Mitoxantrone

Indications
 Intravenous
Acute myeloid leukaemia
Adult: 12 mg/m2 daily for 5 days to induce remission. Alternatively, 12 mg/m2 for 3 days in combination with cytarabine.
Intravenous
Breast cancer
Adult: Initially, 14 mg/m2, then repeat every 3 wk. Adjust subsequent dose according to degree of myelosuppression. Debilitated patients or those who had previous chemotherapy: May reduce initial dose to 12 mg/m2. As part of a combination regimen: May reduce initial dose to 10-12 mg/m2.
Intravenous
Prostate cancer
Adult: Initially, 14 mg/m2, then repeat every 3 wk. Adjust subsequent dose according to degree of myelosuppression. Debilitated patients or those who had previous chemotherapy: May reduce initial dose to 12 mg/m2. As part of a combination regimen: May reduce initial dose to 10-12 mg/m2.
Intravenous
Lymphoma
Adult: Initially, 14 mg/m2, then repeat every 3 wk. Adjust subsequent dose according to degree of myelosuppression. Debilitated patients or those who had previous chemotherapy: May reduce initial dose to 12 mg/m2. As part of a combination regimen: May reduce initial dose to 10-12 mg/m2.
Intravenous
Liver cancer
Adult: Initially, 14 mg/m2, then repeat every 3 wk. Adjust subsequent dose according to degree of myelosuppression. Debilitated patients or those who had previous chemotherapy: May reduce initial dose to 12 mg/m2. As part of a combination regimen: May reduce initial dose to 10-12 mg/m2.
Intravenous
Multiple sclerosis
Adult: 12 mg/m2 by IV infusion over 5-15 min. Initially, dose may be given once every 3 mth provided neutrophil count is >1500 cells/mm3 and LVEF >50%.

Reconstitution: Dilute to at least 50 ml in sodium chloride 0.9% or glucose 5% solution and inj over at least 3 min into a freely running IV infusion of either solution.
Incompatibility: Do not mix in the same infusion as heparin.
Contraindications
 Pregnancy and lactation. Multiple sclerosis with LVEF <50% or clinically significant reduction in LVEF.
Warnings / Precautions
 Preexisting myelosuppression. Perform periodic blood counts. Monitor cardiac function, especially after a cumulative dose of >160 mg/m2 and in patients with prior radiotherapy of the chest and concomitant cytotoxic therapy. Hepatic impairment. Discontinue admin if extravasation occurs. May impair ability to drive or operate machinery.
Adverse Reactions
 Arrhythmia, oedema, ECG changes; pain, fatigue, fever, headache; alopecia, nail bed changes; amenorrhoea, menstrual disorder, hyperglycaemia; abdominal pain, anorexia, nausea, constipation, diarrhoea, GI bleeding, mucositis, stomatitis, dyspepsia, vomiting, wt gain/loss; abnormal urine, UTI; haematologic disorders; elevated LFTs; weakness; increased BUN and creatinine, haematuria; cough, dyspnoea, upper respiratory tract infection; fungal infection, infection, sepsis.
Potentially Fatal: Myelosuppression; cardiotoxicity.
Overdose Reactions
 Symptoms: Leucopenia, tachycardia, marrow hypoplasia, infection. Management: No known antidote; symptom-directed and supportive.
Drug Interactions
 Impaired immune response to vaccines may occur; infection after admin of live vaccines in patients on immunosuppressants is also possible.
See Below for More mitoxantrone Drug Interactions
Lab Interactions
 Blue-green discolouration of urine for 24 hr after dosing may interfere with urine tests.
Mechanism of Actions
 Mitoxantrone, an analogue of the anthracyclines, intercalates DNA and inhibits topoisomerase II causing DNA strand breakage which leads to decreased cell replication.
Absorption: Poor (oral).
Distribution: Rapidly and extensively distributed to body tissues; does not appear to cross the blood-brain barrier; distributes into breast milk.
Metabolism: Hepatic.
Excretion: Via urine and bile (as unchanged drug and metabolites). 5-18 days (elimination half-life).
Storage Conditions
 Intravenous: Store at 15-25°C (59-77°F); do not freeze. Store opened vials at room temperature for 7 days or under refrigeration for up to 14 days.
ATC Classification
 L01DB07 - mitoxantrone ; Belongs to the class of cytotoxic antibiotics, anthracyclines and related substances. Used in the treatment of cancer.
Storage
 Intravenous: Store at 15-25°C (59-77°F); do not freeze. Store opened vials at room temperature for 7 days or under refrigeration for up to 14 days.
Available As
  • Mitoxantrone 2 mg

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