For anthracycline extravasation treated with the antidote, when should infusion be started after extravasation?

• A. Immediately (within minutes)
• B. Within Six Hours
• C. Within Twenty-Four Hours
• D. After Forty-Eight Hours

Answer: (B)

Prompt initiation of the antidote after anthracycline extravasation is crucial because it interrupts the tissue-damaging cascade driven by the drug leaking into surrounding tissues. Dexrazoxane works by chelating iron and preventing the formation of free radicals that cause local injury, reducing the risk of necrosis and preserving tissue integrity.

The protective effect is strongest when the antidote is started as soon as extravasation is suspected, with a practical window of six hours after exposure. Initiating within this timeframe maximizes tissue salvage; waiting longer greatly diminishes the antidote’s effectiveness in preventing severe damage.

In practice, the first dose is given as soon as possible after extravasation, with subsequent doses at 24 and 48 hours to maintain protection during the period of ongoing drug exposure in the tissue. While earlier is better, the key rule for this scenario is starting within six hours.