Hospital Pharmacy - May 2017 - 345

345

Garrett et al.

3.

c. Less than 30 mL/min, reduce dose by
25%.38
Bevacizumab:
a. Creatinine clearance, no adjustment necessary.1-5
b. Proteinuria:
1. Patients with greater than grade 2 proteinuria without nephrotic syndrome,
additional bevacizumab doses should be
held until resolution.1,2,4,39
2. The manufacturer recommends:
a. Patients demonstrating a 2+ or
greater dipstick reading should
undergo further assessment with a
24-hour urine collection.40
b. Bevacizumab should be held in
patients demonstrating 2 g or greater
proteinuria in a 24-hour period
until proteinuria is less than 2 g in a
24-hour collection.40

B. Liver Function
1. Capecitabine:
a. No information available.36
b. No dosage adjustment required.41
2. Oxaliplatin:
a. No information available.38
b. Dosage adjustments for elevated AST, ALT,
and total bilirubin are not required, but regular assessments of liver function to monitor
for oxaliplatin-induced hepatic injury are
advised.42,43
3. Bevacizumab:
a. No dosage adjustment required.1
b. No information available.40
C. Myelosuppression
1. Capecitabine and oxaliplatin:
a. Nadir ANC less than or equal to 500 cells/
mcL or nadir platelet count less than or equal
to 50 000 cells/mcL, decrease capecitabine
dose by 25% to 50%1 and oxaliplatin dose
by 25% to 35%.1
b. Delay treatment1,4 for ANC less than 1500
cells/mcL and platelets less than 75 000
cells/mcL
a. If ANC and platelets recover in 1 week,
give original dose4
b. If ANC and platelets recover in 2 weeks,
decrease dose by 25%4
2. Bevacizumab: No dosage adjustment required1,4
D. Nausea/Vomiting/Diarrhea
1. Capecitabine
a. Grade 3 or 4:
1. Do not give drug.5

2. Decrease dose by 25%.1,4
3. Decrease dose by 50%.1
E. Hypertension
1. According to the manufacturer, if the patient
develops hypertension, treat with appropriate
antihypertensive therapy.40
2. Further administration of bevacizumab should
be temporarily suspended if hypertension cannot
be medically controlled.2,4
3. Bevacizumab should be discontinued in those
patients with hypertensive crisis or hypertensive encephalopathy. Blood pressure should be
monitored at regular intervals in patients with
bevacizumab-induced or bevacizumab-exacerbated hypertension after discontinuation of
bevacizumab.40
F.

Other
1. Oxaliplatin
a. Persistent grade 2 neuropathy (lasting
greater than or equal to 15 days) or temporary grade 3 neuropathy (lasting 8-14 days),
reduce dose to 25% to 35%.1
2. Capecitabine
a. Grade 3 or 4 hand-foot syndrome, reduce
dose by 25%.4
b. Grade 3 or 4 stomatitis, reduce dose 25%.4

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
1. Ogata Y, Shimokawa M, Tanaka T, et al. A prospective study
of XELOX plus bevacizumab as first-line therapy in Japanese
patients with metastatic colorectal cancer (KSCC 0902). Int J
Clin Oncol. 2016;21(2):335-343.
2. Munemoto Y, Kanda M, Ishibashi K, et al. Capecitabine and
oxaliplatin combined with bevacizumab are feasible for treating selected Japanese patients at least 75 years of age with
metastatic colorectal cancer. BMC Cancer. 2015;15:786.
3. Feliu J, Salud A, Safont MJ, et al. First-line bevacizumab and capecitabine-oxaliplatin in elderly patients with
mCRC: GEMCAD phase II BECOX study. Br J Cancer.
2014;111(2):241-248.
4. Hong YS, Lee SS, Kim K, et al. A phase II study of bevacizumab,
oxaliplatin, and capecitabine in patients with previously untreated
metastatic colorectal cancer: a prospective, multicenter trial of the
Korean Cancer Study Group. Am J Clin Oncol. 2014;37(1):19-23.
5. Díaz-Rubio E, Gómez-España A, Massuti B, et al. Firstline XELOX plus bevacizumab followed by XELOX plus



Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
Hospital Pharmacy - May 2017 - 384
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2019
http://www.nxtbook.com/nxtbooks/sage/fai_201909
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_july2019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2019
http://www.nxtbook.com/nxtbooks/sage/canadianpharmacistsjournal_05062019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2019
http://www.nxtbook.com/nxtbooks/sage/sri_supplement_201903
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2019
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2018
http://www.nxtbook.com/nxtbooks/sage/tec_20180810
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2018
http://www.nxtbook.com/nxtbooks/sage/fai_201807
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2018
http://www.nxtbook.com/nxtbooks/sage/sri_supplement_201803
http://www.nxtbook.com/nxtbooks/sage/slas_discovery_201712
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2018
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_november2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_september2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2017
http://www.nxtbook.com/nxtbooks/sage/fai_supplement_201709
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2017
http://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_may2017
http://www.nxtbook.com/nxtbooks/sage/fai_201706
http://www.nxtbook.com/nxtbooks/sage/fai_201607
http://www.nxtbookMEDIA.com