Trastuzumab is incompatible with dextrose solutions because mixing trastuzumab with dextrose (such as 5% dextrose) leads to rapid aggregation of the protein, especially in the presence of human plasma or serum 1 2 8. This aggregation results in the formation of insoluble protein complexes, which can compromise both the safety and efficacy of the drug by potentially causing infusion reactions or reducing therapeutic activity 1 2 8. The aggregation is particularly notable for monoclonal antibodies like trastuzumab that are formulated at an acidic pH (≤ 6.5), as these are more prone to forming aggregates when exposed to dextrose-containing solutions 1.
Because of this risk, manufacturers and clinical guidelines specifically instruct that trastuzumab should only be reconstituted and diluted in 0.9% sodium chloride (normal saline) and never in dextrose solutions 4 5 6.
Citations:
- https://pubmed.ncbi.nlm.nih.gov/31774346/
- https://pubmed.ncbi.nlm.nih.gov/20061815/
- https://www.oncologynewscentral.com/drugs/monograph/16623-399019/trastuzumab-intravenous
- https://www.herceptin.com/hcp/metastatic-gastric-cancer/dosing-and-administration/preparation-and-storage.html
- http://media.oncologynurseadvisor.com/documents/14/ona_stat0510_3272.pdf
- https://www.drugs.com/monograph/trastuzumab.html
- https://www.enhertuhcp.com/en/dosing/preparation-and-administration
- http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Trastuzumab_monograph.pdf
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