20 to 50     : Dose as in normal renal function and monitor closely
10 to 20     : Dose as in normal renal function and monitor closely
<10           : Dose as in normal renal function and monitor closely
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                : Unlikely to be dialysed. Dose as in normal renal function and monitor closely
HD                     : Unlikely to be dialysed. Dose as in normal renal function and monitor closely
HDF/high flux   : Unknown dialysability. Dose as in normal renal function and monitor closely
CAV/VVHD      : Unknown dialysability. Dose as in normal renal function and monitor closely
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)
ADMINISTRATION
Reconstition
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Route
Oral, IV bolus, infusion
Rate of Administration
Bolus: 5–10 minutes Infusion: 20–30 minutes
Comments
Dilute bolus in
20 to 50     : mL with sodium chloride 0.9% Dilute infusion in 125 mL with sodium chloride 0.9% Stable for 24 hours at 2–8°C
OTHER INFORMATION
Widely distributed in the body, mostly in spleen, liver, kidneys, lungs, thymus; moderately in heart, muscles; minimally in fat, brain, bone marrow. High levels are found in both normal and malignant lung tissues, with slow diffusion out of tumour tissue Metabolism appears to be hepatic. Excretion is mainly by the biliary route (18.5% appears in the urine) Flush line with saline after infusion Dose-limiting toxicity is mainly neutropenia In patients where >75% of the liver volume has been replaced by metastases, it is empirically suggested that the dose be reduced by a third, with close haematological follow-up .