mye-toe-ZAN-trone
Therapeutic Classification: antineoplastics, immune modifiers
Pharmacologic Classification: antitumor antibiotics
High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues; limited penetration of CSF.
Half-Life: 5.8 days.
Contraindicated in:
Baseline neutrophils <1500 cells/mm3 (for prostate cancer and MS only)
;Baseline left ventricular ejection fraction (LVEF) <50% (for MS only)
;Use Cautiously in:
Cardiovascular disease, previous mediastinal radiation, or use of anthracyclines (↑ risk of HF)
;CV: arrhythmias, ECG changes, HF
Derm: alopecia, rash
EENT: blue-green sclera, conjunctivitis
GI: abdominal pain, diarrhea, hepatotoxicity, nausea, stomatitis, vomiting
GU: blue-green urine, gonadal suppression, renal failure
Hemat: anemia, neutropenia, thrombocytopenia, SECONDARY LEUKEMIA
Misc: fever, HYPERSENSITIVITY REACTIONS
Drug-drug:
Risk of cardiomyopathy↑ by previous anthracycline antineoplastics (daunorubicin, doxorubicin, idarubicin) or mediastinal radiation
.
Acute Nonlymphocytic Leukemia
Advanced Prostate Cancer
Multiple Sclerosis
Monitor for bone marrow suppression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Monitor chest x-ray, ECG, echocardiography or MUGA, and radionuclide angiography to determine ejection fraction before and periodically during therapy. Patients with MS with baseline LVEF <50% should not receive mitoxantrone. May cause cardiotoxicity, especially in patients who have received daunorubicin or doxorubicin. Assess for rales/crackles, dyspnea, edema, jugular vein distention, ECG changes, arrhythmias, and chest pain. Monitor LVEF with echocardiogram or MUGA if signs of HF occur, before each dose, and yearly after stopping therapy in patients with MS. Additional doses of mitoxantrone should not be administered to patients with MS who have experienced either a ↓ in LVEF to below the lower limit of normal or a clinically significant ↓ in LVEF during therapy. Potentially fatal HF may occur during or for months or years after therapy. Risk is greater in patients receiving a cumulative dose >140 mg/m2. Patients with MS should not receive cumulative dose >140 mg/m2.
Lab Test Considerations:
Monitor CBC with differential before and periodically during therapy. The nadir of leukopenia usually occurs within 10 days, and recovery usually occurs within 21 days.
Mitoxantrone should be administered under the supervision of a physician experienced in the use of cytotoxic chemotherapy agents.
IV Administration:
Mitoxantrone is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days. Initiate antidote (dexrazoxane or topical dimethyl sulfoxide) based on time frame of noting extravasation. If extravasation is noted ≤6 hr of mitoxantrone infusion, administer dexrazoxane 1000 mg/m2 over 1–2 hr on Days 1 and 2 (max dose = 2000 mg/day), followed by 500 mg/m2 over 1–2 hr on Day 3 (max dose = 1000 mg/day). Hold cold compresses 15 min before initiating and after completing dexrazoxane infusion. Concurrent treatment with topical dimethyl sulfoxide should not be used with dexrazoxane because it may ↓ dexrazoxane's effectiveness.If extravasation is noted >6 hr after completion of mitoxantrone infusion, apply dimethyl sulfoxide by saturating a gauze pad and painting on an area twice the size of the extravasation. Allow site to air-dry and repeat application every 8 hr for 7 days. Do not cover the area with dressing.
Instruct patient to notify health care provider promptly if fever; chills; cough; hoarseness; sore throat; signs of infection; lower back or side pain; painful or difficult urination; bleeding gums; bruising; petechiae; blood in stools, urine, or emesis; ↑ fatigue; dyspnea; or orthostatic hypotension occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs; may precipitate gastric bleeding.