Significant hypotension may occur in some patients receiving higher doses of amifostine. A patient who has a hypotensive episode should be managed based on the recorded blood pressures.
Patient selection: high dose (initially 910 mg per square meter BSA)
Blood pressure is measured at baseline and then periodically during the infusion.
If the blood pressure drops below a given threshold then the infusion is halted pending the patient response.
Baseline Systolic Blood Pressure
Drop in Blood Pressure for Cutoff
Halt Infusion if SBP Drops Below
< 100 mm Hg
20
(baseline) - 20
100 - 119
25
(baseline) - 25
120 - 139
30
(baseline) - 30
140 - 179
40
(baseline) - 40
>= 180
50
(baseline) - 50
If the patient's blood pressure returns to baseline within 5 minutes and if the patient is asymptomatic, then the infusion can be restarted with the full dose given.
If the patient remains hypotensive or is symptomatic at 5 minutes, then discontinue this infusion. Any following infusion should be done at a reduced dose. The package inserts recommends 740 mg per square meter BSA as the next dose to try.
Dorr and Holmes modified a table from Schucter for reducing the dose of amifostine for hypotension. This involved continuing to reduce the dose 50 to 100 mg for each failed infusion to a minimum of 400 mg per square meter, after which no further infusions were given.
Hypotension is uncommon at the lower doses given to prevent xerostomia. If serious hypotension occurs at this dose, then the patient probably should not receive a lower dose in the future.
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