Parenteral Manual

Dexrazoxane (NON-FORMULARY)

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): 
ZINECARD
Classification: 
Cardioprotective agent - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
December 2023
Indications: 
  • To prevent or reduce the incidence and severity of cardiotoxicity of doxorubicin or other anthracyclines

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: 
  • Prepare in biohazard hood
  • Reconstitute 500 mg vial of powder with 50 mL sterile water for injection and 250 mg vial with 25 mL of sterile water for injection to yield a 10 mg/mL solution
  • Vials are stable for 30 minutes at room temperature
  • Further dilution with Lactated Ringer's is required to achieve a final concentration of 1.3 to 3mg/mL.
  • The infusion solution is stable for 1 hour at room temperature or if storage is necessary, up to 4 hours when stored under refrigeration
Compatibility: 

- Solutions Compatible: Lactated Ringer's

- Incompatible with other medications and solutions including 0.9% Sodium Chloride

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,

Usual dilution: 1.3 - 3 mg/mL with Lactated Ringer's

Infusion Time:15 - 30 minutes
IV Continuous Infusion NO
Dosage: 

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

  • Ten times the dose of doxorubicin, i.e. if doxorubicin dose is 30 mg/m2, dexrazoxane dose is 300 mg/m2
  • For other anthracyclines, calculate the equivalent cardiotoxic dose of doxorubicin and multiply by 10 for dexrazoxane dose
  • Dosage may differ according to protocol
  • Dosage in renal dysfunction (CrCl<40 mL/min):  recommended dosage ratio is 5:1 (example:  if doxorubicin dose is 30 mg/ m2,   dexrazoxane dose is 150 mg/m2
Potential hazards of parenteral administration: 
  • Pain at injection site (use central line)
  • Mild myelosuppression
  • NOT A VESICANT

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

Notes: 
  • Must be given within 30 minutes of anthracyline infusion
  • Cardioprotective effect of dexrazoxane is less with mitoxantrone
  • No known dosage modifications for hepatic insufficiency
References: 

Zinecard Product Monograph. Pfizer Canada. Revised 30 March 2015.

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