Purpose/ Applicability: To provide a guideline for proper preparation and dispensation of cyclophosphamide for ZooMed patients.

Scope: This applies when cyclophosphamide is reconstituted, aliquoted, and stored for dispensation of additional treatments for ZooMed patients by the Medication Dispensary staff.

Definition(s):

• PPE: Personal Protective Equipment

Equipment:

• Equashield Components
• PPE
• Sterile vial(s)

Procedure:

New Patient Procedure:

• Email vthpharmacy@vetmed.illinois.edu to notify Medication Dispensary staff that a 1-gram vial of cyclophosphamide will need to be ordered for a patient
• Put in a prescription for cyclophosphamide using purple code (60095) and include in instructions the (mL) intended to give and what time ZM will need it by
  o Quantity will be 1 as the charge is for the entire vial
• Cyclophosphamide will be appropriately reconstituted and dispensed in an equashield syringe in a chemo bag, and an LL-2 adaptor for administration will be provided
• When administering, proper PPE (including double gloving with chemotherapy-rated gloves, and chemo gowns) should be worn

Previous Patient Procedure:

• Ensure this patient has a cyclophosphamide vial charge (purple code 60095) entered within the previous 3 months. If administration is within 3 months from original prescription, medication dispensary will still have aliquoted cyclophosphamide available for this patient.
• Put in a prescription for cyclophosphamide using green code (60241) and include in instructions the (mL) intended to give and what time ZM will need it by
  o Quantity will be for the mL intended to give – no charge for medication
  o The standard Chemo Prep Fee (00CSC) will automatically be added.
  o Note: It will take 1 hour to thaw properly before medication can be drawn up. Chemo batch times are at approximately noon and 2pm each day.
• After thawing, required volume of cyclophosphamide will be drawn up and dispensed in an equashield syringe in a chemo bag, and an LL-2 adaptor for administration will be provided. Remaining drug in the vial will be discarded appropriately.
• When administering, proper PPE (including double gloving with chemotherapy-rated gloves, and chemo gowns) should be worn

Medication Dispensary Reconstitution Procedures:

Appropriate Reconstitution:

• In the negative pressure cleanroom, reconstitute the 1-gram vial with 50 mL of Normal Saline for a concentration of 20 mg/mL

Once Reconstituted:

• While still in the negative pressure cleanroom, distribute drug remaining after initial dose in 5 mL aliquots into 5 mL empty sterile vials, label each with drug name, strength, lot #, BUD and patient name, put in chemotherapy bag, and store in freezer
• BUDs
  o Room temperature: 24 hours
  o Refrigerated: 6 days
  o Frozen: 3 months
• When BUD has passed, dispose of all remaining vials in chemotherapy waste container