Adult Dosing
Cardiomyopathy prophylaxis
- Recommended dose: Ratio of dexrazoxane:doxorubicin is 10:1 (eg, dexrazoxane 500 mg/m 2 would be given with doxorubicin 50 mg/m 2 )
- Administer by slow I.V push or rapid drip intravenous infusion from a bag
- Give doxorubicin dose within 30 mins of beginning dexrazoxane dose
Extravasation, anthracycline associated
- 1000 mg/m2 IV on day 1 and 2, 500 mg/m2 IV on day 3
- Start as soon as possible within 6 hrs of extravasation
- Max: 2000 mg/dose on days 1-2, 1000 mg/dose on day 3
Pediatric Dosing
- Safety and effectiveness in pediatrics has not been established
Renal Dose Adjustment (Based on Crcl)
- <40 mL/min: Decrease dose by 50%
Hepatic Dose Adjustment
- Hepatic impairment: Reduce dose proportional to reduction in doxirubicin dose, maintaining 10: 1 ratio; dose adjustments not defined (Totect)
- Dexrazoxane is associated with additive effects to the myelosuppression caused by chemotherapeutic agents
- Avoid using dexrazoxane in conjunction with the initiation of fluorouracil, doxorubicin and cyclophosphamide (FAC) therapy as it interferes with the antitumor efficacy of the regimen
- Use therapy in those patients who have already received a cumulative dose of doxorubicin >300 mg/m2 and are continuing with doxorubicin therapy
- Use of dexrazoxane in patients who have already received a cumulative dose of doxorubicin of 300 mg/m2 without dexrazoxane does not eliminates the potential for anthracycline induced cardiac toxicity; carefully monitor cardiac function
- Possibility of development of T-cell lymphoma, B-cell lymphoma and cutaneous basal cell or squamous cell carcinoma exists
- Avoid administration of doxorubicin prior to IV injection
- Administer by slow IV push or rapid drip IV infusion. Administer doxorubicin within 30 mins after beginning the infusion with this drug
- Closely monitor patients as this drug is intended for using with cytotoxic drugs
- Myelosuppressive additive effects has occurred due to myelosuppressive activity of chemotherapeutic agents
- Patients with compromised renal function are prone to greater exposure of dexrazoxane
- Treatment with this drug is associated with leukopenia, neutropenia, and thrombocytopenia
- Monitor creatinine, cardiac function at baseline; CBC with differential count frequently
- Fetal harm is associated with using this drug (Totect, Zinecard) in pregnant woman. Inform patient about the potential hazard to the fetus associated with using this drug during pregnancy
- Dexrazoxane is not indicated in pediatric patients, as secondary malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) have been reported in pediatric patients who have received dexrazoxane in combination with chemotherapy
Caution: Use cautiously in
- Renal impairment
- Hepatic impairment
- Myelosuppression
- Cytotoxic drug
Pregnancy Category:C (D for Totect and Zinecard)
Breastfeeding: Safety unknown. Since many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
