Department of Pharmacy

Filtration Medications Guidelines

FILTRATION RECOMMENDATIONS TABLE

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Drug

Class

Type of Filter

Comment

Preparation

Administration

Abatacept (Orencia®)

Immunomodulator

n/a

Administer with an infusion set and 0.2 to 1.2 micron filter 1

 

Abciximab (Reopro®)

Platelet aggregation  inhibitor

0.2 or 5 micron filter2

0.22 micron filter: Upon continuous infusion administration 2

 

Albumin
(AlbuRx® or Albuminar®)

 

Human protein

n/a

None for AlbuRx® or Albuminar® (CSL manufacturer)

see comments

 CSL Behring recommends the administration of its products only as directed in the approved product labeling.
A filter is not required for the administration of albumin. CSL Behring has not conducted clinical studies with AlbuRx® or Albuminar® administered using an IV infusion set containing a filter or with an in-line filter.

(Buminate®)

(Buminate®)
see comments

Follow directions for use printed on the administration set container and product. Make certain that the administration set contains an adequate filter (15-micron or smaller).3

Amiodarone (Nexterone®)

Antiarrhythmic agent

n/a

0.22 micron in-line filter 4,5
(see comments)

Data on file with manufacturer of Nexterone suggests no loss of potency with use of a 0.2 micron in-line filter with the 1.8 mg/mL concentration; other sources suggest no significant loss of drug potency with the use of a 0.22 micron cellulose ester membrane filter (Ivex-HP, Millipore).6,7

Amphotericin B

Antifungal agent

n/a

see comments

May administer thorough 1 micron or larger in-line filter.8 

Amphotericin B liposomal
(Ambisome®)

Antifungal agent

Dilute product with 5 micron filter needle provided by the manufacturer 8

see comments

May administer through 1 micron or larger in-line filter.9

Amphotericin B lipid complex
(Abelcet®)                                

Antifungal agent

Use 5 micron filter needle provided by manufacturer10 (see comments)

n/a

Do not use an in-line filter. Each filter needle may be used to filter the contents of up to four 100 mg vials.10

Anti-thymocyte  globulin, equine (Atgam®)

Immune globulin

n/a

0.22 micron in-line filter 11

 

Anti-thymocyte globulin, rabbit (Thymoglobulin®)

Immune globulin

n/a

0.22 micron in-line filter 12

 

Asparaginase (Elspar®)

Antineoplastic agent

n/a

5 micron in-line filter 13

Loss of potency has been observed with a 0.2 micron filter.5

Cabazitaxel (Jevtana®)

Antineoplastic agent

n/a

0.22 micron in-line filter 14

 

Cetuximab (Erbitux®)

Antineoplastic agent

n/a

0.22 micron in-line filter 15

 

Cladribine (Leustatin®)

Antineoplastic agent

0.22 micron filter
(see comments)

n/a

When preparing the 7-day infusion solution, both cladribine and the diluent should be passed through a sterile disposable hydrophilic syringe filter as each solution is being introduced into the infusion reservoir.16

Clofarabine (Clolar®)

Antineoplastic agent

0.2 micron filter (see comments)

n/a

Filter prior to dilution.17

Cytomegalovirus immune globulin IV, human (CytoGam®)

Immune globulin

n/a

0.22 micron in-line filter
(see comment)

0.2 or 15  micron filter is acceptable.18

Epoprostenol (Flolan®)

Vasodilator

n/a

0.22 micron in-line filter

An in-line filter was used during clinical trials.19

Etoposide

Antineoplastic agent

n/a

0.22 micron in-line filter

Etoposide solutions of 0.2 mg/mL may be filtered through a 0.22 micron cellulose ester membrane filter (Ivex-HP, Millipore) without significant loss of drug.6

Factor VIII Products:
Human

Antihemophilic agents

 

 

Antihemophilic factor/ vonWillebrand factor complex
(Humate-P®)

Use filter for withdrawal from the vial. Use either the Mix2Vial® filter transfer set provided by manufacturer or a commercially available double-ended needle and vented filter spike 20

n/a

 

Monoclate-P®

Use filter needle provided by manufacturer 21,22

n/a

 

Koate®-DVI

Recombinant

 

Helixate® FS

Use filter needle provided by manufacturer 23,24

n/a

Recombinate®

Feiba NF®

Anti-factor VIII Inhibitor

Use filter needle provided by manufacturer 25

n/a

 

Factor IX products:
Human

Antihemophilic agents

 

 

Factor IX Complex
(Profilnine SD®)

Use filter needle provided by manufacturer 26

n/a

 

Recombinant

 

 

BeneFIX®

Use filter needle provided by manufacturer 27

n/a

 

Ibritumomab tiuxetan 
(Zevalin®)

Radioimmunotherapeutic
monoclonal antibody

n/a

0.22 micron in-line filter

Use in-line filter between syringe and infusion port prior to injection of each component.28

Infliximab (Remicade®)

Monoclonal antibody

n/a

Administer with an infusion set and 1.2 micron or smaller in-line filter 29

 

Ipilimumab (Yervoy®)

Antineoplastic agent

n/a

0.2 to 1.2 micron in-line filter 30,31

 

Ixebepilone (Ixempra Kit®)

Antineoplastic agent

n/a

0.2 to 1.2 micron in-line filter32

 

Lipid emulsion (Intralipid®)

Nutritional product

n/a

1.2 micron or larger

Filters < 1.2 micron pore size must not be use with Intralipid 20%. 33

Mannitol (Osmitrol®)

Osmotic diuretic

5 micron filter needle

0.22 micron in-line filter
(see comment)

Recommend using a 5 micron filter needle with the 25% diluted mannitol during preparation and a 0.22 micron in-line filter during administration for all mannitol parenteral solutions.

Ofatumumab (Arzerra®)

Antineoplastic
agent

n/a

Use in-line filter set supplied by manufacturer 34

 

Paclitaxel (Taxol®)

Antineoplastic
agent

n/a

0.22 micron or smaller in-line filter for paclitaxel 35

 

Paclitaxel albumin-bound (Abraxane®)

Antineoplastic
agent

n/a

See comments

Use of a filter is not recommended for Abraxane.36

Panitumumab (Vectibix®)

Antineoplastic agent

n/a

0.22 micron in-line filter 37

 

Phenytoin sodium

Anticonvulsant

 

 

 

 

n/a

0.22 micron in-line filter
(see comment)

Although not recommended by the manufacturer, some studies indicate that an IV infusion of phenytoin may be feasible if proper precautions are observed, such as a suitable vehicle (eg, 0.9% sodium chloride or Ringer’s lactated injection), appropriate concentration, preparing the infusion shortly before administration, and using an in-line filter7,38; according to most studies, a 0.22 micron in-line filter is required; phenytoin sodium (250 mg/5mL in a 5 mL syringe) was filtered at a rate of 1 mL/min through a 5 micron stainless steel depth filter without significant reduction in potency.7

Prothrombin Complex Concentrate, Human (Kcentra®)

Hemostatic
agent

Use filter needle provided by manufacturer 39

n/a

 

Ranibizumab (Lucentis®)

Vascular endothelial growth factor antagonist

5 micron filter (see comment)

 

n/a

Withdraw the solution from the vial through a 5-micron, 19-gauge filter needle attached to a 1 mL tuberculin syringe. Discard filter needle and use a non-filter needle for intravitreal injection.40

Solution from glass ampul

n/a

5 micron filter

n/a

 

Temsirolimus (Torisel®)

Antineoplastic
agent

 

n/a

0.2 to 5 micron in-line filter
(see comment)

Administer with in-line polyethersulfone filter (≤ 5 micron) or an endset polyethersulfone filter (0.2 to 5 micron). Do not use both an in-line and endset filter.41

Thiotepa

Antineoplastic
agent

 

 

0.22 micron filter

n/a

Filter prior to administration; polysulfone membrane (Gelman’s Sterile Aerodisc, Single Use) or triton-free mixed ester of cellulose/PVC (Millipore’s MILLEX-GS Filter Unit) are recommended by the manufacturer42; solutions of 10 to 300 mcg/mL did not adsorb to cellulose nitrite/cellulose acetate ester filters (Millipore’s MILLEX-OR) or Teflon filters (Millipore’s MILLEX-FG).7

Total Parental Nutrition (TPN)

Nutritional product

n/a

 

 

Without Lipids

0.22 micron in-line filter

 

With Lipids

1.2 micron in-line filter

 

Ziv-Aflibercept
(Zaltrap®)

Antineoplastic
agent

n/a

0.2 micron filter 43

 

 

References

  1. Orencia [package insert]. Princeton, NJ: Bristol-Myers Squibb; 2011.
  2. ReoPro [package insert]. Indianapolis, IN: Eli Lilly; 2005.
  3. Buminate [package insert]. Westlake Village, CA: Baxter; 2009.
  4. Amiodarone [package insert]. Rockford, IL: Mylan; 2012.
  5. Nexterone [package insert]. Deerfield, IL: Baxter; 2011.
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
  7. Drugs to be used with a filter for preparation and/or administration. Hosp Pharm 2012;47(5):351-359.
  8. Amphotericin B [package insert]. Big Flats, NY: X-Gen Pharmaceuticals, Inc; 2010.
  9. Ambisome [package insert]. San Dimas, CA: Gilead Sciences; 2008.
  10. Abelcet [package insert]. Indianapolis, IN: Sigma-Tau Pharma Source; 2010.
  11. Atgam [package insert]. New York, NY: Pfizer, Inc; 2005.
  12. Thymoglobulin [package insert]. Cambridge, MA: Genzyme; 2008.
  13. Elspar [package insert]. Deerfield, IL: Lundbeck; 2013.
  14. Jevtana [package insert]. Bridgewater, NJ: Sanofi-Aventis; 2013.
  15. Erbitux [package insert]. Princeton, NJ: Bristol-Myers Squibb; 2013.
  16. Leustatin [package insert]. Raritan, NJ: Centocor Ortho-Biotech; 2012.
  17. Clolar [package insert]. Cambridge, MA: Genzyme; 2013.
  18. CytoGam [package insert]. Kankakee, IL: CSL Behring; 2012.
  19. Flolan [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011.
  20. Humate P [package insert]. Kankakee, IL: CSL Behring; 2012.
  21. Monoclate P [package insert]. Kankakee, IL: CSL Behring; 2010.
  1. Koate-DVI [package insert]. Research Triangle Park, NC: Grifols Therapeutics Inc.; 2012.
  2. Helixate FS [package insert]. Kankakee, IL: CSL Behring; 2012.
  3. Recombinate [package insert]. Westlake Village, CA: Baxter; 2010.
  4. Feiba NF [package insert]. Westlake Village, CA: Baxter; 2011.
  5. Profilnine SD [package insert]. Los Angeles, CA: Grifols Biologicals; 2010.
  6. BeneFix [package insert]. Phildelphia, PA: Pfizer; 2011.
  7. Zevalin [package insert]. Irvine, CA: Spectrum Pharmaceuticals; 2011.
  8. Remicade [package insert]. Horsham, PA: Janssen Biotech; 2013.
  9. Yervoy [package insert]. Princeton, NJ: Bristol-Myers Squibb; 2012.
  10. Communication with Bristol-Myers Squibb personnel. 10 October 2013.
  11. Ixempra kit [package insert]. Princeton, NJ: Bristol-Myers Squibb; 2011.
  12. Intralipid [package insert]. Deerfield, IL: Baxter Healthcare Corporation; 2006.
  13. Arzerra [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011.
  14. Paclitaxel [package insert]. New York, NY: Pfizer Labs; 2011.
  15. Abraxane [package insert]. Summit, NJ: Celgene Corporation; 2011.
  16. Vectibix [package insert]. Thousand Oaks, CA: Amgen, Inc; 2011.
  17. Phenytoin sodium [package insert]. Lake Forest, IL: Hospira, Inc; 2010.
  18. Kcentra [package insert]. Kankakee, IL: CSL Behring; 2013.
  19. Lucentis [package insert]. South San Francisco, CA: Genentech, Inc; 2011.
  20. Torisel [package insert]. Philadelphia, PA: Wyeth; 2011.
  21. Thiotepa [package insert]. Bedford, OH: Bedford Laboratories, Inc; 2001.
  22. Zaltrap [package insert].

 

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