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From the May 21,1997 Issue

Hazard Warning

The latest edition of the widely used text, Cancer: Principles and Practice of Oncology, lists a chemotherapy regimen in a manner that could lead to a fatal overdose. In the EPOCH regimen in table 44.6-12 on page 2272, doses are listed as:

etoposide 200mg/m2 IV infusion days 1 to 4
vincristine 1.6mg/m2 IV infusion days 1 to 4
doxorubicin 40mg/m2 IV infusion days 1 to 4

Cyclophosphamide and prednisone are also included in the regimen.

This method of dose expression is ambiguous. The doses for etoposide, vincristine, and doxorubicin are course doses which are supposed to be given as a continuous IV infusion over a four-day period. Similarly expressed doses have led to errors in which the entire course dose was administered daily for 4 days. This type of error has happened many times, including the well known incident in Boston 1995. Instead, the regimen for etoposide, vincristine and doxorubicin should state:

etoposide 50mg/m2/day IV infusion days 1 to 4
vincristine 0.4mg/m2/day IV infusion days 1 to 4
doxorubicin 10mg/m2/day IV infusion days 1 to 4

Please inform relevant staff and make revisions in library texts at your location. The publisher, J.B. Lippincott, has been informed by ISMP.

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