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Dexrazoxane

(deks-ruh-zok-sane)

Trade/other name(s): Zinecard, Totect

Why would this drug be used?

Dexrazoxane belongs to a group of drugs known as cytoprotective (cell-protecting) agents. It has different uses.

It can be used to help reduce the risk of heart damage that can be caused by long-term use of the chemotherapy drug doxorubicin.

It is also used after certain chemotherapy drugs called anthracyclines (doxorubicin, epirubicin, daunorubicin, idarubicin) accidentally leak out of a vein while being given (known as extravasation). This drug can help limit the amount of damage the leaked drug causes to the skin and other nearby body tissues.

How does this drug work?

How dexrazoxane helps protect the heart and other body tissues is not exactly clear. The chemotherapy drugs known as anthracyclines are thought to create substances called free radicals within cells that can damage their internal structures. This can lead to reduced heart function if the total dose of drug over time reaches a certain level. It can also lead to serious damage to the skin and nearby tissues if large amounts of these drugs leak out of a vein in a short amount of time. Dexrazoxane is able to enter cells, and may work by binding to the free radicals and neutralizing them.

Before taking this medicine

Tell your doctor…

  • If you are allergic to any medicines, dyes, additives, or foods.
  • If you have a history of kidney problems. This drug is cleared from the body mainly by the kidneys. Reduced kidney function might result in more drug than expected staying in the body, which could lead to unwanted side effects. Your doctor may need to adjust your dose accordingly.
  • If you have any other medical conditions such as liver disease (including hepatitis), heart disease, congestive heart failure, lung disease, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated, or the drug dose, regimen, or timing may need to be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug should use some kind of birth control during treatment. It is important to check with your doctor about what kinds of birth control can be used with this medicine. This drug should be used during pregnancy only if the potential benefit is thought to justify the potential risk to the fetus.
  • If you are breast-feeding. Although studies are not available, this drug may pass into breast milk and affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
  • If you think you might want to have children in the future. It is not known whether or not this drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Dimethyl sulfoxide (DMSO) is sometimes put on the skin after extravasation, but it should not be used if dexrazoxane will be given. DMSO may make dexrazoxane less effective.

No other serious interactions with other drugs are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Dexrazoxane is given as an injection into a vein (intravenous, or IV). The dose may depend on your body size, the amount of chemotherapy you are getting, and your general health (especially kidney function).

If the drug is being used to help reduce the risk of heart damage, the infusion is started just before giving doxorubicin and is given over several minutes.

If the drug is being used to limit skin and tissue damage after chemotherapy gets out of the vein (extravasation), it is given in 3 daily doses. The first dose is given within 6 hours after the extravasation is noticed. The drug is given in a large vein (away from the area of extravasation) usually over 1 to 2 hours.

Precautions

This drug is always given with chemotherapy that can have serious effects on a person's bone marrow (where new blood cells are made) and other organs. Your doctor will test your blood frequently throughout your treatment, looking for possible effects on blood counts or on blood chemistry levels.

This drug may contribute to lowering your white blood cell count. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5º or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may contribute to lowering your blood platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

While this drug helps reduce the risk of heart damage in most people, it may not work in everyone. Your doctor will test your heart function regularly during treatment to look for any signs of damage. Even after treatment is finished, it is still important to let your doctor know right away if you notice shortness of breath, swollen feet or ankles, or an abnormal heartbeat. These effects can show up months or even years after anthracycline drugs are given.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • lowered white blood cell count with increased risk of infection*
  • lowered blood platelet count with increased risk of bleeding*

Less common

  • pain at injection site
  • nausea
  • changes in lab test values that suggest the drug may be affecting your liver or kidneys. (Your doctor will discuss the importance of this finding, if any.)

Rare

  • none known

*See "Precautions" section for more detailed information.

Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved to prevent heart damage in 1995. (It was approved to treat extravasation in 2007.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 10/23/2009
Last Revised: 10/23/2009