Canterbury DHB
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For transplant regimens with IV busulphan conditioning, seizure prevention prophylaxis is required. Initiate clonazepam 0.5 mg BD, for two doses, starting the day before busulphan commences. Increase to 1 mg BD, from third dose, and give until 48 hours post the last busulphan dose.
The Toxicology laboratory (
80322) needs to be notified in advance that busulphan levels will be required. This is done by the Transplant coordinator.
Correct busulphan dosing is achieved through AUC calculations. Following the first dose of busulphan, take blood levels post dose at 0, 30 mins, 1 hour, 2 hours and 6 hours or as directed on the transplant protocol. The nurses taking the bloods are to complete the AUC form which is attached to the patient’s transplant protocol. After the last sample has been taken the form is faxed to ext 81162.
State clearly the times the dose was administered, the amount given and the exact times each level was taken.
The patient’s height, weight, gender and plasma creatinine must also be completed.
The AUC calculated level range to be achieved will be indicated in the transplant schedule. If levels are low, there is an increased risk of engraftment failure for allogeneic patients. If high, there is increased toxicity and risk of VOD.
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Topic Code: 9124
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