mitoxantrone

Contraindicated in:

Hypersensitivity;
Baseline neutrophils <1500 cells/mm³ (for prostate cancer and MS only)
;
Baseline left ventricular ejection fraction (LVEF) <50% (for MS only)
;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease, previous mediastinal radiation, or use of anthracyclines (↑ risk of HF)
;
Active infection;
↓bone marrow reserve;
Impaired hepatobiliary function;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to drug effects.

Adv. Reactions/Side Effects ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 2 mg/mL

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits DNA synthesis (cell-cycle phase-nonspecific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.
Decreased pain in patients with advanced prostate cancer.
Decreased disability and slowed progression of MS.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics, immune modifiers

Pharmacologic Classification: antitumor antibiotics

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues; limited penetration of CSF.

Metabolism/Excretion: Mostly eliminated by hepatobiliary clearance; <10% excreted unchanged by the kidneys.

Half-Life: 5.8 days.

Time/Action Profile ⬆ ⬇

(effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	10 days	21 days

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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Indications ⬇

Contraind./Precautions ⬆ ⬇