A review of the stability and compatibility of antineoplastic drugs for multiple-drug infusions

It is important that the stability of reconstituted parenteral antineoplastic agents be established, particularly in the context of ambulatory infusion systems for delivery. The stability of selected agents within each of the five classes of compounds (antimetabolites, alkylating agents, antibiotics, alkaloids and glycosides, and metals) is reviewed from the literature together with additional data from studies carried out using high-performance liquid chromatographic (HPLC) technology in clinically applicable volumes and concentrations for ambulatory infusion. The stability of reconstituted drugs varies from a few minutes (mecloethamine) to many months (FU). Compatibility data on two- and three-drug admixtures of cytotoxic agents are reported for a number of common multidrug regimens. Tabular presentation of the drug-drug compatibilities and incompatibilities is included along with a discussion of the mechanisms for drug-drug interaction. The use of a broad spectrum of compatible cytotoxic drugs is possible, including fluoropyrimidine-, anthracycline-, and platinum-based combinations, providing the capability of carrying out multidrug infusions for 4–7 days in an ambulatory delivery system.