Generic Name

Mitomycin

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Classification

FDA Approved Indications

• Bladder cancer (Jelmyto)
• Topical use in ophthalmic procedures (Mitosol)
• Chemotherapy for various solid tumors (Mutamycin, Mitozytrex)

Mechanism of Action

Mitomycin is an alkylating agent that crosslinks DNA, leading to inhibition of DNA synthesis and cell death, particularly affecting rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose varies based on indication; for Jelmyto, intravesical instillation is administered once weekly for six weeks.

Pediatric: Use is limited; consult specific protocols.

Geriatric: Adjust dose based on renal and hepatic function; close monitoring recommended.

Renal Impairment: Use caution; dose adjustments may be necessary.

Hepatic Impairment: Use caution; limited data available, adjust as needed.

Pharmacokinetics

Absorption: Administered locally or intravenously; systemic absorption is minimal with topical use.

Distribution: Widely distributed; large volume of distribution.

Metabolism: Metabolized in the liver.

Excretion: Primarily excreted in urine.

Half Life: Approximately 30 minutes to 2 hours, depending on administration route.

Contraindications

• Hypersensitivity to mitomycin or other quinones.
• Active infections.

Precautions

• Perform complete blood counts prior to therapy.
• Use cautiously in patients with hepatic or renal impairment.
• Risk of myelosuppression, hemorrhage, and wound healing impairment.

Adverse Reactions - Common

• Myelosuppression (Common)
• Nausea and vomiting (Common)
• Hemorrhage or bleeding (Less common)

Adverse Reactions - Serious

• Severe myelosuppression leading to infection or bleeding (Serious)
• Pulmonary toxicity (Less common)
• Secondary malignancies (rare) (Rare)

Drug-Drug Interactions

• Other myelosuppressive agents
• Radiation therapy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection, bleeding, or unusual fatigue.
• Follow instructions regarding precautions during and after therapy.
• Maintain proper communication during treatment cycles.

Special Considerations

Black Box Warnings:

• Bone marrow suppression leading to severe or fatal myelosuppression.
• Potential for pulmonary toxicity and secondary malignancies.

Genetic Factors: None specified.

Lab Test Interference: May cause transient changes in blood counts, liver and renal function tests.

Overdose Management

Signs/Symptoms: Severe myelosuppression, hemorrhage, signs of pulmonary toxicity.

Treatment: Supportive care, blood product transfusions, and possibly leukocyte or platelet transfusions; no specific antidote.

Storage and Handling

Storage: Store in a refrigerator (2°C to 8°C); protect from light.

Stability: Stable for specified duration, check manufacturer guidelines.