Mitomycin (Mitomycin C)

Indications
 Intravenous
Solid tumours
Adult: Refer to published protocols. Suggested regimen: Initially, 10-20 mg/m2; may be repeated every 6-8 wk depending on blood count. Reduce dose depending on previous haematological response. Another suggested regimen is 2 mg/m2 daily for 5 days, repeated after 2 days. Adjust dose according to the effect on bone marrow. Do not repeat treatment unless leucocyte and platelet counts are above acceptable levels. Do not re-administer if the nadir of the leucocyte count is <2000 cells/mm3. Dose may need to be reduced when used with other antineoplastics.
Intravesical
Superficial bladder tumours
Adult: Instil 10-40 mg is instilled into the bladder 1-3 times a wk for a total of 20 doses. Doses are usually given in 10-40 ml of water for inj. Retain the solution in the bladder for at least 1 hr.
Intravesical
Prophylaxis of recurrent bladder tumours
Adult: Instil 20 mg every 2 wk or 40 mg mthly or 3-mthly. Alternatively, 4-10 mg 1-3 times a wk. Doses are usually given in 10-40 ml of water for inj. Retain the solution in the bladder for at least 1 hr.

Reconstitution: Dilute to a concentration of 0.5-1 mg/ml with 0.9% sodium chloride or sterile water for inj.
Incompatibility: Incompatible with aztreonam, cefepime, etoposide phosphate, filgrastim, gemcitabine, piperacillin/tazobactam, sargramostim, topotecan, vinorelbine, bleomycin.
Contraindications
 Thrombocytopenia, coagulation disorders, increase in bleeding tendency due to other causes. Renal impairment, potentially severe infections. Pregnancy and lactation.
Warnings / Precautions
 Repeated haematologic studies are necessary during treatment and for at least 7 wk after discontinuation of the drug. Discontinue use when the leucocyte count decreases to <4000/mm3 or the platelet count decreases to <150,000/mm3 or if a progressive decline in either occurs. Monitor patient for signs of renal or pulmonary toxicity.
Adverse Reactions
 CHF; fever; alopecia, nail banding/discolouration; nausea, vomiting, anorexia; anaemia; rash; stomatitis; paraesthesia; increased creatinine; interstitial pneumonitis, infiltrates, dyspnoea, cough; malaise, pruritus, extravasation, bladder fibrosis/contraction (intravesical admin).
Potentially Fatal: Myelosuppression, haemolytic-uraemic syndrome.
Overdose Reactions
 Symptoms: Bone marrow suppression, nausea, vomiting, alopecia. Management: Symptom-directed and supportive.
Drug Interactions
 Potentially Fatal: Enhanced cardiac toxicity with doxorubicin. Increased risk of haemolytic-uraemic syndrome with fluorouracil or tamoxifen. Acute pulmonary toxicity may occur with vinca alkaloids. Increased bone marrow depressant effects of aclarubicin.
See Below for More mitomycin Drug Interactions
Mechanism of Actions
 Mitomycin is an antineoplastic antibiotic which is enzymatically reduced to its active metabolite within susceptible cells. The active metabolite appears to cause cross-linking of DNA (primarily with guanine and cytosine pairs). It also active against gram-positive bacteria and some viruses, but its antineoplastic activity precludes its use as an antibiotic.
Distribution: Widely distributed but does not cross the blood-brain barrier; rapidly disappears in the blood (IV).
Metabolism: Hepatic.
Excretion: Via urine (as unchanged drug), faeces (small amounts). Half-life elimination: 23-78 min; terminal: 50 min.
Storage Conditions
 Intravenous: Store at controlled room temperature; solution is stable for 7 days at room temperature or 14 days under refrigeration if protected from light. Intravesical: Store at controlled room temperature; solution is stable for 7 days at room temperature or 14 days under refrigeration if protected from light.
ATC Classification
 L01DC03 - mitomycin ; Belongs to the class of other cytotoxic antibiotics. Used in the treatment of cancer.
Storage
 Intravenous: Store at controlled room temperature; solution is stable for 7 days at room temperature or 14 days under refrigeration if protected from light. Intravesical: Store at controlled room temperature; solution is stable for 7 days at room temperature or 14 days under refrigeration if protected from light.
Available As
  • Mitomycin (Mitomycin C) 10 mg
  • Mitomycin (Mitomycin C) 2 mg

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