mitoxantrone

ROUTE	ONSET	PEAK	DURATION
IV	unknown	10 days	21 days

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

Metab: hyperuricemia

Neuro: headache, SEIZURES

Resp: cough, dyspnea

Misc: fever, HYPERSENSITIVITY REACTIONS

Interactions ⬆ ⬇

Drug-drug:

↑bone marrow depression with other antineoplastics or radiation therapy.
Risk of cardiomyopathy↑ by previous anthracycline antineoplastics (daunorubicin, doxorubicin, idarubicin) or mediastinal radiation.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

Route/Dosage ⬆ ⬇

Acute Nonlymphocytic Leukemia

IV (Adults ): Induction: 12 mg/m²/day for 3 days; if incomplete remission occurs, a 2nd induction may be given. Consolidation: 12 mg/m²/day for 2 days, given 6 wk after induction with another course 4 wk later.

Advanced Prostate Cancer

IV (Adults ): 12–14 mg/m² as single dose.

Multiple Sclerosis

IV (Adults ): 12 mg/m² every 3 mo.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 2 mg/mL

Assessment ⬆ ⬇

Monitor for hypersensitivity reactions (rash; urticaria; bronchospasm; tachycardia; hypotension; wheezing; tightness in chest or throat; swelling of mouth, face, lips, tongue, or throat). If signs/symptoms of hypersensitivity reaction occurs, stop infusion and implement supportive measures (epinephrine) as indicated.
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 intake and output, appetite, and nutritional intake. Assess for nausea and vomiting. Antiemetics may be administered prophylactically. Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
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.
Monitor for symptoms of gout (↑ uric acid levels and joint pain and swelling). Encourage patient to drink ≥2 L/day of fluid. Allopurinol may be given to ↓ uric acid levels.
Multiple sclerosis: Asses frequency of exacerbations of symptoms periodically during therapy.

Lab Test Considerations:

Verify negative pregnancy test before starting therapy.
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.
- Monitor liver function (AST, ALT, LDH, bilirubin) and renal function (BUN, serum creatinine) before and periodically during therapy.
- May ↑ uric acid. Monitor periodically during therapy.

Implementation ⬆ ⬇

Do not confuse mitoxantrone with mitomycin or MTX Patch (lidocaine/menthol).
Mitoxantrone should be administered under the supervision of a physician experienced in the use of cytotoxic chemotherapy agents.
There are lifetime maximum doses for mitoxantrone. Check manufacturer's information and patient history before administering.
Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers.
- Avoid contact with skin. Use Luer-Lok tubing to prevent accidental leakage. If contact with skin occurs, immediately wash skin with soap and water.
- Clean all spills with an aqueous solution of calcium hypochlorite. Mix solution by adding 5.5 parts (per weight) of calcium hypochlorite to 13 parts water.

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.
Continuous Infusion: May also be administered over 24 hr.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefotetan
- chloramphenicol
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- dexmedetomidine
- dexrazoxane
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- hydralazine
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- insulin regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methohexital
- methotrexate
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- palonosetron
- pamidronate
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- azithromycin
- aztreonam
- cefazolin
- cefepime
- cefotaxime
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- clindamycin
- dantrolene
- daunorubicin
- dexamethasone
- diazepam
- digoxin
- doxorubicin liposomal
- ertapenem
- foscarnet
- fosphenytoin
- furosemide
- gemtuzumab ozogamicin
- heparin
- idarubicin
- methylprednisolone
- nafcillin
- nitroprusside
- paclitaxel
- pantoprazole
- pemetrexed
- phenytoin
- piperacillin/tazobactam
- potassium phosphates
- propofol
- sodium phosphates
- voriconazole

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
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.
Instruct patient to notify health care provider if abdominal pain, yellow skin, cough, diarrhea, or ↓ urine output occurs.
Inform patient that medication may cause the urine and sclera to turn blue-green.
Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Topical agents may be used if pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care provider.
Rep: May cause fetal harm. Refer patient to a facility with expertise in cancer during pregnancy. Advise patient that although mitoxantrone may cause infertility, contraception during therapy is necessary because of possible fetal harm. Discontinue breastfeeding before starting mitoxantrone.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇