title: Decrease in venous irritation by adjusting the concentration of injected bendamustine.
abstract: Intravenous injection of bendamustine often causes venous irritation and also deteriorates the patient's quality of life. Thus, we evaluated the risk factors associated with venous irritation induced by bendamustine in patients with follicular lymphoma or mantle cell lymphoma. We also evaluated the effectiveness of intervention of changing the preparation procedure for bendamustine. All data were retrospectively collected from the electronic medical record system. In the initial analysis of the total 43 courses of bendamustine therapy, most patients (88%) were administered bendamustine with 250 mL of diluent according to the bendamustine package insert in Japan. The median concentration of bendamustine solution (0.56 mg/mL vs. 0.24 mg/mL) and the incidences of venous irritation (66% vs. 0%, p=0.01) were significantly different between the patients receiving bendamustine at 250 mL and 500 mL of diluent. Based on this result, we proposed changing the final volume of bendamustine dissolution from 250 to 500 mL, which is recommended in other countries. After this intervention, the incidence of venous irritation was significantly reduced from 58 to 20% (p=0.02). The incidence of venous irritation increased in a concentration-dependent manner (≤0.40 mg/mL: 6%; 0.41-0.60 mg/mL: 62%, p<0.001; >0.60 mg/mL: 75%, p<0.001). We conclude that a high concentration bendamustine solution is a risk factor for venous irritation and that 500 mL of diluent is ideal. To further reduce the incidence of venous irritation, the concentration of bendamustine solution is recommended to be 0.40 mg/mL or less.
authors: Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Fukuoka 812-8582, Japan.
authors: Hiroyuki
authors: H
authors: Watanabe
authors: Hiroaki
authors: H
authors: Ikesue
authors: Tomoko
authors: T
authors: Tsujikawa
authors: Kenichiro
authors: K
authors: Nagata
authors: Mayako
authors: M
authors: Uchida
authors: Kimitaka
authors: K
authors: Suetsugu
authors: Nobuaki
authors: N
authors: Egashira
authors: Tsuyoshi
authors: T
authors: Muta
authors: Koji
authors: K
authors: Kato
authors: Katsuto
authors: K
authors: Takenaka
authors: Saiji
authors: S
authors: Ohga
authors: Takamitsu
authors: T
authors: Matsushima
authors: Motoaki
authors: M
authors: Shiratsuchi
authors: Toshihiro
authors: T
authors: Miyamoto
authors: Takanori
authors: T
authors: Teshima
authors: Koichi
authors: K
authors: Akashi
authors: Ryozo
authors: R
authors: Oishi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000069461:Bendamustine Hydrochloride; D007509:Irritants / Q000008:administration & dosage; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control; D000069283:Rituximab; D014680:Veins; D012189:Retrospective Studies
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069461:Bendamustine Hydrochloride; D007509:Irritants; D009588:Nitrogen Mustard Compounds; D000069283:Rituximab