Nurses Compass
Drug Guide
Mitoxantrone Hydrochloride
Classification
Therapeutic: Antineoplastic agent, Immunosuppressant
Pharmacological: Anthracenedione (Type of topoisomerase II inhibitor)
FDA Approved Indications
- Multiple sclerosis (secondary progressive or worsening remitting forms)
- Certain types of cancer such as prostate cancer, breast cancer, leukemia
Mechanism of Action
Mitoxantrone intercalates into DNA strands and inhibits topoisomerase II, leading to DNA strand breakage and inhibition of DNA replication and repair, thereby exerting cytotoxic effects on rapidly dividing cells.
Dosage and Administration
Adult: Dose tailored to indication; for MS, usually 12 mg/m² IV every 3 months; for cancer, dosing varies based on regimen.
Pediatric: Not generally recommended due to limited data.
Geriatric: Adjust dose based on renal and hepatic function; close monitoring required.
Renal Impairment: Use with caution; dose adjustment recommended based on renal function.
Hepatic Impairment: Use with caution; monitor liver function tests and adjust dose if necessary.
Pharmacokinetics
Absorption: Administered IV; absorption not applicable.
Distribution: Widely distributed; crosses the blood-brain barrier to some extent.
Metabolism: Metabolized in the liver; metabolites less active.
Excretion: Primarily via biliary/fecal route, minor renal excretion.
Half Life: Approximately 92 hours; prolonged half-life due to extensive tissue binding.
Contraindications
- Hypersensitivity to mitoxantrone or anthracenedione drugs.
- Myelosuppression, infections, liver disease, cardiac disease.
Precautions
- Monitoring of cardiac function is essential; cumulative dose limits to reduce cardiotoxicity.
- Use with caution during pregnancy; category D. Lactation is not recommended.
Adverse Reactions - Common
- Myelosuppression (neutropenia, leukopenia, thrombocytopenia) (Very common)
- Nausea and vomiting (Common)
- Alopecia (Common)
- Urine discoloration (may turn blue or green) (Common)
Adverse Reactions - Serious
- Myocardial toxicity including cardiomyopathy and heart failure (Rare but serious)
- Secondary leukemia (acute myeloid leukemia) (Rare)
- Severe infections due to myelosuppression (Rare)
Drug-Drug Interactions
- Other cardiotoxic agents (e.g., doxorubicin, trastuzumab)
- Cumulative effect increases risk of cardiotoxicity
- Agents causing myelosuppression
- Immunosuppressants
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor complete blood counts, cardiac function (ejection fraction), hepatic and renal functions before each dose.
Diagnoses:
- Risk of infection related to neutropenia
- Risk of cardiotoxicity
Implementation: Administer IV as prescribed; premedicate if necessary; monitor for adverse reactions.
Evaluation: Assess blood counts, cardiac function, and for signs of toxicity periodically.
Patient/Family Teaching
- Report any symptoms of infection, unusual fatigue, or shortness of breath.
- Understand the importance of regular blood tests and cardiac monitoring.
- Avoid pregnancy during treatment and for at least 6 months after the last dose.
- Report any signs of allergic reactions or side effects promptly.
Special Considerations
Black Box Warnings:
- Myelosuppression, cardiomyopathy, and secondary leukemia risk.
Genetic Factors: No specific genetic tests recommended.
Lab Test Interference: False-positive test results for human chorionic gonadotropin (hCG) may occur.
Overdose Management
Signs/Symptoms: Severe myelosuppression, cardiac failure, symptoms of secondary leukemia, or severe nausea.
Treatment: Supportive care, blood product transfusions, correction of electrolyte imbalances, and management of cardiac failure. No specific antidote; treatment supportive.
Storage and Handling
Storage: Store at room temperature, protected from light and moisture.
Stability: Stable under recommended storage conditions.