title: Tolerability of Vidaza (azacitidine) subcutaneous administration using a maximum volume of 3 ml per injection.
abstract: The azacitidine (Vidaza®) product monograph indicates that doses greater than 4 ml should be divided equally into two syringes and injected into different sites. Although 2 ml is a more commonly used maximum volume for subcutaneous injections, there is a lack of evidence to support the use of any given maximum volume with azacitidine. Applying the status quo of 2 ml to azacitidine results in patients receiving 3-4 injections per visit. This prospective study evaluated the frequency and type of injection site reactions when the maximum subcutaneous injection volume was increased from 2 to 3 ml per injection site. Among 30 patients, 309 doses were administered, and injection site reactions were noted in 92.9% of all doses, with the majority (82.2%) being grade 1; only 10.7% of doses resulted in grade 2 reactions, and there were no grade 3 or 4 reactions. There was no increase in frequency or severity of injection site reactions when the maximum volume was increased to 3 ml. The median number of injections that patients received per visit decreased from 3 to 2 after the volume was increased, and there was a statistically significant reduction in the incidence of pain. Decreasing the number of injections also facilitates ease of rotation of injection sites and decreases pharmacy preparation time. This is the first time that injection site reaction data relating to injection volume have been reported for azacitidine.
authors.affiliation: Department of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON.
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Ferruccio
authors.affiliation: Department of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
authors.forename: Cindy
authors.initials: C
authors.lastname: Murray
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Yee
authors.affiliation: Department of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
authors.forename: Diana
authors.initials: D
authors.lastname: Incekol
authors.affiliation: Department of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON.
authors.forename: Roy
authors.initials: R
authors.lastname: Lee
authors.affiliation: Department of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
authors.forename: Emma
authors.initials: E
authors.lastname: Paisley
authors.affiliation: Department of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON Pamela.Ng@uhn.ca.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects*; D001374:Azacitidine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D011446:Prospective Studies; D013594:Syringes
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
keywords: 3 ml; Subcutaneous; azacitidine; injection; injection site reaction; maximum volume