From the Guidelines
Intravesical gemcitabine should be administered by instilling 1000-2000 mg of gemcitabine diluted in 50-100 mL of normal saline directly into the bladder through a urinary catheter, with the patient retaining the solution for 1-2 hours, as this protocol has been shown to be effective in treating non-muscle invasive bladder cancer, particularly in patients who have failed BCG therapy or cannot tolerate it 1. The administration protocol involves several key steps, including:
- Emptying the bladder before the procedure
- Inserting a sterile urinary catheter into the bladder and draining any residual urine
- Slowly instilling the prepared gemcitabine solution through the catheter into the bladder
- Removing the catheter and instructing the patient to retain the solution in the bladder for 1-2 hours, changing position every 15-30 minutes to ensure the medication contacts all areas of the bladder wall
- Avoiding urination during the retention period
- Increasing fluid intake following treatment to flush the bladder The treatment is typically administered weekly for 6 weeks as induction therapy, followed by monthly maintenance treatments for up to a year in some protocols, as supported by recent guidelines 1. Intravesical gemcitabine works by directly exposing bladder cancer cells to high concentrations of the drug while minimizing systemic absorption and side effects, making it an effective option for treating non-muscle invasive bladder cancer, particularly in patients who have failed BCG therapy or cannot tolerate it 1. Key considerations for the administration protocol include:
- Using a sterile urinary catheter to minimize the risk of infection
- Ensuring the patient retains the solution in the bladder for the recommended time period to maximize the effectiveness of the treatment
- Increasing fluid intake following treatment to help flush the bladder and reduce the risk of side effects
- Monitoring the patient for any signs of side effects or adverse reactions, such as urinary tract infections or bladder irritation, and adjusting the treatment protocol as needed 1.
From the Research
Administration Protocol for Intravesical Gemcitabine
The administration protocol for intravesical Gemcitabine (gemcitabine hydrochloride) is as follows:
- Dose: 2000 mg of gemcitabine in 50/100 ml normal saline 2, 3
- Administration schedule: once a week for 6 weeks, with a dwell time of 1-2 hours 2, 3, 4
- Alternative administration schedule: twice a week for 6 weeks, with a dwell time of 1 hour 5
Pharmacokinetics and Safety
- Systemic absorption: minimal, with peak plasma concentrations of gemcitabine never exceeding 1000 ng/ml 4
- Local side effects: modest signs of local toxicity, including dysuria, headache, fatigue, and heavy legs 2, 6, 4
- Systemic side effects: reversible, non-limiting, and WHO grade 1 6
- Pharmacokinetics: gemcitabine plasma levels are immeasurable or low, with peak levels between 30 and 60 minutes, decreasing after more instillations 6