Mitoxantrone Brand Name– Novantrone
What is Mitoxantrone
Mitoxantrone is a parenteral, synthetic antineoplastic agent. Chemically, it is an anthracenedione and is structurally similar to the anthracyclines, doxorubicin, daunorubicin and idarubicin.
Mitoxantrone is sometimes substituted for doxorubicin or daunorubicin because it has considerably less cardiotoxicity and mitoxantrone is not a vesicant as are the other anthracyclines.
Mitoxantrone is indicated for the treatment of acute myelogenous leukemia in combination with other chemotherapy agents such as cytarabine. Response rates with this combination range 50—70%.
Mitoxantrone is also active in other hematologic malignancies such as acute lymphocytic leukemia, chronic myelogenous leukemia, non-Hodgkin’s lymphoma and pediatric leukemias.
Mitoxantrone in combination with corticosteroids is indicated for the treatment of pain related to advanced, hormone-refractory prostate cancer.
Mitoxantrone is active in various solid tumors including breast cancer, ovarian cancer, and various sarcomas.
Mitoxantrone is not active in non-small cell lung, gastric, and advanced bladder cancers, malignant mesothelioma, germ cell tumors or Kaposi’s sarcoma. The FDA initially approved mitoxantrone in 1987.
In October 2000, the FDA approved the use of mitoxantrone to slow the worsening of neurologic disability and to reduce relapse rate in patients with clinically worsening forms of relapsing-remitting and secondary progressive multiple sclerosis.
Indications
- acute lymphocytic leukemia (ALL)
- acute myelogenous leukemia (AML)
- breast cancer
- chronic lymphocytic leukemia (CLL)
- hepatocellular cancer
- multiple sclerosis
- non-Hodgkin’s lymphoma (NHL)
- pleural effusion
- prostate cancer
- stem cell transplant preparation
For the treatment of acute myelogenous leukemia (AML)
NOTE: Mitoxantrone has been designated an orphan drug by the FDA for this indication.
NOTE: If used, consolidation therapy is recommended to be withheld until full hematologic recovery occurs.
Side Effects
- abdominal pain
- alopecia
- amenorrhea
- anaphylactoid reactions
- anemia
- anorexia
- anxiety
- arthralgia
- back pain
- bleeding
- bone marrow suppression
- cardiomyopathy
- chest pain (unspecified)
- chills
- conjunctivitis
- constipation
- cough
- dehydration
- depression
- diarrhea
- dyspnea
- ecchymosis
- edema
- elevated hepatic enzymes
- erythema
- fatigue
- fever
- GI bleeding
- headache
- heart failure
- hematuria
- hyperglycemia
- hyperhidrosis
- hyperuricemia
- hypocalcemia
- hypokalemia
- hyponatremia
- hypotension
- impotence (erectile dysfunction)
- infection
- infertility
- injection site reaction
- intracranial bleeding
- jaundice
- leukopenia
- libido decrease
- lymphopenia
- malaise
- myalgia
- nausea
- neutropenia
- neutropenia
- new primary malignancy
- onycholysis
- pancytopenia
- petechiae
- phlebitis
- pneumonitis
- proteinuria
- pulmonary edema
- rash
- renal failure (unspecified)
- seizures
- sinus tachycardia
- sinusitis
- skin discoloration
- skin ulcer
- stomatitis
- thrombocytopenia
- tissue necrosis
- tumor lysis syndrome (TLS)
- urine discoloration
- urticaria
- vomiting
- weight loss
Monitoring Parameters
- CBC with differential
- chest x-ray
- ECG
- echocardiogram
- ejection fraction
- LDH
- LFTs
- multi-gated radionuclide angiography (MUGA)
- pregnancy testing
- serum bilirubin (total and direct)
- serum uric acid
Contraindications
- accidental exposure
- bone marrow suppression
- breast-feeding
- cardiac disease
- cardiotoxicity
- coagulopathy
- dental disease
- dental work
- extravasation
- fungal infection
- heart failure
- hepatic disease
- herpes infection
- hyperkalemia
- hyperphosphatemia
- hyperuricemia
- hypocalcemia
- intraarterial administration
- intramuscular administration
- intramuscular injections
- intrathecal administration
- jaundice
- maximum cumulative lifetime dose
- neutropenia
- new primary malignancy
- ocular exposure
- pregnancy
- radiation therapy
- requires an experienced clinician
- subcutaneous administration
- thrombocytopenia
- tumor lysis syndrome (TLS)
- vaccination
- varicella
- ventricular dysfunction
- viral infection
Interactions
- Acalabrutinib
- Alpha interferons
- Amlodipine; Celecoxib
- Antithymocyte Globulin
- Azelastine; Fluticasone
- Beclomethasone
- Betamethasone
- Budesonide
- Budesonide; Formoterol
- Carbamazepine
- Celecoxib
- Ciclesonide
- Ciprofloxacin
- Clozapine
- Corticosteroids
- Cortisone
- Cyclosporine
- Cytarabine, ARA-C
- Daclatasvir
- Deflazacort
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Echinacea
- Elbasvir; Grazoprevir
- Eltrombopag
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Febuxostat
- Fenoprofen
- Fludrocortisone
- Flunisolide
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fostamatinib
- Glecaprevir; Pibrentasvir
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Itraconazole
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Leflunomide
- Live Vaccines
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methylprednisolone
- Mometasone
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Natalizumab
- Nonsteroidal antiinflammatory drugs
- Ocrelizumab
- Osimertinib
- Oxaprozin
- Ozanimod
- Palifermin
- Pegfilgrastim
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Penicillamine
- Piroxicam
- Ponatinib
- Prednisolone
- Prednisone
- Rofecoxib
- Safinamide
- Simeprevir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Sulindac
- Teriflunomide
- Tolmetin
- Triamcinolone
- Tuberculin Purified Protein Derivative, PPD
- Valdecoxib
