dexrazoxane

REMS

Reducing incidence and severity of cardiomyopathy from doxorubicin in women with metastatic breast cancer who have already received a cumulative dose of doxorubicin >300 mg/m² and who will continue to receive doxorubicin therapy to maintain tumor control.
Treatment of extravasation resulting from IV anthracycline chemotherapy.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Any other type of chemotherapy except other anthracyclines (doxorubicin-like agents);
Hepatic impairment (for treatment of extravasation only);
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment (CCr <40 mL/min) (↓ dose);
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

GU: ↓fertility (males)

Hemat: leukopenia, neutropenia, thrombocytopenia

Local: pain at injection site

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), MALIGNANCY

Interactions ⬆ ⬇

Drug-drug:

Myelosuppression may be ↑ by antineoplastics or radiation therapy.
Antitumor effects of concurrent combination chemotherapy with fluorouracil and cyclophosphamide may be ↓ by dexrazoxane.

Availability ⬆ ⬇

(Generic available)

Lyophilized powder for injection: 250 mg/vial; 500 mg/vial

Route/Dosage ⬆ ⬇

Cardioprotective

IV (Adults ): 10 mg of dexrazoxane/1 mg doxorubicin.

Renal Impairment

IV (Adults ): CCr <40 mL/min:↓ dose by 50%.

Extravasation Treatment

IV (Adults ): 1000 mg/m² (maximum 2000 mg) given on days 1 and 2, and followed by a dose of 500 mg/m² (maximum 1000 mg) on day 3.

Renal Impairment

IV (Adults ): CCr <40 mL/min:↓ dose by 50%.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts as an intracellular chelating agent.

Therapeutic effects:

Diminishes the cardiotoxic effects of doxorubicin.
Decreased damage from extravasation of anthracyclines.

Classifications ⬆ ⬇

Therapeutic Classification: cardioprotective agents

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Some metabolism occurs; 42% eliminated in urine.

Half-Life: 2.1–2.5 hr.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(cardioprotective effect)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain the purpose of the medication to the patient.
Emphasize the need for continued monitoring of cardiac function.
Rep: Dexrazoxane may cause fetal harm. Advise females of reproductive potential to use highly effective contraception during and for 6 mo after last dose of dexrazoxane and to avoid breastfeeding during and for 2 wk after last dose. Advise males with female partners of reproductive potential to use highly effective contraception during and for 3 mo after last dose. Advise patient to notify health care professional immediately if pregnancy is suspected. May impair fertility in males.

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Indications ⬇