Prior to administering these products, pharmacists will need to use caution in reviewing dosage regimens. A potential source of medication error is the variation in units of measure for the various products. Some products are dosed in micrograms/kilogram (mg/kg) rather than milligrams/kilogram (mg/kg). Also, some units of measure may be unique to the product, e.g., Chiron or Roche units. Dosage calculations need to be carefully checked to avoid potential errors.
Biotech products are primarily administered parent-erally although many other routes of administration are in development. Some products may be given by either the intravenous or subcutaneous route while others are restricted to the subcutaneous or intramus-cular routes. In some cases, manufacturers have information on unapproved routes of administration or other new information that may be available by contacting the individual manufacturer. In any case, the manufacturer should always be consulted in order to obtain supporting evidence for a particular route that is not approved, but may be more convenient for the patient. For example, G-CSF should be adminis-tered by the subcutaneous or intravenous route only, while GM-CSF is given by intravenous infusion, over a two-hour period (McEvoy, 2005). Aldesleukin is approved for intravenous administration only. However, subcutaneous administration, while not approved, has been used by some (Chiron, 1992). Erythropoietin should only be administered by the intravenous or subcutaneous routes (Amgen, 2006), while alteplase is only approved for the intravenous route (Genentech, 2005; McEvoy, 2005). Alteplase has also been administered by the intracoronary, intra-arterial, and intraorbital routes as well (McEvoy, 2005).
Filtering biotech products is not generally recom-mended since most of these proteins will adhere to the filter. Some hospitals and home infusion companies routinely use in-line filters for all intravenous solu-tions to minimize the introduction of particulate matter into the patient. In the case of biotech products, they should be infused below the filter to avoid a potential decrease in the amount of drug delivered to the patient (Banga and Reddy, 1994; Koeller et al., 1991).
Pharmaceutical biotechnology products are usually flushed with either saline or dextrose 5% in water. The product literature should be consulted and care should be taken to assure that the proper solution is used with each agent. In general, biotech drugs should not be administered with other drugs since, in most cases, data do not exist that demonstrate whether biotech products are compatible with other drugs or fluids.
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