mitomycin

Resp: PULMONARY TOXICITY.

CV: edema.

GI: nausea, vomiting, anorexia, stomatitis.

GU: infertility, renal failure.

Derm: alopecia, desquamation.

Hemat: leukopenia, thrombocytopenia, anemia.

Local: phlebitis at IV site.

Misc: HEMOLYTIC UREMIC SYNDROME, fever, prolonged malaise.

Interactions ⬆ ⬇

Drug-Drug:

Additive bone marrow depression with other antineoplastics or radiation therapy.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
Concurrent or sequential use with vinca alkaloids may result in respiratory toxicity.

Route/Dosage ⬆ ⬇

IV (Adults): 20 mg/m² every 6–8 wk.

Implementation ⬆ ⬇

Do not confuse mitomycin with mitoxantrone.
Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers.
- Ensure patency of IV. Extravasation may cause severe tissue necrosis. If patient complains of discomfort at IV site, discontinue immediately and restart infusion at another site. Promptly notify physician of extravasation.

IV Administration:

IV Push: Reconstitute 5-mg vial with 10 mL and 10-mg vial with 40 mL of sterile water for injection. Shake the vial; may need to stand at room temperature for additional time to dissolve. Final solution is blue-gray. Reconstituted solution is stable for 7 days at room temperature, 14 days if refrigerated.
Rate: May be administered IV push over 5–10 min through free-flowing IV of 0.9% NaCl or D5W.
Y-Site Compatibility:
- alfentanil
- amifostine
- amphotericin B lipid complex
- amphotericin B liposome
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- bivalirudin
- bleomycin
- bumetamide
- buprenorphine
- butorphanol
- calcium chloride
- calicum gluconate
- carboplatin
- caspofungin
- cefoxitin
- ceftazidime
- ceftriaxone
- chloramphenicol
- chlorpromazine
- ciprofloxacin
- cisplatin
- cyclophosphamide
- cyclosporine
- dactinomycin
- dexamethasone
- dexmedetomidine
- doxorubicin hydrochloride
- droperidol
- epirubicin
- ertapenem
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- granisetron
- heparin
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- ketorolac
- leucovorin calcium
- levofloxacin
- linezolid
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- methotrexate
- methylprednisolone
- metoclopramide
- metronidazole
- moxifloxacin
- nitroglycerin
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pemetrexed
- potassium chloride
- procainamide
- quinupristin/dalfopristin
- ranitidine
- rituximab
- sodium bicarbonate
- tacrolimus
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- trastuzumab
- vasopressin
- verapamil
- vinblastine
- vincristine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- allopurinol
- amikacin
- aminophylline
- amiodarone
- amphotericin B deoxycholate
- aztreonam
- cefepime
- cefotaxime
- cefotetan
- cefuroxime
- clindamycin
- dacarbazine
- daptomycin
- dexrazoxane
- diazepam
- dobutamine
- docetaxel
- dopamine
- doxycycline
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- filgrastim
- gemcitabine
- gentamicin
- glycopyrrolate
- haloperidol
- idarubicin
- insulin
- irinotecan
- isoproterenol
- labetalol
- lorazepam
- midazolam
- milrinone
- morphine
- naloxone
- pantoprazole
- phenytoin
- piperacillin/tazobactam
- promethazine
- propranolol
- sargramostim
- succinylcholine
- topotecan
- vancomycin
- vecuronium
- vinorelbine

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antitumor antibiotics

Availability ⬆ ⬇

(Generic available)

Powder for injection (requires reconstitution): 5 mg/vial; 20 mg/vial; 40 mg/vial;

Time/Action Profile ⬆ ⬇

(effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	3–8 wk	4–8 wk	up to 3 mo

Assessment ⬆ ⬇

Monitor vital signs periodically during administration.
Monitor for bone marrow depression. 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 increased fatigue, dyspnea, and orthostatic hypotension.
Monitor intake and output, appetite, and nutritional intake. Nausea and vomiting usually occur within 1–2 hr. Vomiting may stop within 3–4 hr; nausea may persist for 2–3 days. Antiemetics may be administered prophylactically. Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
Assess respiratory status and chest x-ray examination prior to and periodically throughout course of therapy. Cough, bronchospasm, hemoptysis, or dyspnea usually occurs after several doses and may be indicative of pulmonary toxicity, which may be life threatening.
Monitor for potentially fatal hemolytic uremic syndrome in patients receiving long-term therapy. Symptoms include microangiopathic hemolytic anemia, thrombocytopenia, renal failure, and hypertension.

Lab Test Considerations:

Monitor CBC with differential, platelet count, and observation for fragmented RBCs on peripheral blood smears prior to and periodically throughout therapy and for several mo following therapy.
- The nadirs of leukopenia and thrombocytopenia occur in 4–8 wk. Notify health care professional if leukocyte count is <4000/mm³ or if platelet count is <150,000/mm³ or is progressively declining. Recovery from leukopenia and thrombocytopenia occurs within 10 wk after cessation of therapy. Myelosuppression is cumulative and may be irreversible. Repeat courses of therapy are held until leukocyte count is >4000/mm³ and platelet count is >100,000/mm³.
- Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) prior to and periodically throughout therapy to detect hepatotoxicity and nephrotoxicity. Notify health care professional if creatinine is >1.7 m g/dL.

Pot. Nursing Diagnoses ⬆ ⬇

Risk for injury (Side Effects).
Risk for infection (Side Effects).
Disturbed body image (Side Effects).

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional 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; increased 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 professional if decreased urine output, edema in lower extremities, shortness of breath, skin ulceration, or persistent nausea occurs.
Instruct patient to inspect oral mucosa for redness and ulceration. If ulceration occurs, 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 professional.
Rep: Advise patient that, although mitomycin may cause infertility, contraception during therapy is necessary because of teratogenic effects.
Emphasize need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in size and spread of malignant tissue.

Code ⬆

NDC Code^*

0143- West-Ward Pharmaceuticals Corp
0143-9279- Mitomycin 0143-9279-01- 1 VIAL in 1 BOX, UNIT-DOSE (0143-9279-01) > 40 mL in 1 VIAL

0143- West-Ward Pharmaceuticals Corp
0143-9280- Mitomycin 0143-9280-01- 1 VIAL in 1 BOX, UNIT-DOSE (0143-9280-01) > 80 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-108- Mitomycin 16729-108-11- 1 VIAL in 1 BOX, UNIT-DOSE (16729-108-11) > 40 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-115- Mitomycin 16729-115-05- 1 VIAL in 1 CARTON (16729-115-05) > 10 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-116- Mitomycin 16729-116-38- 1 VIAL in 1 BOX, UNIT-DOSE (16729-116-38) > 80 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-246- Mitomycin 16729-246-05- 1 VIAL in 1 CARTON (16729-246-05) > 10 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-247- Mitomycin 16729-247-11- 1 VIAL in 1 CARTON (16729-247-11) > 10 mL in 1 VIAL

16729- Accord Healthcare Inc
16729-248- Mitomycin 16729-248-38- 1 VIAL in 1 CARTON (16729-248-38) > 10 mL in 1 VIAL

49771- Mobius Therapeutics LLC
49771-002- Mitosol 49771-002-03- 3 TRAY in 1 CARTON (49771-002-03) > 1 KIT in 1 TRAY (49771-002-01) * 1 mL in 1 VIAL, SINGLE-USE * 1 mL in 1 SYRINGE

67457- Mylan Institutional LLC
67457-518- Mitomycin 67457-518-05- 1 VIAL in 1 CARTON (67457-518-05) > 10 mL in 1 VIAL

67457- Mylan Institutional LLC
67457-519- Mitomycin 67457-519-20- 1 VIAL in 1 CARTON (67457-519-20) > 40 mL in 1 VIAL

67457- Mylan Institutional LLC
67457-520- Mitomycin 67457-520-40- 1 VIAL in 1 CARTON (67457-520-40) > 80 mL in 1 VIAL

68001- BluePoint Laboratories
68001-389- Mitomycin 68001-389-36- 1 VIAL in 1 CARTON (68001-389-36) > 10 mL in 1 VIAL (68001-389-28)

68001- BluePoint Laboratories
68001-390- Mitomycin 68001-390-77- 1 VIAL in 1 BOX, UNIT-DOSE (68001-390-77) > 40 mL in 1 VIAL (68001-390-78)

68001- BluePoint Laboratories
68001-391- Mitomycin 68001-391-79- 1 VIAL in 1 BOX, UNIT-DOSE (68001-391-79) > 80 mL in 1 VIAL (68001-391-80)

69448- Accord BioPharma Inc.
69448-001- MUTAMYCIN 69448-001-05- 1 VIAL in 1 CARTON (69448-001-05) > 10 mL in 1 VIAL

69448- Accord BioPharma Inc.
69448-002- MUTAMYCIN 69448-002-11- 1 VIAL in 1 BOX, UNIT-DOSE (69448-002-11) > 40 mL in 1 VIAL

69448- Accord BioPharma Inc.
69448-003- MUTAMYCIN 69448-003-38- 1 VIAL in 1 BOX, UNIT-DOSE (69448-003-38) > 80 mL in 1 VIAL

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇