MITOXANTRONE HYDROCHLORIDE

MITOXANTRONE HYDROCHLORIDE
(mi-tox'an-trone)
Novantrone
Classifications: antineoplastic; antibiotic; immunosuppressant;
Therapeutic: antineoplastic; immunosuppressant

Prototype: Doxorubicin
Pregnancy Category: D

Availability

2 mg/mL injection

Action

Non-cell-cycle specific antitumor agent with less cardiotoxicity than doxorubicin. Interferes with DNA synthesis by intercalating with the DNA double helix, blocking effective DNa and RNA transcription.

Therapeutic Effect

Highly destructive to rapidly proliferating cells in all stages of cell division.

Uses

In combination with other drugs for the treatment of acute nonlymphocytic leukemia (ANLL) in adults, bone pain in advanced prostate cancer. Reducing neurologic disability and/or the frequency of clinical relapses in patients with multiple sclerosis.

Unlabeled Uses

Breast cancer, non-Hodgkin's lymphomas.

Contraindications

Hypersensitivity to mitoxantrone; myelosuppression; multiple sclerosis; baseline LVEF less than 50%; pregnancy (category D), lactation.

Cautious Use

Impaired cardiac function; impaired liver and kidney function; systemic infections.

Route & Dosage

Combination Therapy for ANLL
Adult: IV Induction Therapy: 12 mg/m2/d on days 1–3, may need to repeat induction course IV Consolidation Therapy: 12 mg/m2 on days 1 and 2 (max: lifetime dose 80–120 mg/m2)

Prostate Cancer
Adult: IV 12–14 mg/m2 q21d

Multiple Sclerosis
Adult: IV 12 mg/m2 over 5–15 min q3mo (max: lifetime dose 140 mg/m2)

Administration

Intravenous
  • If mitoxantrone touches skin, wash immediately with copious amounts of warm water.

PREPARE: IV Infusion: ??Must be diluted prior to use. Withdraw contents of vial and add to at least 50 mL of D5W or NS. May be diluted to larger volumes to extend infusion time. ??Use goggles, gloves, and protective gown during drug preparation and administration

ADMINISTER: IV Infusion: Administer into the tubing of a freely running IV of D5W or NS and infused over at least 3 min or longer (i.e., 30–60 min) depending on the total volume of IV solution. If extravasation occurs, stop infusion and immediately restart in another vein.  

INCOMPATIBILITIES Solution/additive: Heparin, hydrocortisone, paclitaxel. Y-site: Amphotericin B cholesteryl complex, aztreonam, cefepime, doxorubicin liposome, paclitaxel, piperacillin/tazobactam, propofol, TPN.

  • Discard unused portions of diluted solution.
  • Once opened, multiple-use vials may be stored refrigerated at 2°–8° C (35°–46° F) for 14 d.

Adverse Effects (≥1%)

CV: Arrhythmias, decreased left ventricular function, CHF, tachycardia, ECG changes, MI (occurs with cumulative doses of >80–100 mg/m2), edema, increased risk of cardiotoxicity. GI: Nausea, vomiting, diarrhea, hepatotoxicity. Hematologic: Leukopenia, thrombocytopenia. Other: Discolors urine and sclera a blue-green color. Skin: Mild phlebitis, blue skin discoloration, alopecia.

Interactions

Drug: May impair immune response to vaccines such as influenza and pneumococcal infections. May have increased risk of infection with yellow fever vaccine.

Pharmacokinetics

Distribution: Rapidly taken up by tissues and slowly released into plasma, 95% protein bound. Metabolism: In liver. Elimination: Primarily in bile. Half-Life: 37 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor IV insertion site. Transient blue skin discoloration may occur at site if extravasation has occurred.
  • Monitor cardiac functioning throughout course of therapy; report signs and symptoms of CHF or cardiac arrhythmias.
  • Lab tests: Perform liver function tests prior to and during course of treatment. Monitor serum uric acid levels and initiate hypouricemic therapy before antileukemic therapy. Monitor carefully CBC with differential prior to and during therapy.

Patient & Family Education

  • Understand potential adverse effects of mitoxantrone therapy.
  • Expect urine to turn blue-green for 24 h after drug administration; sclera may also take on a bluish color.
  • Be aware that stomatitis/mucositis may occur within 1 wk of therapy.
  • Do not to risk exposure to those with known infections during the periods of myelosuppression.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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