Home Drug Guide Dexrazoxane Hydrochloride

Drug Guide

Generic Name

Dexrazoxane Hydrochloride

Brand Names Zinecard, Totect

Classification

Therapeutic: Cardioprotectant, Antineoplastic agent adjunct

Pharmacological: Iron chelator, Topoisomerase II inhibitor

FDA Approved Indications

Prevention of cardiomyopathy associated with doxorubicin therapy in patients receiving significant cumulative doses.
Treatment of extravasation of anthracyclines, including doxorubicin and daunorubicin.

Mechanism of Action

Dexrazoxane acts as an iron chelator, reducing free radical formation that can cause tissue damage, and inhibits topoisomerase II, which is involved in DNA replication. This dual action helps protect cardiac tissue from anthracycline-induced damage and mitigates tissue injury from extravasation.

Dosage and Administration

Adult: For cardioprotection, typically 10:1 ratio of dexrazoxane to doxorubicin dose, administered IV 30 minutes prior to doxorubicin infusion.

Pediatric: Dosing based on body surface area, generally 10 times the amount of doxorubicin (e.g., for a dose of doxorubicin, dexrazoxane 10 times that amount, administered IV 30 minutes before doxorubicin).

Geriatric: Adjust as needed based on renal function, with careful monitoring.

Renal Impairment: Use with caution; doses may need adjustment based on renal function.

Hepatic Impairment: No specific adjustments well established; monitor hepatic function.

Pharmacokinetics

Absorption: Administered IV, so absorption phase is bypassed.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver through hydrolysis and conjugation.

Excretion: Excreted mainly via urine.

Half Life: Approximately 2-3 hours.

Contraindications

Hypersensitivity to dexrazoxane or any component of the formulation.
Patients with active infection or febrile illness.

Precautions

Use with caution in patients with renal or hepatic impairment.
Monitor for myelosuppression; it can occur with dexrazoxane.

Adverse Reactions - Common

Nausea (Common)
Vomiting (Common)
Bone marrow suppression (Common)
Fatigue (Common)

Adverse Reactions - Serious

Allergic reactions including rash, itching, or swelling (Serious)
Secondary malignancies (rare) (Rare)
Severe myelosuppression leading to infection or bleeding (Serious)

Drug-Drug Interactions

Increased risk of myelosuppression when combined with other marrow-suppressing agents.
Potential interaction with other cardioprotective agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor patient’s blood counts, cardiac function, and for signs of extravasation.

Diagnoses:

Risk for infection due to myelosuppression.
Risk for tissue injury due to extravasation.

Implementation: Administer IV as prescribed; premedicate as needed for nausea. Monitor infusion site closely during extravasation treatment.

Evaluation: Assess for reduction in cardiotoxicity, monitor for adverse reactions, effective prevention or treatment of extravasation.

Patient/Family Teaching

Report any allergic reactions immediately.
Understand the importance of monitoring blood counts.
Notify healthcare provider of any signs of extravasation or tissue injury.

Special Considerations

Black Box Warnings:

Potential for secondary malignancies including myelodysplastic syndrome and acute leukemia.
Risk of severe tissue necrosis with extravasation during administration.

Genetic Factors: None established.

Lab Test Interference: May affect blood counts.

Overdose Management

Signs/Symptoms: Severe myelosuppression, allergic reactions, tissue necrosis.

Treatment: Supportive care, monitor blood counts, manage symptoms, no specific antidote.

Storage and Handling

Storage: Store at controlled room temperature (20°C to 25°C).

Stability: Stable for the duration of the shelf life when stored properly.