do not replace missed doses.

Short Acting (sc ampoules or multidose vials):

• Subcutaneous self-administration (or administered by home caregiver); drug available by outpatient prescription.
• Rotate injection sites; multiple SC injections at the same site within short periods of time should be avoided.
• For day-to-day use, may be stored at room temperature for up to 2 weeks, protected from light. Open ampoule(s) just prior to administration and discard unused portion
• Incompatible in TPN solutions.
• For IV infusion (emergency treatment for carcinoid syndrome only): further dilute in NS (preferred) or D5W.
• Keep refrigerated; protect from light.

Long Acting (ie. Sandostatin LAR®):

• May only be administered by deep intragluteal injection
• To be injected at doctor’s office or cancer centre. Drug available by outpatient prescription.
• Alternate between left and right gluteal muscles for subsequent injections.
• Vials can remain at room temperature, protected from light, on the day of the injection.
• Reconstitute with supplied diluent as directed. Suspension must be prepared immediately before IM injection.
• Patients switching over to the long-acting injection may need to continue to receive SC octreotide (short acting) for approximately 2 weeks, and some individuals may need additional rescue SC octreotide (short acting) for up to 2 to 3 months because of the time required to reach steady-state octreotide levels, as the drug is slowly released from the microspheres.
• Keep refrigerated; protect from light.

• Oxaliplatin should always be administered before 5-FU.
• May be mixed in 250-500 mL bag (D5W only - not NS or alkaline solutions, and should not be mixed with fluorouracil) and given by slow infusion. Concentration must be between 0.2 to 0.7 mg/mL
• Infuse over 120 minutes. Increasing infusion time to 6 hours may decrease acute toxicity such as pharyngolaryngeal dysesthesia.
• Infusion may be given at the same time as Leucovorin in separate bags using a Y-site (not in the same bag) providing trometamol is not used as an excipient. May not be administered with fluorouracil.
• Do not use with injection equipment containing aluminum.

• Use non-PVC equipment, including 0.22 micron in-line filter; infuse over 3 hours.
  
• Dilute in 500-1000 mL Normal Saline or 5% Dextrose, in a final concentration of 0.3-1.2 mg/mL.
  
• May be infused over 1 hour-mix in 250mL bag as above (not approved by manufacturer).
  
• May be given as 24 hour infusion-mix in 1000mL bag and use non-PVC equipment and in-line filter; given as inpatient or using CADD pump.
  
• Excessive shaking, agitation, or vibration may induce precipitation and should be avoided.
  

• Outpatient prescription for home administration (self or by home caregiver)
• For subcutaneous use only. Do not shake drug.
• Do not mix with any diluents.
• Keep refrigerated and protect from light.
• May be allowed to reach room temperature for a maximum of 72 hours before injection.

• Reconstitute as directed with NS.
• Mix drug in 100mL (NS); infuse over 10 minutes through free flowing IV.
• Incompatible with calcium containing solutions
  

• Direct intravenous: preferred route, over 3-5 minutes 40-50 hours prior to laser light delivery. Reconstitute powder with D5W to a final concentration of 2.5 mg/mL. Do not reconstitute with normal saline solutions since this will result in precipitation.
• Refer to package insert for details regarding photo activation.

• Oral self-administration; drug available by retail prescription.

• Oral self-administration; drug available by retail prescription.

• Mix in 100mL (NS, D5W); Infuse over 15 minutes.
• Do not admix with other drugs.
• Reconstituted and diluted solutions do not need to be protected from light.

• Rituximab infusions should be administered in a setting where full resuscitation facilities are immediately available, and under the close supervision of someone experienced and capable of dealing with severe infusion-related reactions.
• DO NOT administer as an I.V. push or bolus.
• Dilute to a final concentration of 1-4mg/ml in normal saline or D5W
• To avoid foaming, gently invert the bag to mix the solution.
• Do not admix with other drugs.
• Administer rituximab through a dedicated line.

• First infusion: initial rate of 50 mg/h, then escalate rate in 50 mg/h increments every 30 minutes, to a maximum of 400 mg/h.
• Subsequent infusions:
• Initial rate of 100 mg/h, then escalate rate in 100 mg/h increments every 30 minutes, to a maximum of 400 mg/h as tolerated.
• Published data suggest that a 90 minute infusion (20% of the dose in the first 30 min then the remaining 80% over 60 min) can be used for second and subsequent infusions if no reaction occurred with the 1st infusion (Sehn et al. and Salar et al.)
• Consider a slower infusion rate or split dosing over 2 days for the first cycle, in patients with high bulk disease who are at a higher risk of tumour lysis syndrome and infusion related reactions.

• Oral self-administration; drug available by outpatient prescription.
• Prescribed dose should be administered orally on an empty stomach, or with a low fat or moderate-fat meal with a large glass of water.

• Mix in 50-250 mL bag (NS or D5W); Infuse over 30 to 60 minutes.
• Incompatible with allopurinol, aztreonam or piperacillin / tazobactam.

• Prescribed dose should be administered orally, once daily with or without food.
• Grapefruit or grapefruit juice must be avoided.
• Stored at room temperature (25°C).

• Oral self-administration; drug available by outpatient prescription.

• Oral self-administration; drug available by retail prescription.
• Temozolomide should be administered in the fasting state, at least one hour before a meal. Capsules must not be opened or chewed, but are to be swallowed whole with a glass of water.
• If vomiting occurs after the dose is administered, a second dose should not be administered.

• Reconstitute as directed with Sterile Water for Injection.  Swirl gently; do not shake.
• Transfer required dose of reconstituted drug into an empty 250mL PVC infusion bag.
• Infuse IV over 90 minutes.
• Reconstituted product must be used within 14 hours, including infusion time.
• No data available on the compatibility of temozolomide with other IV solutions/drugs.
• Other medications should be not infused simultaneously through the same IV line.

• Dilute in supplied diluent (contains polysorbate 80 and PEG 400) and then dilute further in 250mL Normal Saline, infuse over 30 -60 minutes.
• Use non-PVC bags and tubing, including in-line filter ≤ 5 micron
• Stop the infusion and observe the patient for at least 30-60 minutes, if hypersensitivity reaction occurs. If deemed appropriate by the physician, temsirolimus may be resumed; administer an H1-receptor antagonist if one was not previously administered and/or an H2-receptor antagonist such as intravenous famotidine 20 mg or intravenous ranitidine 50 mg approximately 30 minutes before restarting the infusion at a slower rate of up to 60 minutes.

• May mix in 250mL bag (doses < or = 100mg) or 500mL bag (doses>100mg) (NS); Infuse over 1-2 hours (adjust infusion time for blood pressure response)
• Use non-DEHP container and administration sets.
• To avoid the possibility of hypotensive reactions, teniposide should not be administered by bolus injection or rapid infusion.
• Care should be taken to ensure that teniposide infusions are given i.v. with indwelling catheter in proper position prior to infusion as extravasation, necrosis and/or thrombophlebitis may result with improper administration.

• Oral self-administration; drug available by retail prescription in pharmacy registered with the S.T.E.P.S program from Celgene. Available as 50mg capsules
  
• Contents of capsules can be mixed with semi-solid food, but must be ingested immediately.
  
• Thalidomide should be administered at bedtime to minimize adverse effects such as dizziness and somnolence.
  
• Thalidomide should be taken with water, at least 1 hour after a meal.
  

• Oral self-administration; drug available by retail prescription.

• In order to eliminate haze, solutions should be filtered through a 0.22 micron filter prior to administration. Filtering does not alter potency. Solution that remains opaque or precipitate after filtration should not be used.
• Push through sidearm of free flowing IV (NS, D5W,2/3:1/3).
• May mix in 50mL minibag (NS, D5W); Infuse over 15 minutes.

• Mix in 50mL-100mL minibag (NS or D5W); Infuse over 30 minutes.
• Final concentration should be 20 mcg - 500 mcg/mL.

• The tositumomab and ¹³¹ I -tositumomab therapeutic regimen should be administered in a setting where full resuscitation facilities are immediately available and under the close supervision of someone experienced and capable of dealing with severe infusion-related reactions.
• Precautions should be taken to avoid extravasation. A free-flowing intravenous line should be established prior to administration of tositumomab and ¹³¹ I–tositumomab infusions. Close monitoring for evidence of extravasation is required. If any signs or symptoms of extravasation occur, the infusion should be immediately terminated and restarted in another vein.
• Consult the Product Monograph for detailed administration guidelines.

• Mix in 250 mL bag NS; Do not use D5W. Do not shake.
• Infuse loading dose over 90 minutes; subsequent infusions may be over 30 minutes if previous infusions well tolerated.
• DO NOT ADMINISTER AS AN IV PUSH OR BOLUS.
• Should not be mixed or diluted with other drugs.
• Herceptin infusions should not be administered or mixed with Dextrose solutions.
• Diluent supplied - Bacteriostatic Water for Injection (BWFI)- contains benzyl alcohol 1.1%; if patient is hypersensitive to benzyl alcohol, may reconstitute with Sterile Water for Injection, but must be used immediately and discard unused portion.
• Solution reconstituted with the supplied BWFI is stable up to 28 days refrigerated.
• Do not freeze the reconstituted solution.

• Oral self-administration; drug available by outpatient prescription.
  
• Should be administered with food.
  
• Tretinoin capsules should not be opened. 
  
• Store at room temperature, away from heat and direct light.
  

• Intramuscular injection in Cancer Centre or physician’s office, drug supplied by outpatient prescription.
• Vary injection site. Maintain schedule of injections.
• Reconstitute with 2 mL sterile water for injection (forms a suspension) using a 21–gauge needle or using the single dose delivery system (Clip’n’Ject®). Refer to product monograph for detailed instructions.
• Store at room temperature and protected from light; administer triptorelin suspension right after reconstitution. Any unused portion should be discarded immediately.
  

Vinblastine is lethal if injected intrathecally.   The Compendium of Pharmaceuticals and Specialties (CPS) and the United States Pharmacopeia (USP) require that vinblastine be dispensed in an overwrap bearing the statements "Do not remove covering until moment of injection. Fatal if given intrathecally. For intravenous use only".

• Quick push through sidearm of free flowing IV (5% Dextrose or Normal Saline); Inject over 1 minute.  Do not admix with solutions that can change pH (e.g. lactate containing solutions).
• May mix in 50 mL minibag (NS or D5W); infuse over 20-30 minutes

Vincristine is lethal if given intrathecally. No successful antidotes have been described. The Compendium of Pharmaceuticals and Specialties (CPS) requires that vincristine be dispensed in an overwrap bearing the statements "Warning: For I.V. use only. Do not remove this covering until time of injection. Fatal if given intrathecally."

• May limit dose to 2mg for selected regimens or at discretion of prescriber.
• Direct IV push not recommended, due to risk of inadvertent intrathecal administration.
• For intermittent IV use, may mix in small volume minibag (ie. 50mL NS or D5W for adults).
• Infuse IV via gravity. Infusion pumps should not be used peripherally, since they deliver infusions at higher pressures and may continue to infuse when extravasation occurs.
• During the infusion, suggest nurse to remain present with the patient to observe the IV site for extravasation.

• Mix in 50mL minibag (D5W, NS) to a final concentration 0.5-2mg/mL; Infuse over 6-10 minutes through free-flowing IV.
• May push (at final concentration of 1.5 - 3mg/ml) through sidearm of free flowing IV (NS); Inject over 6-10 minutes.
• After administration is completed, flush IV line with 200 to 300ml NS or D5W.
• Vinorelbine should be administered only via the iv route; intrathecal administration is fatal.

• Outpatient prescription for home administration.
• Capsules should not be opened or crushed.
• Patients should be instructed to drink at least 2 L/day of fluids for adequate hydration.

• Must not be mixed with calcium containing solutions.
• Mix in minimum of 100mL solution (D5W or NS) and infuse over = 15 minutes.
• Should be administered as a single intravenous solution in a line separate from all other drugs.
• Dehydrated patients must be adequately rehydrated prior to treatment with zoledronic acid.