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Mitoxantrone

(my-toe-zan-trone)

Trade/other name(s): Novantrone, DHAD, DHAQ

Why would this drug be used?

Mitoxantrone is used to treat leukemia and prostate cancer, and as well as other conditions.

How does this drug work?

Mitoxantrone is part of a general group of chemotherapy drugs known as antibiotics. It stops the growth of cancer cells, which are then destroyed.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as heart disease, congestive heart failure or other heart problems, low blood cell counts, gout, liver disease (including hepatitis), or infections. These conditions may require extra testing or that your medicine dose, regimen, or timing be changed.
  • If you have multiple sclerosis. You may need extra testing on your heart before, during, and after treatment.
  • If you have ever been treated for cancer with daunorubicin, doxorubicin, epirubicin, idarubicin (types of chemotherapy), or other medicines that might affect the heart (including mitoxantrone). This could worsen your risk of heart damage.
  • If you have ever had radiation treatment to your chest. This may increase your risk of heart damage.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects 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 need to use some kind of birth control. It is important to check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. This drug is known to pass into breast milk and may harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. 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

No serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, 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 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?

Mitoxantrone is given by a shot in the vein (IV) over 5 to 20 minutes, daily for 3 days, or once every 3 weeks. You will be given a mild anti-nausea medicine before the mitoxantrone. The dose and how often you get the medicine depends upon your size, your blood counts, how well your liver is working, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed. This medicine may be given along with other anti-cancer medicines.

Precautions

Mitoxantrone can cause an allergic reaction with symptoms such as itching, dizziness, shortness of breath, and hives (welts). Tell your nurse right away if you notice any of these symptoms.

Mitoxantrone can cause damage to the skin and tissues if it gets out of the vein. Tell your doctor or nurse right away if you have burning, pain, swelling, redness or other symptoms at or near the IV while you are getting the drug.

Mitoxantrone turns the urine blue/green for about 24 to 48 hours before it returns to its normal color. Rarely, the whites of the eyes may turn light blue for a few days.

Do not get any immunizations (vaccinations), either during or after treatment with this drug, without your doctor’s OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. 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 (100.5° or higher), chills, pain when passing urine, a new cough, sore throat, or bringing up sputum.

This drug may lower your 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.

This drug can raise the blood level of uric acid (hyperuricemia), which can worsen gout and cause serious kidney damage. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids during treatment to help prevent this.

Mitoxantrone can damage the heart muscle during treatment, or even many years after treatment. Your doctor will test your heart function before you receive your first treatment, during treatment, and sometimes even after treatment is finished. This way, any damage can be found early. If you notice problems such as shortness of breath, fast heartbeat, chest pain, pounding in your chest, or swelling in the feet or ankles, call your doctor right away.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Possible side effects

Most of the following side effects probably will not occur. Your doctor or nurse will want to discuss specific care instructions with you. They can help you understand these side effects and help you deal with them.

Common

  • Decreased white blood cell count with increased risk of infection*
  • Nausea
  • Vomiting
  • Stomach pain
  • Headache
  • Sores in your mouth or on lips
  • Irregular menstrual periods or no menstrual periods
  • Weakness or tiredness (fatigue)
  • Blue-green urine for the first day or so after taking the drug*

Less common

  • Thinning hair or hair loss (body and facial hair as well as scalp hair)
  • Poor appetite
  • Fetal damage if pregnancy occurs while receiving this drug
  • Fever, cough, or sore throat due to infection*

Rare

  • Decreased platelet count with increased risk of bleeding*
  • Heavy menstrual bleeding
  • Loss of menstrual periods
  • Allergic reaction with hives, difficulty breathing, itching, or dizziness*
  • Heart damage with shortness of breath, fast heartbeat, chest pain, or swelling in the feet or ankles*
  • Second type of cancer that may occur years after treatment*

*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 in 1987.

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: 04/20/2012
Last Revised: 04/20/2012