Parenteral Manual

MitoXANTRONE

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
NOVANTRONE®
Classification: 
Antitumor antibiotic, (anthracenedione class) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Acute non-lymphocytic leukemia
  • Relapsed acute lymphocytic leukemia
  • Non-Hodgkin's lymphoma

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as a 2 mg/mL solution.
  • Store at room temperature
  • Drug is dark blue in color
  • Diluted solution stable 7 days at room temperature or in the refrigerator
  • DO NOT freeze
Compatibility: 

- Solutions Compatible: D5W, 0.9%, combinations

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: allopurinol, cyclophosphamide, cytarabine, fludarabine, hydrocortisone, KCl, ondansetron, teniposide

INCOMPATIBLE: amphotericin B, heparin, piperacillin/tazobactam, propofol, TPN

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion YES, chemotherapy trained RN only
Usual dilution: in 50-100 mL of IV fluid
Infusion time: > 30 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 12 mg/m2 over 2-3 days Q 3 weeks
  • Decrease dose by 50% if bilirubin is >50 umol/L
  • Children BSA <0.5 m2 should be dosed on a mg/kg basis.  To obtain mg/kg dose, divide mg/m2 dose by 30 (ie 1 m2 = 30 kg).

** Dosage may differ according to protocol

Potential hazards of parenteral administration: 

Immediate (within minutes to hours):

  • Nausea and vomiting (mild to moderate emetogenic potential), diarrhea
  • Hypotension - rare, monitor blood pressure
  • Transient arrhythmias
  • Phlebitis
  • Anaphylaxis (very rare) - shortness of breath, swelling of face, eyelids, lips, tightness in chest
  • Anorexia
  • Non-vesicant - if extravasates, may result in pain or swelling.  Refer to Treatment of Infiltrations, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

Delayed (within days to weeks):

  • Myelosuppression (nadir 9 days)
  • Cardiotoxicity - CHF, monitor cardiac function (ECG, echocardiogram, MUGA, chest X-ray), see lifetime cumulative dose (below)
  • Alopecia
  • Mucositis
  • May impart blue-green coloration to urine, sclera, tears, sweat for 24 hours after administration
  • Transient increases of liver function tests

Late:

  • Congestive heart failure, cardiomyopathy, EKG changes and arrhythmias

 - Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor hematologic parameters, BP, hepatic function, renal function, serum electrolytes
  • Verify whether cardiac function studies are needed prior to administration
  • Cardiotoxicity may be enhanced in patients who have received mediastinal radiotherapy or who have pre-existing cardiac disease or who are receiving high doses of cyclophosphamide (>2 g/m2)
  • Mitoxantrone is contraindicated in impaired cardiac function (see protocol specifics)
  • Total cumulative lifetime dose in children is 160 mg/m2 which is approximately equivalent to 450 mg/m2 of anthracycline (ie. doxorubicin).  (Anthracycline factor is 2.5.)
  • If child receives concomitant radiation to the mediastinum (field of the heart), or is receiving high doses of cyclophosphamide the cumulative lifetime dose should be decreased to 120 mg/m2 which is regarded as equivalent to 360 mg/m2 of anthracycline.
  • Recall dermatitis may occur in previously irradiated areas

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

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