Etiology and management of venous pain during intravenous administration of oxaliplatin

: In Japan, XELOX (capecitabine plus oxaliplatin) was approved for the treatment of advanced/recurrent colorectal cancer in September 2009. However, patients treated with XELOX sometimes experience intense, sporadic venous pain during administration of oxaliplatin through peripheral vein. To investigate the etiology and management of this event, we measured the titratable acidity, osmotic pressure, and pH of 5% dextrose in water (D5W) containing oxaliplatin with or without dexamethasone. The dexamethasone-containing solution was then tested for its efficacy in venous pain relief. D5W containing oxaliplatin had a pH of approximately 4. 8, whereas the titratable acidity and osmotic pressure were 0. 1 mEq/L and 300-320 mOsm/L, respectively, suggesting that the venous pain was partly attributable to the pH.When 1. 65-6. 6 mg of dexamethasone was added to this solution, the pH of the resulting solution was increased to 6. 5-7. 6. Moreover, pain was relieved in patients administered oxaliplatin with dexamethasone in D5W. When adjusted for pH by the addition of 1. 65-3. 3 mg of dexamethasone, oxaliplatin in D5W is associated with less venous pain without decreasing oxaliplatin content although it is not generally recommended to dissolve oxaliplatin in a basic solution since it is unstable under alkaline conditions.