Extravasation
Neutral (non-irritant)
Drugs which do not cause
irritation when extravasated
Leakage of a drug out of a blood vessel to surround tissue
Irritant Irritant with vesicant Vesicants
properties
Drug which causes Drugs which are capable of Drug capable of causing necrosis when extravasated
irritation such as pain, causing necrosis and ulceration
tightness or phlebitis in proportion to the
when extravasated concentration

Anthracyclines DNA Binding Non-DNA Binding Cisplatin (>0.5mg/mL)

 Liposomal Doxorubicin Direct progressive tissue
 Mitozantrone damage to healthy tissue due
Taxanes to cellular DNA binding
 Docetaxel  Ulceration
 Paclitxel  Necrosis
 Nab-Paclitaxel  Tendon damage
Alkylating Agents  Nerve damage
 Melphalan Anthracyclines Vinca Alkaloids
Platinum Compounds  Daunorubicin  Vincristine
 Oxaliplatin  Doxorubicin  Vinblastine
 Epirubicin  Vinorelbine
 Idarubicin  Vinflunine
Dactinomycin
Mitomycin
Drug name Class/clinical procedure Warm or cold compress Antidote

Aflibercept Non-irritant (neutral) Not indicated Not indicated

Alemtuzumab Non-irritant (neutral) Not indicated Not indicated

Amifostine Non-irritant (neutral) Not indicated Not indicated

Amsacrine Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hours

Antithymocyte globulin (horse) Non-irritant (neutral) * Not indicated Not indicated

(ATGAM®)

Antithymocyte globulin (rabbit) Non-irritant (neutral) * Not indicated Not indicated

(Thymoglobulin®)

Arsenic trioxide Non-irritant (neutral) Not indicated Not indicated

Asparaginase Non-irritant (neutral) Not indicated Not indicated

(L-aspariginase)

Atezolizumab Non-irritant (neutral) Not indicated Not indicated

Azacitidine Non-irritant (neutral) Not indicated Not indicated

Drug name Class/clinical procedure Warm or cold compress Antidote

(this does not preclude

subcutaneous therapy)

Bendamustine Irritant with vesicant properties* COLD compress apply 15 to 20 minutes Not indicated
FOUR times daily for 48 hours

Bevacizumab Non-irritant (neutral) Not indicated Not indicated

Bleomycin Non-irritant (neutral) Not indicated Not indicated

Blinatumomab Non-irritant (neutral) * Not indicated Not indicated

Bortezomib Irritant COLD compress Not indicated

(this does not preclude (initial for comfort measures)
subcutaneous therapy)

Brentuximab Non-irritant (neutral) Not indicated Not indicated

Busulfan Irritant COLD compress Not indicated

(initial for comfort measures)

Cabazitaxel Irritant* COLD compress Not indicated

(initial for comfort measures)
Drug name Class/clinical procedure Warm or cold compress Antidote

Calcium leucovorin Non-irritant (neutral) Not indicated Not indicated

Carboplatin Irritant COLD compress Not indicated

(initial for comfort measures)

Carfilzomib Non-irritant (neutral) Not indicated Not indicated

Carmustine Irritant COLD compress Not indicated

(initial for comfort measures)

Cetuximab Non-irritant (neutral) Not indicated Not indicated

Cisplatin ≤ 0.5 mg/mL Irritant COLD compress Not indicated

(initial for comfort measures)

Cisplatin > 0.5 mg/mL Vesicant (treated as an irritant COLD compress apply 15 to 20 minutes No recommended antidote
with vesicant properties) FOUR times daily for 48 hours

Cladribine Non-irritant (neutral) Not indicated Not indicated

Cyclophosphamide Non-irritant (neutral) Not indicated Not indicated

Cytarabine Non-irritant (neutral) Not indicated Not indicated

Drug name Class/clinical procedure Warm or cold compress Antidote

Dacarbazine Irritant COLD compress Not indicated

(initial for comfort measures)
(Phlebitis and pain not to be confused
with extravasation)

Dactinomycin (Actinomycin D) Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Daunorubicin Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Denosumab Non-irritant (neutral) Not indicated Not indicated

Docetaxel Irritant with vesicant properties COLD compress apply 15 to 20 minutes No recommended antidote
FOUR times daily for 48 hour

Doxorubicin Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Doxorubicin liposomal Irritant with vesicant properties* COLD compress apply 15 to 20 minutes No recommended antidote
FOUR times daily for 48 hour Do not use DMSO 99% solution

Durvalumab Non-irritant (neutral) Not indicated Not indicated

Drug name Class/clinical procedure Warm or cold compress Antidote

Epirubicin Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Eribulin mesilate Non-irritant (neutral) Not indicated Not indicated

Etoposide Irritant COLD compress Not indicated

(initial for comfort measures)

Etoposide phosphate Irritant* COLD compress Not indicated

(initial for comfort measures)

Fludarabine Non-irritant (neutral) Not indicated Not indicated

Fluorouracil Irritant COLD compress Not indicated

(initial for comfort measures)

Fotemustine Irritant COLD compress Not indicated

(initial for comfort measures)

Ganciclovir Non-irritant (neutral) Not indicated Not indicated

Gemcitabine Irritant COLD compress Not indicated

(initial for comfort measures)
(phlebitis and pain not to be confused
Drug name Class/clinical procedure Warm or cold compress Antidote

with extravasation)

Idarubicin Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Ifosfamide Irritant COLD compress Not indicated

(initial for comfort measures)

Interferon Non-irritant (neutral) Not indicated Not indicated

Ipilimumab Non-irritant (neutral) Not indicated Not indicated

Irinotecan Irritant COLD compress Not indicated

(initial for comfort measures)

Irinotecan nanoliposomal Irritant COLD compress No recommended antidote

(initial for comfort measures)

Melphalan Irritant with vesicant properties COLD compress apply 15 to 20 minutes No recommended antidote
FOUR times daily for 48 hour

Mesna Non-irritant (neutral) Not indicated Not indicated

Drug name Class/clinical procedure Warm or cold compress Antidote

Methotrexate Non-irritant (neutral) Not indicated Not indicated

Mitomycin Vesicant COLD compress apply 15 to 20 minutes Dimethyl sulfoxide (DMSO 99% solution)
FOUR times daily for 48 hour

Mitozantrone Irritant with vesicant properties COLD compress apply 15 to 20 minutes No recommended antidote
FOUR times daily for 48 hour

Nivolumab Non-irritant (neutral) Not indicated Not indicated

Obinutuzumab Non-irritant (neutral) Not indicated Not indicated

Ofatumumab Non-irritant (neutral) Not indicated Not indicated

Oxaliplatin Irritant with vesicant properties No warm or cold compress recommended No recommended antidote

Paclitaxel Irritant with vesicant properties COLD compress apply 15 to 20 minutes There have been some clinical reports of
FOUR times daily for 48 hour positive outcomes with using hyaluronida
If hyaluronidase is administered no comp
recommended.

Paclitaxel nab (Abraxane®) Irritant with vesicant properties COLD compress apply 15 to 20 minutes No recommended antidote
FOUR times daily for 48 hour
Drug name Class/clinical procedure Warm or cold compress Antidote

Pamidronate Non-irritant (neutral) Not indicated Not indicated

Panitumumab Non-irritant (neutral) Not indicated Not indicated

Pegasparaginase  Non-irritant (neutral) Not indicated Not indicated

Pembrolizumab Non-irritant (neutral) Not indicated Not indicated

Pemetrexed Non-irritant (neutral) Not indicated Not indicated

Pertuzumab Non-irritant (neutral) Not indicated Not indicated

Pralatrexate Non-irritant (neutral)* Not indicated Not indicated

Raltitrexed Non-irritant (neutral) Not indicated Not indicated

Ramucirumab Non-irritant (neutral) Not indicated Not indicated

Rituximab Non-irritant (neutral) Not indicated Not indicated

Romidepsin Irritant COLD compress No recommended antidote

(initial for comfort measures)
Drug name Class/clinical procedure Warm or cold compress Antidote

Temsirolimus Non-irritant (neutral) Not indicated Not indicated

Teniposide Irritant COLD compress Not indicated

(initial for comfort measures)

Thiotepa Non-irritant (neutral) Not indicated Not indicated

Topotecan Irritant COLD compress Not indicated

(initial for comfort measures)

Trastuzumab (Herceptin®) Non-irritant (neutral) Not indicated Not indicated

Trastuzumab emtansine (Kadcyla®) Irritant Not indicated Not indicated

Vinblastine Vesicant WARM compress apply 15 to 20 minutes Hyaluronidase

FOUR times daily for 48 hour

Vincristine Vesicant WARM compress apply 15 to 20 minutes Hyaluronidase

FOUR times daily for 48 hour

Vindesine Vesicant WARM compress apply 15 to 20 minutes Hyaluronidase

FOUR times daily for 48 hour
Drug name Class/clinical procedure Warm or cold compress Antidote

Vinflunine Vesicant WARM compress apply 15 to 20 minutes Hyaluronidase

FOUR times daily for 48 hour

Vinorelbine Vesicant WARM compress apply 15 to 20 minutes Hyaluronidase

FOUR times daily for 48 hour

Zoledronic acid Irritant* COLD compress Not indicated

(initial for comfort measures)