An infusion of amifostine is often complicated by hypotension. This can be avoided or minimized by taking steps before and during the infusion.
Evaluation
Intervention Before Infusion
current antihypertensive therapy
discontinue antihypertensive medication 24 hours prior to infusion
current medications that may promote hypotension
consider discontinuation prior to infusion if feasible
clinical hydration status
infuse 1 liter of normal saline if hydration status normal; infuse 2 liters if dehydrated
significant hypotension during last infusion of amifostine
reduce the infused dose
For the infusion:
(1) The patient should be in a supine position.
(2) Blood pressure should be monitored at least every 5 minutes during the infusion and afterwards until the blood pressure has normalized.
If mild hypotension occurs, then temporarily stop the infusion. If the blood pressure returns to normal within 5 minutes (transient drop), then restart the infusion.
If significant hypotension occurs or the drop in blood pressure is prolonged:
(1) Place the patient in the Trendelenberg position (feet and legs elevated).
(2) Discontinue the infusion of amifostine.
(3) Hydrate the patient with normal saline.
(4) Use a lower dose of amifostine during the next infusion.
To read more or access our algorithms and calculators, please log in or register.
