Alemtuzumab (Campath)
Altretamine (Hexalen) |
Unknown
No dose reduction |
Amifostine (Ethyol)
| No dose reduction (link to the reference)
|
Aminoglutethimide (Cytadren)
| No dose reduction |
Amsacrine (Amsidine)
Anastrozole (Arimidex)
| If bilirubine > 2 mg/dL, reduce dose by 25%
No dose reduction (link to the reference)
|
Arsenic trioxide (As2O3, Trisenox)
| No dose reduction |
L-Asparaginase (Elspar)
Bendamustine (Treanda)
Bicalutamide (Casodex) | No dose reduction
If SGOT or SGPT 2.5-10 upper normal limit and bilirubin 1.5-3 upper normal limit, or bilirubin > 3 upper normal limit, do not use (link to the reference)
No dose reduction (link to the reference) |
Bleomycin (Blenoxane)
| No dose reduction |
Buserelin (Suprefact)
| No dose reduction |
Busulfan (Myleran)
| No dose reduction |
Capecitabine (Xeloda)
| No dose reduction (link to the reference)
|
Carboplatin (Paraplatin)
| No dose reduction (link to the reference) |
Carmustine (BCNU)
| No dose reduction |
| Chlorambucil (Leukeran) | No dose reduction |
Cisplatin (CDDP)
| No dose reduction |
Cladribine (2-CdA)
| No dose reduction |
Cyclophosphamide (Cytoxan)
| If bilirubin 3-5 mg/dL or SGOT > 180 mg/dL, reduce dose by 25%
If bilirubin > 5 mg/dL, do not use (link to the reference)
|
Cytarabine (Ara-C)
Dacarbazine (DTIC)
| If bilirubin 1.5-3 mg/dL, reduce dose by 25%
If bilirubin > 3 mg/dL, reduce dose by 50%
No dose reduction |
Dactinomycin (Actinomycin)
Dasatinib (Sprycel)
| If bilirubin > 3 mg/dL, reduce dose by 50%
Unknown. Metabolism mainly hepatic (link to the reference)
|
Daunorubicin (Daunomycin)
| If bilurubin 1.5-3 mg/dL, reduce dose by 25%
If bilirubin 3.1-5 mg/dL, reduce dose by 50%
If bilirubin > 5 mg/dL, do not use (link to the reference)
|
Docetaxel (Taxotere)
| If bilirubin > upper normal limit, do not use
If SGOT and/or SGPT > 1.5 upper normal limit plus alkaline
phosphatase > 2.5 upper normal limit, do not use (link to the reference)
|
Doxorubicin (Adriamycin) And
Pegylated liposomal doxorubicin (Doxil) | If bilirubin 1.2-3 mg/dL, reduce dose by 50%
If bilirubin 3.1-5 mg/dL, reduce dose by 75%
If bilirubin > 5 mg/dL, do not use (link to the reference)
|
Erlotinib (Tarceva)
Estramustine (Estracyte)
| If AST > 3 upper normal limit, 50 mg
If direct bilirubin 1-7 mg/dL, 75 mg (link to the reference)
No dose reduction |
Etoposide (VP-16)
| If bilirubin 1.5-3 mg/dL or SGOT 60-180 mg/dL, reduce dose by 50%
If bilirubin > 3 mg/dL or SGOT > 180 mg/dL, do not use (link to the reference)
|
Exemestane (Aromasin)
Floxuridine (FUDR)
| No dose reduction (link to the reference)
No dose reduction
|
Fludarabine (Fludara)
| No dose reduction |
Fluorouracil (5-FU)
Fulvestrant (Faslodex) | If bilirubin < 5 mg/dL, no dose reduction
If bilirubin > 5 mg/dL, do not use (link to the reference)
No dose reduction for infusional administration (link to the article)
If SGOT, SGPT, bilirubin and alkaline phosphatase < 2 upper normal limit, no dose reduction
If SGOT, SGPT, bilirubin and alkaline phosphatase > 2 upper normal limit, unknown (link to the reference)
|
| Gemcitabine (Gemzar) | No dose reduction (link to the reference)
|
| Goserelin (Zoladex) | No dose reduction (link to the reference)
|
Hydroxyurea (Hydrea)
| No dose reduction |
Idarubicin (Idamycin)
| If bilirubin 1.5-3 mg/dL or SGOT 60-180 mg/dL, reduce dose by 25%
If bilirubin 3.1-5 mg/dL or SGOT > 180 mg/dL, reduce dose by 50%
If bilirubin > 5 mg/dL, do not use (link to the reference) |
Ifosfamide (Ifex)
| No dose reduction |
Imatinib (Gleevec)
| If bilirubin < 3 upper normal limit, no dose reduction
If bilirubin > 3 upper normal limit, use with caution (link to the reference) |
| Interferon –alpha | No dose reduction |
Interleukin-2
Irinotecan (Camptosar, CPT-11)
Ixabepilone (Ixempra) | Do not use in liver failure
If bilirubin 1-2 mg/dL, may need to reduce the dose
If bilurubin > 2 mg/dL, may not use (link to the reference)
Monotherapy:
If AST and ALT < 2.5 upper normal limit, and bilirubin < 1 upper normal limit, use 40 mg/m2
If AST or ALT < 10 upper normal limit, and bilirubin < 1 upper normal limit, use 32 mg/m2
If AST and ALT < 10 upper normal limit, and bilirubin 1.5-3 upper normal limit, use 20-30 mg/m2
If AST or ALT > 10 upper normal limit, or bilirubin > 3 upper normal limit, do not use In combination with capecitabine:
If AST and ALT < 2.5 upper normal limit, and bilirubin < 1 upper normal limit, use 40 mg/m2
If AST or ALT > 2.5 upper normal limit, or bilirubin > 1 upper normal limit, do not use (link to the reference)
|
Lapatinib (Tykerb)
Lenalidomide (Revlimid)
Letrozole (Femara)
Leucovorin (LV)
| If Child-Pugh C, reduce dose to 750 mg/d (link to the reference)
Unknown (link to the reference)
If Child-Pugh A or B, no dose reduction
If Child-Pugh C, reduce dose by 50% (link to the reference)
No dose reduction |
| Leuprolide (Lupron) | No dose reduction |
Lomustine (CCNU)
| No dose reduction |
Mechlorethamine (Nitrogen mustard)
| No dose reduction |
Megestrol acetate (Megace)
| No dose reduction |
Melphalan (Alkeran)
| No dose reduction |
6-Mercaptopurine (6-MP)
| No dose reduction |
| Mesna | No dose reduction |
Methotrexate (MTX)
| If bilirubin 3.1-5 mg/dL or SGOT > 180 mg/dL, reduce dose by 25%
If bilirubin > 5 mg/dL, do not use (link to the reference)
|
Mitomycin-C (Mutamycin)
| No dose reduction |
Mitoxantrone (Novantrone)
Nilotinib (Tasigna)
| If bilirubin > 3 mg/dL, reduce dose by 25%
Unknown (link to the reference)
|
| Paclitaxel (Taxol) | For 3-hour infusion:
If transaminase < 10 upper normal limit and bilirubin < 1.25 upper normal limit, no dose reduction (175mg/m2)
If transaminase < 10 upper normal limit and bilirubin 1.26-2 upper normal limit, reduce to 135 mg/m2
If transaminase < 10 upper normal limit and bilirubin2.01-5 upper normal limit, reduce to 90 mg/m2
If transaminase > 10 upper normal limit or bilirubin > 5 upper normal limit, do not use For 24-hour infusion:
If transaminase < 2 upper normal limit or bilirubin < 1.5 mg/mL, no dose reduction (135 mg/m2)
If transaminase 2-10 upper normal limit and bilirubin < 1.5 mg/dL, reduce to 100 mg/m2
If transaminase < 10 upper normal limit and bilirubin 1.6-7.5 mg/dL, reduce to 50 mg/m2
If transaminase > 10 upper normal limit or bilirubin > 7.5 mg/dL, do not use (link to the reference)
|
Pegasparaginase (Oncaspar)
| No dose reduction |
| Pemetrexed (Alimta) | No dose reduction (link to the reference)
|
Pentostatin (Nipent)
| No dose reduction |
Rituximab (Rituxan)
Sorafenib (Nexavar)
| No dose reduction
If Child-Pugh A or B, no dose reduction
If Child-Pugh C, unknown (link to the reference)
|
Streptozocin (Zanosar)
Sunitinib (Sutent)
| No dose reduction
If Child-Pugh A or B, no dose reduction
If Child-Pugh C, unknown (link to the reference)
|
Tamoxifen (Nolvadex)
| No dose reduction |
Temozolomide (Temodar)
Temsirolimus (Torisel) | No dose reduction
Unknown (link to the reference)
|
Thioguanine (6-TG)
| If bilirubin > 5 mg/dL, do not use |
Topotecan (Hycamtin)
| No dose reduction (link to the reference) |
Tretinoin (ATRA)
| If bilirubin 3.1-5 mg/mL or SGOT > 180 mg/dL, reduce
dose to a maximum of 25 mg/m2
If bilirubin > 5 mg/dL, do not use |
| UFT | No dose reduction |
Vinblastine (Velban)
| If bilirubin 1.5-3 mg/dL or SGOT 60-180 mg/dL, reduce
dose by 50%
If bilirubin > 3 mg/dL or SGOT > 180 mg/dL, do not use (link to the reference)
|
Vincristine (Oncovin, VCR)
| If bilirubin 1.5-3 mg/dL or SGOT 60-180 mg/dL, reduce
dose by 50%
If bilirubin > 3 mg/dL or SGOT > 180 mg/dL, do not use (link to the reference) |
Vinorelbine (Navelbine)
| If bilirubin 2-3 mg/dL, reduce dose by 50%
If bilirubin 3.1-5 mg/dL, reduce dose by 75%
If bilirubin > 5 mg/dL, do not use |
