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Dexrazoxane: Indications, Dosing, Side Effects and Interactions
Dexrazoxane is an iron chelator.
MedNext Academy | 3 min read
Dexrazoxane: Indications, Dosing, Side Effects and Interactions
Dexrazoxane is an iron chelator.
Drug action
Dexrazoxane is an iron chelator.
Indications and dose
**Prevention of chronic cumulative cardiotoxicity caused by doxorubicin or epirubicin treatment in advanced or metastatic breast cancer patients who have received a prior cumulative dose of 300 mg/m of doxorubicin or a prior cumulative dose of 540 mg/m of epirubicin when further anthracycline treatment is required**
- **Adult** (By Intravenous Infusion): Administer 10 times the doxorubicin-equivalent dose or 10 times the epirubicin-equivalent dose, dose to be given 30 minutes before anthracycline administration.
**Anthracycline extravasation**
- **Adult** (By Intravenous Infusion): Initially 1 g/m 2 daily (max. per dose 2 g) for 2 days, then 500 mg/m 2
Cautions
Myelosuppression (effects may be additive to those of chemotherapy) Cautions For Cardioxane Heart failure-no information available; myocardial infarction in previous 12 months-no information available; symptomatic valvular heart disease-no information available; uncontrolled angina-no information available
Side effects
Common or very common Alopecia; anaemia; appetite decreased; asthenia; constipation; cough; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; embolism and thrombosis; fever; gastrointestinal discomfort; headache; increased risk of infection; leucopenia; myalgia; nail disorder; nausea; neutropenia; peripheral neuropathy; peripheral oedema; post procedural infection; sensation abnormal; skin reactions; stomatitis; syncope; tachycardia; thrombocytopenia; tremor; vaginal haemorrhage; vomiting; weight decreased; wound complications Uncommon Acute myeloid leukaemia; lymphoedema; sepsis; thirst; vertigo Frequency not known Anaphylactic reaction
Interactions
**Severe interactions:**
- Co-administration of doxorubicin (50 to 60 mg/m 2 ) or epirubicin (60 to 100 mg/m 2 ) did not affect dexrazoxane pharmacokinetics significantly.
**Other interactions (9):**
- Use an inactivated vaccine where this exists (poliomyelitis).
- Dexrazoxane is not recommended in combination with phenytoin.
- Concomitant use to assess carefully: Ciclosporin, tacrolimus: Excessive immunosuppression with risk of lymphoproliferative disease.
- Interactions common to all cytotoxics: Due to an increased thrombotic risk in patients with malignant diseases, the use of anticoagulants treatment is frequent.
- Patients treated with anticoagulants should be monitored more frequently as cytotoxic agents may interact with oral anticoagulants.
- Interaction specific to dexrazoxane: When tested in five major cytochrome P450 isoenzymes CYP1A, CYP2C9, CYP2C19, CYP2D6 and CYP3A4, none of these were inhibited by dexrazoxane.
Pregnancy
Avoid unless essential (toxicity in animal studies).
Breast feeding
Discontinue breast-feeding.
Hepatic impairment
For Cardioxane Manufacturer advises caution (no information available). Dose adjustments Manufacturer advises if anthracycline dose is reduced, reduce the Cardioxane dose by a similar ratio. Hepatic impairment For Savene Manufacturer advises avoid (no information available).
Renal impairment
Dose adjustments Reduce dose by 50% if creatinine clearance less than 40 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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