Version May 2024
Hemorrhagic cystitis due to chemotherapy or radiation therapy, severe or refractory (off-label use): Note: Alum irrigation is a compounded product; various compounding formulas and final concentrations exist; follow institution protocols. Bladder irrigation: A 1% alum solution (50 g of alum dissolved in 5 L of sterile water) has been administered at 250 to 300 mL/hour as a continuous bladder irrigation (Ref). Residual clots should be removed from the bladder prior to initiation of alum irrigation (Ref).
Accumulation may occur as a result of kidney insufficiency; alum irrigation should be reserved for patients without kidney function impairment (Ref).
Information regarding use in hepatic impairment is not available.
Refer to adult dosing.
Postmarketing:
Endocrine & metabolic: Metabolic acidosis (Shoskes 1992)
Genitourinary: Bladder spasm (Arrizabalaga 1987, Westerman 2016), suprapubic pain (Arrizabalaga 1987), urinary tract infection (Westerman 2016)
Nervous system: Confusion (Shoskes 1992), delirium (Westerman 2016), disorientation (Murphy 1992), drowsiness (Shoskes 1992), encephalopathy (Ghahestani 2009, Murphy 1992), lethargy (Murphy 1992), mental status changes (Murphy 1992), tonic-clonic seizure (Murphy 1992)
Respiratory: Respiratory depression (Shoskes 1992), tachypnea (Shoskes 1992)
Miscellaneous: Aluminum toxicity (Murphy 1992, Westerman 2016)
Contraindication information is not available for this product.
Warnings/precautions information is not available for this product.
Alum irrigation is not available as a commercially prepared final product; it is a compounded product (refer to institution procedures).
Intravesicular bladder irrigation: For bladder irrigation only; not for injection. Alum 1% solution for continuous bladder irrigation has been administered at 250 to 300 mL/hour (Ref).
See "Use: Off-Label: Adult" (not approved in the United States).
Hemorrhagic cystitis due to chemotherapy or radiation therapy, severe or refractory
Following bladder irrigation, clinically significant systemic absorption is not expected in patients with normal kidney function (Westerman 2016).
Following bladder irrigation, clinically significant systemic absorption is not expected in patients with normal kidney function (Westerman 2016).
Consider monitoring serum aluminum levels. Monitor for signs/symptoms of bladder spasms.
Alum is an astringent; when administered via bladder irrigation, it decreases bleeding by locally stimulating vasoconstriction and decreasing capillary permeability (Westerman 2016).
Absorption: Clinically significant absorption is not expected in patients with normal kidney function (Westerman 2016).
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