Mitoxantrone
Mechanism :
It is an anthracycline. Replication is decreased by binding to DNA topoisomerase II and seems to inhibit the incorporation of uridine into RNA and thymidine into DNA.
Indication :
- Initial treatment of acute non-lymphocytic leukemia
- Secondary progressive or relapsing-remitting multiple sclerosis (MS)
- Off-label:
- Acute lymphocytic leukemia (ALL)
- Autologous hematopoietic stem cell transplantation (HSCT) (conditioning regimen)
- Breast cancer (metastatic)
- Hodgkin lymphoma (refractory)
- Non-Hodgkin lymphomas (NHL)
- Pediatric acute myelogenous leukemia (AML)
- Pediatric acute promyelocytic leukemia (APL)
- Relapsed acute myeloid leukemia (AML)
Contraindications :
Hypersensitivity to mitoxantrone or any component of the formulation.
Dosing :
Acute myeloid leukemia (AML) consolidation phase (second course), acute promyelocytic leukemia (APL) consolidation phase (second course):
10 mg/m² IV once daily for 5 days.
Adverse Effect :
Nausea, alopecia, UTI, amenorrhea, diarrhea, stomatitis, constipation, headache, back pain, cardiotoxicity, myelosuppression, decreased left ventricular ejection fraction, hepatotoxicity, and abnormal transaminases.
Interaction :
Clozapine: Myelosuppressive Agents may enhance the adverse/toxic effect of Clozapine.
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide.
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of live vaccines.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Not dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
Mitoxantrone clearance is reduced in patients with hepatic impairment, so a lower dose is advised. Patients with multiple sclerosis should not receive mitoxantrone.