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BCCA - Chemotherapy Protocols & Stability Chart - July - 2019 PDF
BCCA - Chemotherapy Protocols & Stability Chart - July - 2019 PDF
DRUG & STRENGTH Reconstitute To Give: Vial Product Product Stability Special
(Storage Prior to Use, With: Stability Precautions/Notes
Manufacturer,
Preservative Status)
AGS-16C3F
1 1 1
30 mg 5.1 mL SWI 6 mg/mL discard unused ≥ 0.3 mg/mL complete - unopened vials
1
(Astellas) portion administration within may be kept at RT
2,3
(F)(PFL) swirl gently; do NOT 100 mL D5W 6 h RT of for up to 4h prior to
1 1 1
do not shake shake (PFL) reconstitution use if protected from
1 1
no preservative mix by gentle light
1
allow foam to clear inversion **(PFL)
1
before proceeding
record time of
reconstitution
Aldesleukin
4,5 4 4 4
22 million units 1.2 mL SWI 18 million unit/mL 48 h F 50 mL D5W 48 h F - do not use in-line
4,5 4,5
(1.3 mg) (1.1 mg/mL) filter
4
(Novartis) direct diluent against 30 – 70 mcg/mL - avoid bacteriostatic
(F)(PFL) side of vial during water for injection or
4 4
no preservative reconstitution Less than 30 mcg/mL: NS due to increased
4
dilute in D5W aggregation
4
do NOT shake containing human
5
albumin 0.1%
6,7 7
SC syringe 14 d F
**(PFL)
Amsacrine
12 12 12 12-14
75 mg/1.5 mL glass syringes 5 mg/mL 24 h RT 500 mL D5W 7 d F, 48 h RT - contains DMA***
(Erfa Canada) preferred during
12
(RT) reconstitution; (**PFL) (plastic or glass
12 12
no preservative max. time in plastic container)
12
syringe : 15 min
13.5 mL supplied
diluent (L-lactic
1
acid)
Arsenic
15 15
10 mg/10 mL N/A 1 mg/mL discard unused 100-250 mL NS, 24 h RT, 48 h F
15 15
(Lundbeck/Teva) portion D5W
(RT) (use filter needle to
15
no preservative withdraw from
ampoule)
Erwinia asparaginase
19 19 19
(asparaginase Erwinia 1-2 mL NS 10 000-5000 15 min RT glass or 4 h RT - contact with the
chrysanthemi) units/mL polypropylene rubber stopper may
19
10,000 units do NOT shake; mix syringe denature the
(CGF/EUSA) gently to minimize (use 5 micron filter reconstituted drug,
(F) bubbles and contact needle to withdraw creating filaments of
19 19 20 19
no preservative with stopper from vial) insoluble material
- discard if
particulate matter is
20
present
- do not use sterile
water for
reconstitution as the
resulting product is
19
not isotonic
PEG-asparaginase -
see pegaspargase in
L-Z chart
(pegylated
asparaginase E. coli)
Avelumab
23 23
200 mg/10 mL N/A 20 mg/mL discard unused 250 mL NS, complete - do NOT shake
18
(EMD) portion 0.45% sodium administration within - use 0.2 micron in-
23 23
(F)(PFL) chloride 24 h F, 8 h RT line filter to
23 23
no preservative if refrigerated, administer
bring vial to RT mix by gentle if refrigerated, bring
23 23
prior to use inversion bag to RT prior to
23
administration
Refrigerated
24
syringes :
allow up to 30 min
prior to
administration to
reach a
temperature of ~20-
25°C
discard syringe if
time elapsed at RT
is greater than 30
min
Refrigerated
28
syringes :
allow up to 30 min
prior to
administration to
reach a
temperature of
approximately 20-
25°C
discard syringe if
time elapsed at RT
is greater than 30
min
BCG
8 31
(Tice substrain) 1 mL preservative 1 to 8×10 2hF transfer from vial to use within 2 h F of - auxiliary info:
31 31 30,31 30
intravesical free NS CFU/vial 60 mL syringe and qs reconstitution biohazard
8 31 31 31
50 mg = 1 to 8 x 10 (PFL to 50 mL with NS - do NOT filter
31 31
CFU allow to stand for a **(PFL) - do NOT shake
(Merck USA) few minutes, then
(F)(PFL) gently swirl to
31 31
no preservative suspend
record time of
reconstitution
record time of
reconstitution
Belinostat
33 33 33 33
500 mg 9 mL SWI 50 mg/mL 12 h RT 250 mL NS complete - use 0.22 micron
(Spectrum) administration within inline filter to
33 33
(RT) 36 h RT administer
33
no preservative
Bendamustine
34 34
25 mg 25 mg vial: 5 mg/mL 30 minutes 0.2-0.6 mg/mL NS, complete
34 34
100 mg add 5 mL SWI D2.5-½NS administration within
35
(Lundbeck/Teva) 24 h F, 3 h RT
34
(RT,F)(PFL) 100 mg vial: 250* - 500 mL
34 34
no preservative add 20 mL SW
shake well;
dissolves completely
34
in 5 minutes
Bleomycin
39 39 39 39
15 units 6 mL* NS 2.5 units/mL 48 h F 50 mL* NS 24 h RT
(NB: dose in units only)
(Fresenius Kabi)
(F)(PFL)
39
no preservative
Bleomycin
40 40 41
15 units 6 mL* NS, SWI 2.5 units/mL 48 h F, 24 h RT 50 mL* NS{14216}} 4 h RT
(NB: dose in units only)
(Pfizer/Hospira)
(F)(PFL)
40
no preservative
Bortezomib
43 43 44,45 43 44,45
SC injection 1.4 mL NS 2.5 mg/mL 2 d F, RT SC syringe 14 d F, 48 h RT - auxiliary info:
3.5 mg WARNING:
(Actavis) SUBCUTANEOUS
(RT)(PFL) use only. Fatal if
43
no preservative given by other
routes.
Bortezomib
43 43 44,45 43 44,45
3.5 mg 3.5 mL NS 1 mg/mL 2 d F, RT IV syringe 14 d F, 48 h RT - auxiliary info:
(Actavis) WARNING:
(RT)(PFL) INTRAVENOUS use
43
no preservative only. Fatal if given by
other routes.
Bortezomib
46 46 30,47 46 30,47
3.5 mg 3.5 mL NS 1 mg/mL 2d F, RT IV syringe 14 d F, 48 h RT - auxiliary info:
(Apotex) WARNING:
(RT)(PFL) INTRAVENOUS use
46
no preservative only. Fatal if given by
other routes.
Bortezomib
48 48 44,45 48 44,45
SC injection 1.4 mL NS 2.5 mg/mL 2 d F, RT SC syringe 14 d F, 48 h RT - auxiliary info:
3.5 mg WARNING:
(Janssen) SUBCUTANEOUS
(RT)(PFL) use only. Fatal if
48
no preservative given by other
routes.
Bortezomib
48 48 44,45 48 44,45
3.5 mg 3.5 mL NS 1 mg/mL 2 d F, RT IV syringe 14 d F, 48 h RT - auxiliary info:
(Janssen) WARNING:
(RT)(PFL) INTRAVENOUS use
48
no preservative only. Fatal if given by
other routes.
Bortezomib
49 49 44,45 49 44,45
3.5 mg 3.5 mL NS 1 mg/mL 2 d F, RT IV syringe 14 d F, 48 h RT - auxiliary info:
(Teva) WARNING:
(RT)(PFL) INTRAVENOUS use
49
no preservative only. Fatal if given by
other routes.
Brentuximab vedotin
50 50 50 50
50 mg 10.5 mL SWI 5 mg/mL 24 h F 0.4-1.8 mg/mL in NS, 24 h F - solution should be
(GMD/Seattle Genetics) D5W, Lactated clear to slightly
(F)(PFL) direct diluent against Ringer’s opalescent,
50
no preservative side of vial during colorless, and free of
50 50 50
reconstitution 100-250 mL visible particulates
50
do NOT shake
Busulfan
52
60 mg/10 mL N/A 6 mg/mL discard unused NS, D5W in NS: complete - contains DMA***
18,52
(SteriMax) portion (dilute to volume 10 administration within - always add
52
(F) times drug volume to 12 h F, 8 h RT busulfan to diluent to
52
no preservative achieve final mix; do not add
52
concentration of ~0.5 in D5W: complete diluent to busulfan
52
mg/mL) administration within
52
8 h RT
CARBOplatin
54 54 54
50 mg/5 mL N/A 10 mg/mL discard unused 0.5-10 mg/mL 24 h F, 8 h RT - do NOT use
54
150 mg/15 mL portion aluminum-containing
54
450 mg/45 mL NS, D5W needle, syringe, or
54
600 mg/60 mL tubing
(Accord)
(RT)(PFL)
54
no preservative
CARBOplatin
57 57 57
50 mg/5 mL N/A 10 mg/mL discard unused 0.3-10 mg/mL 48 h F - do NOT use
57
150 mg/15 mL portion aluminum-containing
57
450 mg/45 mL NS, D5W needle, syringe, or
57
600 mg/60 mL tubing
(Pfizer/Hospira)
(RT)(PFL)
57
no preservative
CARBOplatin
58 59 58
50 mg/5 mL N/A 10 mg/mL discard unused 0.5-10 mg/mL 8 h RT - do NOT use
58
150 mg/15 mL portion RT aluminum-containing
58,60,61
450 mg/45 mL NS, D5W needle, syringe, or
58
(Teva/Novopharm) tubing
(RT)(PFL)
58
no preservative
if foaming occurs,
allow to settle until
clear (about 5
62
minutes)
record time of
reconstitution
record time of
reconstitution
Cemiplimab
66
250 mg/5 mL N/A 50 mg/mL discard unused 50 or 100 mL NS, complete
66 66
(Regeneron) portion D5W administration within
66
(F)(PFL) 24 h F, 6 h RT
do not shake dilute to final volume
66
no preservative by withdrawing
volume from bag
equal to volume of
66
drug to be added
mix by gentle
inversion
CISplatin
68 68
10 mg/10 mL N/A 1 mg/mL discard unused Less than or equal to 24 h RT - do NOT use
30
50 mg/50 mL portion 60 mg: 100 mL* NS aluminum-containing
100 mg/100mL needle, syringe or
68
(Accord) Greater than 60 mg: tubing
(RT)(PFL) 250 mL* NS
68
no preservative
2 L of D5 in one-half
or one-third NS
containing 37.5 g of
68
mannitol
CISplatin
69 69
50 mg/50 mL N/A 1 mg/mL discard unused Less than or equal to 24 h RT - do NOT use
30
100 mg/100mL portion 60 mg: 100 mL* NS aluminum-containing
(Pfizer/Hospira) needle, syringe or
69
(RT)(PFL) Greater than 60 mg: tubing
69
no preservative 250 mL* NS
2 L of D5 in one-half
or one-third NS
containing 37.5 g of
69
mannitol
2 L of D5 in one-half
or one-third NS
containing 37.5 g of
70
mannitol
CISplatin
73 73
10 mg/10 mL N/A 1 mg/mL discard unused Less than or equal to 24 h RT - do NOT use
18
50 mg/50 mL portion 60 mg: 100 mL* NS aluminum-containing
100 mg/100mL needle, syringe or
73
(Teva) Greater than 60 mg: tubing
(RT)(PFL) 250 mL* NS
73
no preservative
2 L of D5 in one-half
or one-third NS
containing 37.5 g of
73
mannitol
74
Cassette: at least 7 days
qs to 100 mL with
bacteriostatic NS
only via SIMS
DELTEC INC.
MEDICATION
74
CASSETTES® filter
drug and diluent
through 0.22 micron
filter as each solution
is being introduced
into the cassette
Cytarabine
80 80
1000 mg/10mL N/A 100 mg/mL discard unused 0.1-37.5 mg/mL NS, 10 d F, 48 h RT
30,80 80
2000 mg/20mL portion D5W, SWI
(Pfizer/Hospira) **(PFL)
(RT)(PFL) 100 mL* NS, D5W,
80
no preservative SWI
Cytarabine
80
IT injection N/A 100 mg/mL use within 4 h of diluents containing use within 4 h of - auxiliary info: IT
30 30
1000 mg/10mL initial vial preservatives should initial vial puncture injection
30
2000 mg/20mL record time of puncture NOT be used for - label to include
(Pfizer/Hospira) puncture intrathecal **(PFL) route in full (i.e.,
80
(RT)(PFL) administration INTRATHECAL
80
no preservative injection) attached to
qs to 6 mL with both syringe and
41
preservative free outer ziplock bag
81,82
NS
Cytarabine
84 84
1000 mg/10mL N/A 100 mg/mL discard unused 0.1-37.5 mg/mL NS, 10 d F, 48 h RT
30,84 84
2000 mg/20mL portion D5W, SWI
(PMS) **(PFL)
(RT)(PFL) 100 mL* NS, D5W,
84
no preservative SWI
Cytarabine
84
IT injection N/A 100 mg/mL use within 4 h of diluents containing use within 4 h of - auxiliary info: IT
30 30
1000 mg/10mL initial vial preservatives should initial vial puncture injection
30
2000 mg/20mL record time of puncture NOT be used for - label to include
(PMS) puncture intrathecal **(PFL) route in full (i.e.,
84
(RT)(PFL) administration INTRATHECAL
84
no preservative injection) attached to
qs to 6 mL with both syringe and
41
preservative free outer ziplock bag
81,82
NS
Dacarbazine
85 85 85
100 mg 100 mg: 10 mg/mL 72 h F, 8 h RT 250-1000 mL* NS, 24 h F, 8 h RT - protect container
85
200 mg 9.9 mL SWI D5W from light during
60,85
(Abraxis) **(PFL) storage and
86
(F)(PFL) 200 mg: administration
85 85
no preservative 19.7 mL SWI - overfill unknown
Dacarbazine
87 87 13,87 87
200 mg 200 mg: 10 mg/mL 8 h RT, 48 h F 0.19–3.0 mg/mL 24 h F - protect container
87
600 mg 19.7 mL SWI from light during
88 86
(Hospira) (PFL) 250-1000 mL* NS, **(PFL) storage and
86
(F)(PFL) 600 mg: D5W administration
87 87 88,89
no preservative 59.1 mL SWI - no overfill
Dacarbazine
90 90 90 90
600 mg 59.1 mL SWI 10 mg/mL 24 h F, 8 h RT 0.19-3.0 mg/mL in 24 h F - protect container
90
(Pfizer) D5W or NS from light during
86
(F)(PFL) **(PFL) storage and
90 86
no preservative administration
DACTINomycin
91
0.5 mg 1.1 mL SWI 0.5 mg/mL discard unused syringe use within 4 h of - drug loss reported
91 91 71 71
(GMD Pharma for (preservative-free) (500 mcg/mL) portion initial vial puncture with some cellulose
Daratumumab
93
100 mg/5mL N/A 20 mg/mL discard unused 500-1000 mL NS 24 h F, followed by - administer with a
93
400 mg/20mL portion 15 h infusion (total 39 0.22 or 0.2 micron in-
93 93
(Janssen) dilute to final volume h) line filter
(F)(PFL) by withdrawing - discard if visible
do not shake volume from bag allow bag to come to particles are
93 93
no preservative equal to volume of room temperature, observed
93
drug to be added then use - complete infusion
93 93
immediately within 15 hours
mix by gentle
93
inversion **(PFL)
DAUNOrubicin
94 94,97 96 94
20 mg 4 mL SWI 5 mg/mL 48 h F, 24 h RT 100-250 mL in 48 h F, 24 h RT
94
(Erfa Canada Inc.) isotonic solution e.g.,
95 94
(RT)(PFL) NS
96
no preservative
96
no data for D5W
DAUNOrubicin
98 98 98 98
20 mg 4 mL SWI 5 mg/mL 48 h F, 24 h RT 100-250 mL 48 h F, 24 h RT
60
(Teva/Novopharm) NS or D5W
98 98
(RT)(PFL) **(PFL) **(PFL)
98
no preservative
reconstitution may
99
take up to 15 min
Dexrazoxane
102 102
250 mg 250 mg: 10 mg/mL 3 h F, 30 min MUST BE FURTHER 4 h F, 1 h RT
102 103
500 mg 25 mL SWI RT DILUTED With
(Pfizer) Lactated Ringers
(RT) 500 mg: Injection to 1.3 – 3.0
102 102 102
no preservative 50 mL SWI mg/mL
DOCEtaxel
107 18,108 107
20 mg/2 mL N/A 10 mg/mL 14 d F, RT 0.3-0.74 mg/mL complete - use non-DEHP bag
80 mg/8 mL administration within and IV administration
107 107,109 107
160 mg/16 mL 250 mL* NS, D5W 24 h F, 4 h RT set
(Sandoz)
(F,RT)(PFL)
107
preservative
DOXOrubicin
112 112 112
10 mg/5 mL N/A 2 mg/mL 8h syringe 24 h F, RT from initial - for ULYEPOCHR
112
20 mg/10 mL vial puncture protocol, see entry
50 mg/25 mL for EPOCHR
200 mg/100 mL (3-in-1solution
(Accord) containing
(F)(PFL) etoposide,
112
no preservative DOXOrubicin,
vinCRIStine)
(NS reconstitution
113
takes longer)
DOXOrubicin
115 115 115 115
10 mg/5 mL N/A 2 mg/mL 8h syringe 48 h F, 24 h RT - for ULYEPOCHR
20 mg/10 mL from initial vial protocol, see entry
50 mg/25 mL record time of puncture for EPOCHR
200 mg/100 mL puncture (3-in-1solution
(Teva/Novopharm) containing
(F)(PFL) etoposide,
115
no preservative DOXOrubicin,
vinCRIStine)
DOXOrubicin
117 117 117
Pegylated Liposomal N/A 2 mg/mL discard unused Less than 90 mg: 250 24 h F - do not filter
117 117
20 mg/10 mL portion mL D5W only
(Janssen)
(F) Greater than or equal
117
no preservative to 90 mg: 500mL
117
D5W only
Durvalumab
118 118 118
120 mg/2.4 mL N/A 50 mg/mL discard unused 1-15 mg/mL NS, 24 h F, 4 h RT - do NOT shake
118 118
500 mg/10 mL portion D5W - use 0.2-0.22 micron
(AstraZeneca) in-line filter to
118
(F)(PFL) (e.g., 100 mL* NS, administer
do not shake D5W)
118
no preservative
mix by gentle
118
inversion
Epirubicin
120 120 120
10 mg/5 mL N/A 2 mg/mL 8h syringe 48 h F, 24 h RT
50 mg/25 mL from initial vial
120
200 mg/100 mL record time of puncture
(Fresenius Kabi) puncture
(F)(PFL)
120 18,120
no preservative 100 mL* NS, D5W 2 d F, RT
Epirubicin
121 121 121
10 mg/5 mL N/A 2 mg/mL 8h syringe 48 h F, 24 h RT from
121
50 mg/25 mL initial vial puncture
200 mg/100 mL record time of
(Pfizer) puncture
60 122
(F)(PFL) 100 mL* NS, D5W 2 d F, RT
121
no preservative
eriBULin
127 127 127
1 mg/2 mL N/A 0.5 mg/mL discard unused IV syringe 24 h F, 6 h RT - do not administer
18,127
(Eisai Limited) portion through dextrose
127 127
(RT)(PFL) containing lines
18
no preservative - vials contain
dehydrated alcohol
127
USP (5% v/v)
130 130,133
D5W 4 h RT
Etoposide phosphate
134,135 18,134,135 134,135
(ETOPOPHOS®) 5 mL NS, D5W, 20 mg/mL 48 h F , 24 500 mL* NS, 24 h F, RT
134,135 134,135 134,135
100 mg SWI, BWI h RT , D5W
(BMS)
(F)(PFL) (do not dilute to less
134 134,135 134,135
no preservative 10 mL NS, D5W, 10 mg/mL than 0.1 mg/mL)
134,135
SWI, BWI
Fludarabine
139 139 13,122 13,122
50 mg 2 mL SWI 25 mg/mL 48 h F, RT dilute to maximum of 48 h F, RT
139,140
(Berlex) 1 mg/mL
(F)
139
no preservative 50-100 mL NS,
139
D5W
Fludarabine
141 141
50 mg N/A 25 mg/mL discard unused dilute to maximum of 48 h F, 24 h RT
141 141
(Teva/Novopharm) portion 1 mg/mL
(F)
141
no preservative (e.g., 50-100 mL* NS,
D5W)
Fluorouracil
145 145 145 30,145
5000 mg/100 mL N/A 50 mg/mL 8 h RT syringe 8 h RT
(Pfizer/Hospira)
(RT)(PFL)
145 146 145
no preservative 0.5-10 mg/mL 24 h RT
Gemcitabine
151 151 151 151
1000 mg 200 mg: 38 mg/mL 24 h RT syringe 24 h RT
151
2000 mg 5 mL NS
(Accord)
151 18,152,153
(RT) 1000 mg: 0.1-10 mg/mL NS 48 h RT
151 151
no preservative 25 mL NS
2000 mg:
151
50 mL NS
Gemcitabine
154 154 154
200 mg/5.3 mL N/A 38 mg/mL discard unused syringe 24 h RT
18
1000 mg/26.3 mL portion
2000 mg/52.6 mL
(Hospira) 0.1 – 38 mg/mL NS,
154
(F) D5W
154
no preservative
IDArubicin
156 156 156
5 mg 5 mg: 1 mg/mL 48 h F, syringe 48 h F, 24 h RT - avoid alkaline
156 156 156
10mg 5 mL SWI 24 h RT solutions
(Pfizer)
156
(RT)(PFL) 10 mg: **(PFL)
156 156
no preservative 10 mL SWI
IDArubicin PFS
156 156
5 mg/5 mL N/A 1 mg/mL 48 h F, 24 h RT, syringe 4 h from initial - avoid alkaline
18 156
10 mg/10 mL puncture solutions
156
20 mg/20 mL **(PFL)
(Pfizer)
(F)(PFL)
156
no preservative
Ifosfamide
158 158 158
1000 mg 1000 mg: 50 mg/mL 48 h F, 24 h 0.6–20 mg/mL 72 h F, 24 h RT
158 18,158
3000 mg 20 mL SWI RT
(Baxter) 500–1000 mL* NS, 24 h F, RT when
60
(RT) 3000 mg: D5W, Lactated mixed with mesna
158 158 158
no preservative 60 mL SWI Ringer’s
shake well
Ifosfamide
159 159 159
1000 mg 1000 mg: 50 mg/mL 48 h F, 24 h 0.6-20 mg/mL 72 h F, 24 h RT
159 18,159
3000 mg 20 mL SWI RT
(Fresenius Kabi) 24 h F, RT when
60
(RT) 3000 mg: 500-1000 mL* NS mixed with mesna
159 159
no preservative 60 mL SWI D5W, Lactated
159
Ringer’s
shake well
Inotuzumab
161 161 161 161
ozogamicin 4 mL SWI 0.25 mg/mL 4hF 0.01 – 0.1 mg/mL complete - do NOT shake
161
0.9 mg NS administration within - protect container
(Pfizer) gently swirl vial to record time of dilute dose within 8 h of reconstitution from UV and
161 161 161
(F)(PFL) mix reconstitution 4 hours of (50 mL NS) RT,F fluorescent light
161 161
no preservative reconstitution during storage and
161 161,162
(PFL) administration
protect from light mix by gentle - protect
161
if not used inversion if refrigerated, bring administration line
162
immediately bag to RT over 1 h from light ONLY if
prior to hang time will be
161 161,162
administration longer than 1 h
Irinotecan
166
40 mg/2 mL N/A 20 mg/mL discard unused 0.12–3 mg/mL D5W 48 h F, 24 h RT
166 166
100 mg/5 mL portion (preferred), NS
166
500 mg/25 mL **(PFL)
60
(Accord) 500* mL
(RT)(PFL)
166
no preservative
Irinotecan
167,168
40 mg/2 mL N/A 20 mg/mL discard unused 0.12-3 mg/mL 14 d F, 48 h
167,168 30,167,168
100 mg/5 mL portion D5W (preferred), RT
167,168
300 mg/15 mL NS
500 mg/25 mL
60 167,168
(Pfizer/Hospira) 500* mL **(PFL)
(RT)(PFL)
167,168
no preservative
Ixabepilone
170 170 170
15 mg 15 mg: 2 mg/mL 1 h RT 0.2 – 0.6 mg/mL in 6 h RT - use 0.2-1.2 micron
170
(contains 16 mg) 8 mL supplied Lactated Ringer’s in-line filter
170
45 mg diluent Injection USP (use - use non-DEHP bag
(contains 47 mg) non-DEHP infusion and administration
170 170
(BMS) 45 mg: container) set
(F)(PFL) 23.5 mL supplied
170 170
no preservative diluent
* Suggested volume based on usual dose range and any concentration range of stability data
** Protect from light means minimizing exposure to direct sunlight over a storage period. More specific information on protection from light (eg, protecting container and tubing during
administration) will be indicated in the Special Precautions/Notes column.
*** Contains DMA (N,N dimethylacetamide). Product may be incompatible with closed system transfer devices such as ChemoLock.
Centres are not to change the content locally but should forward suggestions to the Cancer Drug Manual staff.
Abbreviations
BWI = bacteriostatic water for injection
CIVI: ambulatory pump = Continuous Intravenous Infusion (e.g., elastomeric infusor)
D5W = dextrose 5% in water
DMA = N,N dimethylacetamide
F = refrigerate
Non-DEHP = not containing Di(2-ethylhexyl) phthalate (DEHP)
NS = normal saline
PFL = protect from light
RT = room temperature
SWI = sterile water for injection
References
1. Agensys. Pharmacy Guide Protocol AGS-16C3F-15-3: A multi-center, open label, randomized phase 2 study of AGS-16C3F vs. axitinib in metastatic renal cell carcinoma. Santa
Monica, California; 8 June 2016 - version 2.0.
2. BC Cancer. (Study Code GUT16C3F) Clinical Trial Dispensing Instructions for: A multi-center, open label, randomized phase 2 study of AGS-16C3F vs. aXitinib in metastatic renal
cell carcinoma. Vancouver, British Columbia: BC Cancer; 18 April 2018.
3. Laura Standley. Personal communication. Lead Clinical Study Manager, Astellas Pharma Global Development Inc.; 23 January 2019.
4. Novartis Pharmaceuticals Canada Inc. PROLEUKIN® product monograph. Dorval, Quebec; 6 July 2006.
5. McEvoy GK, editor. AHFS 2008 Drug Information. Bethesda, Maryland: American Society of Health-System Pharmacists, Inc. p. 917-925.
6. Koreth J, Matsuoka K, Kim HT, et al. Interleukin-2 and regulatory T cells in graft-versus-host disease. N Engl J Med 2011;365(22):2055-2066.
7. Koreth J, Alyea EP, Cutler C, Ho VT, et al. Clinical Study Protocol: A phase I study of ultra-low dose subcutaneous interleukin-2 (IL-2) for treatment of refractory chronic graft versus
host disease. Boston, MA, USA: Dana Farber Cancer Institute; Harvard Medical Centre; 14 Dec 2010.
8. Rui Paiva. Personal communication. Business Unit Director, Transplant and Oncology; 1 June 2009.
9. Bayer HealthCare Pharmaceuticals. MabCampath® Package Insert. Toronto, Ontario; 1 September 2007.
10. Lundin J, Porwit-MacDonald A, Rossmann ED, et al. Cellular immune reconstitution after subcutaneous alemtuzumab (anti-CD52 monoclonal antibody, CAMPATH-1H) treatment
as first-line therapy for B-cell chronic lymphocytic leukaemia. Leukemia 2004(18):484-490.
Leucovorin
3 3 3
50 mg/5 mL N/A 10 mg/mL 8h syringe 8 h RT
500 mg/50 mL
(Pfizer/Hospira)
(F)(PFL) 0.05 – 10 mg/mL NS, NS, D5W, LR,
3
no preservative D5W, LR, Ringer’s, Ringer’s:
3 3
D10W, D5NS 24 h RT
D5W:
4
12 h RT
D10NS:
4
6 h RT
Mesna
11
400 mg/4 mL N/A 100 mg/mL discard unused greater than 1 mg/mL complete
11
1000 mg/10 mL portion in D5W, D5½NS, NS, administration within
11-13 11
(Baxter) (use filter needle to LR 24 h RT
(RT) withdraw from
11
no preservative ampoule)
Mesna
11 11
1000 mg/10 mL N/A 100 mg/mL 8 days RT greater than 1 mg/mL complete
5000 mg/50 mL in D5W, D5½NS, NS, administration within
11-13 11
(Baxter) (vial may be LR 24 h RT
(RT) punctured up to 4
11 11
preservative times)
Mesna
14 14,15 14
1000 mg/10mL N/A 100 mg/mL 14 d RT,F greater than or equal 24 h RT, 48 h F
(Fresenius Kabi) to 1 mg/mL in NS or
16
(RT) D5W
14
preservative
Methotrexate
17 2
IT Injection N/A 25 mg/mL discard unused qs to 6 mL with use within 4 h of initial - auxiliary info
17 2
Only preservative free portion preservative free puncture - label to include
24,25
methotrexate may be NS route in full (i.e.,
administered by the INTRATHECAL
23
intrathecal route injection) attached
50 mg/2mL to both syringe and
26
(Accord) outer ziplock bag
(RT)(PFL)
17
no preservative
Methotrexate
27
50 mg/2mL N/A 25 mg/mL 50mg: syringe use within 8 h RT of - for high-dose
27
500 mg/20mL discard unused initial puncture regimens (e.g., 1-
27 2
1 g/40mL portion 12 g/m as a single
18-22
2.5 g/100 mL dose) : use
(Pfizer/Hospira) 500 mg, 1 g, or 0.4–2 mg/mL NS, use within 24 h RT of preservative-free
27 27 27
(RT)(PFL) 2.5 g: D5W initial puncture methotrexate
27 27
no preservative 8 h RT - do not use for IT
(100 mL* NS, D5W) **(PFL) injection
Methotrexate
27 15,27 15
50 mg/2mL N/A 25 mg/mL 14 d F syringe 14 d F - contains benzyl
27
500 mg/20mL alcohol
(Pfizer/Hospira) - do NOT use for
(RT)(PFL) 0.4–2 mg/mL NS, 24 h RT
27 high-dose
27
preservative D5W
27 regimens (e.g., 1-
2
12 g/m as a single
27
(100 mL* NS, D5W) dose)
- do NOT use for IT
27
injection
Mitomycin
28 28 28 28
20 mg 40 mL SWI 0.5 mg/mL 6 h RT, 72 h F syringe 6 h RT, 72 h F
(Accord)
28 28 28
(RT)(PFL) shake well **(PFL) **(PFL)
28
no preservative
Mitomycin
28 28 28 28
intraperitoneal 40 mL SWI 0.5 mg/mL 6 h RT, 72 h F 0.02-0.04 mg/mL NS:
28
20 mg 3 h RT, 18 h F
28 28 28
(Accord) shake well **(PFL) NS, sodium lactate
(RT)(PFL) sodium lactate:
28 28
no preservative 3 h RT, 6 h F
Mitomycin
32 32 32 32
20 mg 40 mL SWI 0.5 mg/mL 6 h RT, 72 h F syringe 6 h RT, 72 h F
(Teva/Novopharm)
32 32 32
(RT)(PFL) shake well **(PFL) **(PFL)
32
no preservative
Mitomycin
32 32 32 32
intraperitoneal 40 mL SWI 0.5 mg/mL 6 h RT, 72 h F 0.02-0.04 mg/mL NS:
32
20 mg 6 h RT, 18 h F
32 32 32
(Teva/Novopharm) shake well **(PFL) NS, sodium lactate
(RT)(PFL) sodium lactate:
32 32
no preservative 6 h RT, F
mitoXANTRONE
33 33 33
20 mg/10 mL N/A 2 mg/mL discard unused NS, D5W 24 h RT
33
(Fresenius Kabi) portion
(RT) Greater than or equal
33 33
no preservative to *50 mL
mitoXANTRONE
35 35
20 mg/10 mL N/A 2 mg/mL discard unused Greater than or equal 24 h RT
35 35
(Teva/Novopharm) portion to *50 mL NS, D5W
36
(RT)(PFL) **(PFL)
35
no preservative
Nivolumab
37
40 mg/4 mL N/A 10 mg/mL discard unused 1-10 mg/mL NS, complete - administer with a
37 37
100 mg/10 mL portion D5W administration within 0.2 to 1.2 micron
37 37
(BMS) 8 h RT or 24 h F in-line filter
(F)(PFL) (50-100* mL) - discard if cloudy
37
do not shake **(PFL) or has pronounced
37
no preservative mix by gentle colour change
inversion; do not (should be clear to
37 37
shake pale yellow)
Octreotide
41 41 41 41
50 mcg/mL N/A 50 mcg/mL Use within 4 h NS 24 h RT
100 mcg/mL
41
500 mcg/mL 100 mcg/mL volume adjusted to
(Omega) ensure a continuous
41
(F)(PFL) 500 mcg/mL infusion of octreotide
41 41
no preservative at 25 mcg/hour
Octreotide
41 41 41 41
multidose vial: N/A 200 mcg/mL 15 d F NS 24 h RT
1000 mcg/5 mL
(Omega) volume adjusted to
(F)(PFL) ensure a continuous
41
preservative infusion of octreotide
41
at 25 mcg/hour
Octreotide
42 42,43 42,43
multidose vial: N/A 200 mcg/mL 14 d F SC syringe use within 14 d F
1000 mcg/5 mL
(Teva/Novopharm)
42 42
(F)(PFL) infusion: NS 24 h RT
42
preservative
Octreotide
44 10,46,47 46
(SANDOSTATIN®) N/A 200 mcg/mL discard unused 50–200 mL NS 24 h RT
45
1000 mcg/5 mL portion
(Novartis) SC infusion: adjust
(F)(PFL) volume to ensure
44
preservative infusion rate of 25
46
mcg/h
Octreotide
(SANDOSTATIN LAR®) 2 mL supplied 10 mg: 5 mg/mL discard unused deep intragluteal use within 4 h of initial - do NOT shake
46 46 7,46
10 mg diluent portion administration only reconstitution
20 mg 20 mg: 10 mg/mL
30 mg gently run 2 mL
46
(Novartis) down sides of the 30 mg: 15 mg/mL
(F)(PFL) vial; do NOT disturb
45
no preservative for 2–5 min, then
46
swirl moderately
record time of
reconstitution
Olaratumab
49 49
500 mg/50 mL N/A 10 mg/mL discard unused dilute to a final complete - do NOT shake
39,49
(Lilly) portion volume of 250 mL administration within
49
(F)(PFL) NS 24 h F, plus an
49
do not shake additional 12 h RT
49
no preservative do NOT use D5W or
other dextrose
49
containing solutions
49
gently invert to mix
Oxaliplatin
51 39,53 51
50 mg/10 mL N/A 5 mg/mL 2 d F, RT 0.2-0.7 mg/mL 0.2-2 mg/mL:
51
100 mg/20 mL 24 h RT, 48 h F
51
150 mg/30 mL 250-500 mL D5W
200 mg/40 mL
(Sandoz) do NOT use NS or
(RT)(PFL) other chloride-
51 51
no preservative containing solution
do NOT use
aluminum-containing
51
needle and syringe
do NOT use
aluminum-containing
54
needle and syringe
PACLitaxel
55
30 mg/5 mL N/A 6 mg/ mL 30 mg: 0.3-1.2 mg/mL in NS, complete - use non-DEHP
39,55 55
100 mg/16.7 mL 48 h RT D5W, D5NS, D5LR administration within bag and tubing with
55
300 mg/50 mL 27 h RT 0.22 micron in-line
55
(Accord) 100 mg: (e.g., 100-1000 mL)* filter
39,55
(RT)(PFL) 48 h RT - avoid excessive
55 55
no preservative shaking
300 mg:
55
24 h RT
59
0.012-0.12 mg/mL in 16 h RT
61
NS
PACLitaxel
64 39,64,65
30 mg/5 mL N/A 6 mg/mL 48 h RT 0.3-1.2 mg/mL in NS, complete - use non-DEHP
64
100 mg/16.7 mL D5W, D5NS, D5LR administration within bag and tubing with
64
150 mg/25 mL 27 h RT 0.22 micron in-line
64
300 mg/50 mL (e.g., 100-1000 mL)* filter
(Hospira)
(RT)(PFL)
63
preservative
Pamidronate
70 70
30 mg/10 mL N/A 3 mg/mL discard unused Less than or equal to 24 h RT - do NOT mix with
70 70
60 mg/10 mL portion 0.36 mg/mL NS, calcium containing
70 70
90 mg/10 mL D5W solutions
70
(Fresenius Kabi) 6 mg/mL
(RT)
70
no preservative
70
9 mg/mL
Pamidronate
72 72
30 mg/10 mL N/A 3 mg/mL discard unused 0.06–0.36 mg/mL in 24 h F followed by 24 h - do NOT mix with
72 72 72
60 mg/10 mL portion NS, D5W RT (total 48 h) calcium containing
90 mg/10 mL solution (e.g.,
72 72 72
(Omega) 6 mg/mL **(PFL) Ringer’s)
(RT)
72
no preservative
72
9 mg/mL
Pamidronate
73
30 mg/10 mL N/A 3 mg/mL discard unused 0.06-0.36 mg/mL in 24 h F followed by 24 h - do NOT mix with
73 73 73
60 mg/10 mL portion NS, D5W RT (total 48 h) calcium containing
90 mg/10 mL solution (e.g.,
73 73 73
(Pfizer) 6 mg/mL **(PFL) Ringer’s)
(RT)
73
no preservative
73
9 mg/mL
PANitumumab
75 75,76
100 mg/5 mL N/A 20 mg/mL discard unused Less than or equal to 24 h F, 6 h RT - administer with
75
400 mg/20 mL portion 1000 mg: 0.2 or 0.22 micron
75 75
(Amgen) 100 mL NS in-line filter
(F)(PFL) - solution may
do not shake Greater than 1000mg: contain particulates
75 75
no preservative 150 mL NS which do not affect
75
product quality
75,76
1-10mg/mL - do not administer
75
if discoloured
IV: bag:
77
100 mL NS, D5W use within 4 h of vial
39,77
puncture
Pembrolizumab
78
100 mg/4 mL N/A 25 mg/mL discard unused 1-10 mg/mL complete - use a 0.2 to 5
39,78 78
(Merck) portion NS, D5W administration within micron in-line
78 78
(F)(PFL) 6 h RT, 24 h F filter
do not shake mix by gentle - allow vials and
78 78
no preservatives inversion diluted solutions to
come to RT prior to
78
use
- vials contain 0.25
78
mL overfill
Pemetrexed
80 80 80
100 mg 100 mg: 25 mg/mL 24 h F, RT 100 mL 24 h F, RT - do NOT mix with
80 80
500 mg 4.2 mL NS NS calcium containing
(Accord) solution (e.g.,
80
(RT) 500 mg: Ringer’s)
80 80
no preservative 20 mL NS
Pemetrexed
81 81 81
100 mg 100 mg: 25 mg/mL 24 h F, RT 100 mL 24 h F, RT - do NOT mix with
81 81
500 mg 4.2 mL NS NS calcium containing
(Eli Lilly) solution (e.g.,
82
(RT) 500 mg: Ringer’s)
81
no preservative 20 mL preservative-
81
free NS
Plerixafor
84 84 43,85
24 mg/1.2 mL N/A 20 mg/mL discard unused SC syringe 48 hours RT
84
(sanofi-aventis) portion
(RT)
84
no preservative
Porfimer
86 86
15 mg 15 mg: 2.5 mg/mL 24 h F syringe use within 4 h of initial - avoid contact with
86 7,87
75 mg 6.6 mL D5W reconstitution skin and eyes;
86
(Axcan) **(PFL) protect exposed
86 86
(RT)(PFL) 75 mg: **(PFL) area from light
86 86
no preservative 31.8 mL D5W
record time of
reconstitution
Raltitrexed
88 88 88
2 mg 4 mL SWI 0.5 mg/mL 24 h F, RT 50-250 mL NS, complete
88
(Pfizer) D5W administration within
88
(F,RT)(PFL) 24 h F, RT
88
(no preservative)
riTUXimab
91 92,93
100 mg/10 mL N/A 10 mg/mL discard unused 1-4 mg/mL NS, 24 h F, 12 h RT - once removed
91 91
500 mg/50 mL portion D5W from the fridge,
(Roche) compounded
(F)(PFL) (e.g., 250-500 mL)* product is stable
91 92,93
no preservative for 12h RT
riTUXimab
94 94 94
subcutaneous N/A 120 mg/mL discard unused SC syringe 48 h F plus 8 h RT - contains
94 94
1400 mg/11.7 mL portion hyaluronidase
1600 mg/13.4 mL - formulations are
(Roche) NOT
94
(F)(PFL) interchangeable
94
no preservative
Siltuximab
98 98 98
100 mg 100 mg: 20 mg/mL 2 h RT 250 mL D5W complete - use 0.2 micron in-
98 98
400 mg 5.2 mL SWI administration within line filter
98
(Janssen) dilute to 250 mL final 6 h RT
(F)(PFL) 400 mg: volume by
98 98
no preservative 20 mL SWI withdrawing volume
from bag equal to
allow vial to come to volume of drug to be
98
room temperature added
prior to use (~30
98
minutes)
Temsirolimus
100,101 100,101 100,101
30 mg/1.2 mL 1.8 mL supplied 10 mg/mL 24 h RT 250 mL NS complete - use non-DEHP
100,101
(Wyeth) diluent administration within 6 bag and tubing with
100,101 100 100,101 100,101
(F)(PFL) **(PFL) h in-line filter
102
no preservative
Teniposide
103
50 mg/5 mL N/A 10 mg/mL discard unused 50 – 500 mL NS or 0.1-0.4 mg/mL: 24 h - do not refrigerate
103
(BMS) portion D5W for a final RT - use non-DEHP
103
(RT) concentration of 0.1-1 bag and tubing
103 103
preservative mg/mL 1 mg/mL: complete - do not use if
103,104
administration within 4 precipitates
h of preparation - contains DMA***
103,104
RT - excessive
agitation may
cause
103
precipitation
record time of
reconstitution
Thyrotropin alfa
108 108 108 108 108
1.1 mg 1.2 mL SWI 0.9 mg/mL 24 h F syringe 24 h F
(Genzyme)
108
(F)(PFL) swirl contents
108
no preservative
do NOT shake
Topotecan
110 2,110
4 mg/4 mL N/A 1 mg/mL discard unused 0.025-0.5 mg/mL 14 d F, 48 h RT
2,110
(Accord) portion
(RT)(PFL) 50-100 mL NS,
110 110
no preservative D5W
Topotecan
111 111 111
1 mg 1 mg: 1 mg/mL 24 h F,RT 0.02-0.5 mg/mL 24 F,RT
111
4 mg 1.1 mL SWI
(Actavis) 50-100 mL NS,
111
(RT)(PFL) 4 mg: D5W
111 111
no preservative 4 mL SWI
Topotecan
112 112
4 mg/4 mL N/A 1 mg/mL discard unused 0.02-0.5 mg/mL 24 h F, RT
2,112
(Pfizer/Hospira) portion
(F)(PFL) 50-100 mL NS,
112 112
no preservative D5W
Trastuzumab
114 39 114 114 114
(HERCEPTIN®) 20 mL supplied 21 mg/mL 14 d F 250 mL NS only 24 h F, RT - do NOT shake
114
440 mg BWI
(Roche) do NOT use dextrose
114
(F) swirl vial gently; containing solutions
114
preservative allow to stand
undisturbed for 5
114
min
Treosulfan
118 7,118 119 7,118
1g pre-heat SWI to 50 mg/mL 48 h RT undiluted 48 h RT - compatible with
5g 30°C (not higher) polytetrafluoroethyl
118
(medac) shake vial carefully dilute with NS or D5W ene filters
(RT) before adding the in empty infusion bag - may require
118
no preservative warmed SWI for final concentration vigorous shaking to
118 118
1 g vial: 20 mL SWI, = 20 mg/mL reconstitute
while slightly
shaking vial and
syringe; continue
shaking the
reconstituted
solution for another
118
2 min
5 g vial: 100 mL
SWI, while slightly
shaking vial and
syringe; continue
shaking the
reconstituted
solution for another
118
2 min
vinBLAStine
126
10 mg/10 mL N/A 1 mg/mL discard unused 25-50 mL NS, use within 4 h of initial - auxiliary info:
126 121,127 39
(Teva) portion D5W puncture WARNING: FOR
(F)(PFL) INTRAVENOUS
126
no preservative USE ONLY –
FATAL IF GIVEN
BY OTHER
124,125
ROUTES
Vinorelbine
131 131 131
10 mg/1 mL N/A 10 mg/mL discard unused 0.5-2.0 mg/mL 24 h F, RT - auxiliary info:
131
50 mg/5mL portion WARNING: FOR
(Fresenius Kabi) NS, D5W, ½NS, INTRAVENOUS
(F)(PFL) D5½NS, Ringer’s, USE ONLY –
131 131
no preservative Ringer’s Lactate FATAL IF GIVEN
BY OTHER
124,125
ROUTES
Vinorelbine
133 133 133
10 mg/1 mL N/A 10 mg/mL discard unused 0.5–2.0 mg/mL 24 h F, RT - auxiliary info:
133
50 mg/5 mL portion WARNING: FOR
(Teva) 50 mL* NS, D5W, INTRAVENOUS
(F)(PFL) ½NS, D5½NS, USE ONLY –
133
no preservative Ringer’s, Ringer’s FATAL IF GIVEN
133
Lactate BY OTHER
124,125
ROUTES
Zoledronic acid
134 134
4 mg/5 mL N/A 0.8 mg/mL discard unused 100 mL NS, D5W complete infusion - do NOT mix with
134
(Dr Reddy’s) portion within 24 h of calcium containing
134 134
(RT) preparation solutions
134
no preservative
Refrigerate diluted
product if not used
immediately after
preparation; bring to
RT prior to
134
administration
Zoledronic acid
136 136
4 mg/5 mL N/A 0.8 mg/mL discard unused 100 mL NS, D5W complete infusion - do NOT mix with
136
(MDA) portion within 24 h of calcium containing
136 136
(RT) preparation solutions
136
no preservative
Refrigerate diluted
product if not used
immediately after
preparation; bring to
RT prior to
136
administration
Zoledronic acid
138 138
4 mg/5 mL N/A 0.8 mg/mL discard unused 100 ml NS, D5W complete infusion - do NOT mix with
138
(Sandoz) portion within 24 h of calcium- or other
138
(RT) preparation divalent cation-
138
no preservative containing infusion
Refrigerate diluted solutions (e.g.,
product if not used Lactated
138
immediately after Ringer’s)
preparation; bring to
RT prior to
138
administration
* Suggested volume based on usual dose range and any concentration range of stability data
** Protect from light means minimizing exposure to direct sunlight over a storage period. More specific information on protection from light (eg, protecting container and tubing during
administration) will be indicated in the Under the Special Precautions/Notes column.
*** Contains DMA (N,N dimethylacetamide). Product may be incompatible with closed system transfer devices such as ChemoLock.
Centres are not to change the content locally but should forward suggestions to the Cancer Drug Manual staff.
Abbreviations
BWI = bacteriostatic water for injection
CIVI: ambulatory pump = Continuous Intravenous Infusion (e.g., elastomeric infusor)
D5W = dextrose 5% in water
DMA = N,N dimethylacetamide
F = refrigerate
Non-DEHP = not containing Di(2-ethylhexyl) phthalate (DEHP)
NS = normal saline
PFL = protect from light
RT = room temperature
SWI = sterile water for injection
References
1. Generic Medical Partners Inc. Leucovorin calcium injection product monograph. Toronto, Ontario; 13 August 2018.
2. BC Cancer. Provincial Pharmacy Directive Number II-20: Chemotherapy Preparation Chart. Vancouver, British Columbia: BC Cancer; 5 December 2018.
3. Pfizer Canada Inc. Leucovorin calcium injection product monograph. Kirkland, Quebec; 21 June 2018.
4. Teva Canada Limited. Leucovorin calcium injection® product monograph. Toronto, Ontario; 5 May 2014.
5. Hospira Healthcare Corporation. LEUCOVORIN CALCIUM INJECTION® product monograph. Saint-Laurent, Quebec; 7 June 2007.
6. Novopharm Limited (Teva). LEUCOVORIN CALCIUM® Injection product information package. Toronto, Ontario; undated.
7. BC Cancer Agency. Pharmacy Policy Number II-20: Guiding Principles for Chemotherapy Preparation Chart. Vancouver, British Columbia: BC Cancer Agency; 6 January 2006.
8. Jenny Yeung. Personal communication. Medical Information Specialist, Teva Canada; 12 April 2017.
9. GlaxoSmithKline Inc. Alkeran Package Insert. Mississauga, Ontario; Montreal, Quebec; 2004.
10. Trissel LA. Handbook on Injectable Drugs. 13th ed. Bethesda, MD: American Society of Health-System Pharmacists, Inc.; 2005.
11. Baxter Corporation. UROMITEXAN® product monograph. Mississauga, Ontario; 6 August 2013.
12. Mona Ghobros BPharm MSc. Personal communication. Medical Information, Baxter Corporation; 29 November 2018.
13. Trissel's® 2 Clinical Pharmaceutics Database (database on the Internet). Mesna. Lexi-Comp Inc.; created by Lawrence A. Trissel, Available at: http://online.lexi.com. Accessed 29
November 2018.
14. Fresenius Kabi Canada Ltd. Mesna for injection product monograph. Richmond Hill, Ontario; 21 December 2017.