What is best practice when dispensing and supplying intrathecal therapy?

From Cancer Guidelines Wiki


Several peer-reviewed publications outline the risks associated with the accidental administration of neurotoxic chemotherapy by the intrathecal route and a number of guidelines outline the processes for reducing these risks.

All staff responsible for dispensing and administering chemotherapy by ANY route should be aware of the catastrophic outcomes associated with the errors in administering incorrect chemotherapy medications via the intrathecal route.

Back to top

Evidence Summary

Errors in administration of cytotoxic agents NOT intended for intrathecal use can occur due to inherent system defects and lack of awareness of the risks posed by incorrect administration.[1][2][3][4][5][6]

Cancer pharmacists are responsible for the safe preparation and dispensing of cancer therapy agents (including cytotoxics, monoclonal antibodies and corticosteroids) in accordance with legislative requirements, national standards and local policy.

Back to top


Consensus-based recommendationQuestion mark transparent.png

All staff involved in the dispensing of intrathecal therapy should undergo appropriate training and be assessed as competent to perform their roles and responsibilities regarding intrathecal therapy.

The pharmacist must ensure:

  • The prescription or order for intrathecal chemotherapy is complete and correct as per national and local policies and procedures.
  • The clinical verification of the intrathecal chemotherapy order is performed according to the protocol, the patient’s treatment plan and patient parameters.
  • Local procedures for manufacturing and delivery of intrathecal chemotherapy are adhered to in order to eliminate risk of misadventure related to intrathecal therapy. All intrathecal therapy must be delivered and stored separately to cytotoxic chemotherapy administered by other routes.
  • All staff involved in the verification, manufacturing checking and distribution of intrathecal chemotherapy are trained and appropriately validated as per local policy.

Practice pointQuestion mark transparent.png

Pharmacists should be aware of the risks of inadvertent administration of chemotherapy by the incorrect route irrespective of whether the institute administers cytotoxic chemotherapy via the intrathecal route (Gilbar and Seger, 2013; Society of Hospital Pharmacists of Australia, 2005).

(Gilbar and Seger, 2013)[7] ;(Society of Hospital Pharmacists of Australia, 2005)[8]

Back to top


  1. Department of Health UK (Chief Medical Officer). Health Service Circular HSC 2008/001: Updated national guidance on the safe administration of intrathecal chemotherapy.; 2008 [cited 2016 Sep] Available from: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_086844.pdf.
  2. Australian Commission on Safety and Quality in Health Care. High Risk Medication Alert – Vincristine. [homepage on the internet]; 2005 Dec [cited 2016 Sep]. Available from: https://safetyandquality.gov.au/wp-content/uploads/2012/01/valert.pdf.
  3. Goldspiel BR, DeChristoforo R, Hoffman JM. Preventing chemotherapy errors: updating guidelines to meet new challenges. Am J Health Syst Pharm 2015 Apr 15;72(8):668-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25825190.
  4. Marliot G, Le Rhun E, Sakji I, Bonneterre J, Cazin JL. Securing the circuit of intrathecally administered cancer drugs: example of a collective approach. J Oncol Pharm Pract 2011 Sep;17(3):252-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20525750.
  5. Noble DJ, Donaldson LJ. The quest to eliminate intrathecal vincristine errors: a 40-year journey. Qual Saf Health Care 2010 Aug;19(4):323-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20211962.
  6. Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2010 Sep;6(3):220-37 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20887505.
  7. Gilbar PJ, Seger AC. Accidental intrathecal administration of bortezomib: preventing fatalities. Asia Pac J Clin Oncol 2013 Sep;9(3):290-1 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23176407.
  8. Society of Hospital Pharmacists of Australia. High-risk medication alert for vincristine injection. Appendix 3: Literature review.; 2005 [cited 2016 Sep] Available from: https://safetyandquality.gov.au/wp-content/uploads/2012/02/vlitera2.pdf.

Back to top