Dexrazoxane (Intravenous Route)

Dexrazoxane is used to prevent cardiotoxic side-effects, drug-induced cardiomyopathy and extravasation injuries following intravenous chemotherapy treatment.

Overview

Although cancer medications can be effective in killing cancer cells, they can be extremely harmful to other parts of the body. As many chemotherapy drugs are highly toxic, patients may require additional treatments to prevent damage occurring to other organs.

When patients are given chemotherapeutic drugs for the treatment of cancer, there may a risk of toxic side-effects occurring. This is of particular concern when patients are treated with anthracyclines. If drug-induced cardiomyopathy occurs, the patient’s heart muscle may be damaged and, as a result, it may become enlarged. As well as being a life-threatening condition, cardiomyopathy can cause patients to experience various symptoms, including fatigue and shortness of breath.

Due to the seriousness of drug-induced cardiomyopathy, it’s essential that physicians administer further treatment to prevent this from occurring or to lessen the severity of the condition.

When Dexrazoxane is administered, it bonds to iron, reducing the number of metal ions in the patient’s system and decreases the formation of superoxide radicals. As iron-mediated free radicals are associated with the onset of drug-induced cardiomyopathy, reducing the number of these radicals in the body can greatly reduce the risk of patients developing the condition.

Furthermore, Dexrazoxane may be used to treat patients if chemotherapy drugs have damaged bodily tissues. When chemotherapeutic drugs are administered intravenously, they should be delivered directly into the patient’s veins via a needle. Due to the toxicity of these drugs, patients can suffer serious adverse effects if the medication is allowed to leak onto surrounding tissue.

By administering Dexrazoxane to patients who are suffering from tissue damage caused by the leaking of chemotherapy agents, physicians can help to prevent further damage from occurring and can potentially prevent the surrounding tissue from necrotizing.

Conditions Treated:

  • Drug-induced cardiomyopathy
  • Tissue damage caused by leaking chemotherapy medications

Type of Medicine:

  • Cardioprotective agent
  • Antimitotic agent

Side effects:

After Dexrazoxane has been administered, patients may experience some adverse effects. The following side-effects are not particularly uncommon after patients are treated with this medication and usually subside once the patient becomes accustomed to the medicine:

  • Weight loss
  • Diarrhea
  • Vomiting
  • Difficulty having a bowel movement (stool)
  • Trouble sleeping
  • Discouragement
  • Trouble concentrating
  • Dizziness
  • Feeling empty or sad
  • Stomach pain
  • Thinning of hair or hair loss
  • Loss of pleasure or interest
  • Nausea
  • Headache
  • Muscle spasms, pain, stiffness or cramps
  • Irritability
  • Loss or lack of appetite

Although the side-effects listed above do not tend to cause the patient serious problems, patients should always seek medical help if they are concerned about the presence of any side-effects.

The following side-effects, in particular, do require medical help and patients should contact their doctor as soon as possible if they experience any of the following:

  • Pain in chest
  • Bluish color
  • Cold feet and hands
  • Changes to skin color
  • Hoarseness or cough
  • Labored or difficult breathing
  • Chills or fever
  • Pain in lower back or side
  • Swelling, redness or pain in leg or arm
  • Difficulty urinating
  • Pale skin
  • Painful urination
  • Shortness of breath
  • Wheezing
  • Sneezing
  • Chest tightness
  • Sore throat
  • Tenderness
  • Swelling of ankles, hands, lower legs or feet
  • Trouble breathing
  • Tarry, black stools
  • Unusual bruising or bleeding
  • Pain at site of injection
  • Chest discomfort
  • White spots, sores or ulcers in mouth
  • Unusual weakness or tiredness
  • Pounding, irregular or fast heartbeat

It is important that patients seek medical help if they begin to exhibit any of the side-effects listed above. Whilst patients may contact their doctor regarding their side effects, they should also request emergency assistance or visit their nearest emergency room if any of their side effects appear to be life-threatening or extremely serious.

A fast heartbeat, trouble breathing or pain and inflammation at the injection site may require emergency attention, for example, and patients shouldn’t hesitate to seek help if they need it.

Dosage:

When physicians prescribe Dexrazoxane to prevent or reduce drug-induced cardiomyopathy, the patient’s dose will depend on various factors. Typically, the appropriate dose of Dexrazoxane will depend on how much chemotherapy medication the patient is also receiving. As Dexrazoxane is often administered before a chemotherapy agent, physicians will base the dose of Dexrazoxane on the amount of medication the patient is about to receive.

In addition to this, the patient’s clinical presentation and medical history will be taken into account when Dexrazoxane is prescribed. If patients are exhibiting signs of renal impairment, for example, the dose of Dexrazoxane may be substantially reduced.

If patients are given Dexrazoxane to treat tissue damage caused by intravenous chemotherapy, treatment normally occurs over a three day period. Ideally, Dexrazoxane should be administered as soon as possible after the tissue damage has occurred. In order to be effective, Dexrazoxane needs to be given within six hours of the tissue damage occurring.

Generally, patients are prescribed 1000mg of Dexrazoxane per meter of body mass area on the first and second days of treatment, with 500mg per meter of body mass area being given on the third day. If necessary, doctors may prescribe a larger dose of Dexrazoxane but the maximum given is usually 2000mg on the first two days of treatment, followed by 1000mg on the third day of treatment.

If cooling packs have been used on the affected area, they should be removed at least 15 minutes before treatment with Dexrazoxane commences. Normally administered over a period of one or two hours, Dexrazoxane should be given intravenously into a vein which is not in the area or extremity affected by the tissue damage.

If possible, treatment on the second and third day should be administered at the same time as on the first day.

As patients are given Dexrazoxane intravenously, they will receive this medication in a hospital or clinical setting. They will not, therefore, be required to calculate the appropriate dose of Dexrazoxane or administer the medication themselves.

Potential Drug Interactions:

Generally, Dexrazoxane is not administered at the same time as the following medications:

  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin

However, if doctors believe that both medications will benefit the patient, they may alter the respective doses so that both drugs can be administered.

Warnings:

If patients have existing medical problems, it may affect how Dexrazoxane works in their body. If patients have kidney problems, for example, the effects of Dexrazoxane may be increased. As kidney disease prevents the medicine from being removed from the body at normal speed, lower doses of Dexrazoxane may be given.

In addition to this, Dexrazoxane may make some blood disorders and bleeding problems worse. Due to this, patients may be treated with an alternative medication if they have been diagnosed with conditions, such as leukopenia, thrombocytopenia and/or neutropenia.

Before undergoing treatment, patients should discuss their medical history with their physician so that they are given an appropriate amount of Dexrazoxane.

Studies have shown that Dexrazoxane can cause harm to an unborn fetus if it is administered to a pregnant patient. Due to this, pregnant patients should only be treated with Dexrazoxane if they understand the risks associated with the medication. Although doctors would not usually prescribe Dexrazoxane to pregnant patients, it may be appropriate to do so if the patient is at risk of a life-threatening situation or serious illness.

When receiving treatment with Dexrazoxane, patients should use effective forms of birth control to avoid pregnancy occurring. If patients do become pregnant whilst receiving treatment with Dexrazoxane, they should contact their doctor for medical advice.

Generally, patients are advised to stop breastfeeding if they are undergoing treatment with Dexrazoxane. Although the risks to the child are undetermined, there is a potential risk to the infant if patients breastfeed after being treated with Dexrazoxane. Patients should discuss the possible risks with their doctor before breastfeeding if they are currently being treated with Dexrazoxane or if they have been treated with Dexrazoxane recently.

Dexrazoxane can lower the number of white blood cells in the patient’s blood and this can increase their chances of contracting an infection. To try and avoid developing an infection, patients should wash their hands thoroughly at regular intervals, avoid people who they know are unwell and avoid busy or crowded environments.

If patients suspect that they have developed an infection or contracted a virus, they should seek medical help immediately.

Dexrazoxane can also lower the number of platelets in the patient’s blood and this may affect the blood clotting process. When receiving treatment, patients may notice that they bleed or bruise more easily. Due to this, patients should take extra care to avoid suffering cuts and lacerations. Patients should be particularly careful when brushing their teeth or flossing so that they avoid bleeding gums.

If patients are treated by any healthcare practitioners, they should inform them that they are being treated with Dexrazoxane.

Patients who have any known allergies should discuss them with their doctor prior to receiving treatment. Occasionally, patients may develop an allergic reaction to Dexrazoxane and, in such cases, it should be treated as a medical emergency. Signs of an allergic reaction may include trouble breathing, wheezing, skin rashes and/or swelling of the throat, lips and face.

Storage

In most cases, Dexrazoxane is supplied in single-use vials and these should be stored at a temperature of approximately 25°C (77°F). Alternatively, storing Dexrazoxane at a temperature between 15-30°C (59-86°F) should suffice.

However, patients will not be required to store this medication at home. Dexrazoxane is only usually administered in a hospital or clinic and qualified healthcare practitioners will, therefore, handle the storage, preparation and administration of this medication.

Summary

Although chemotherapy medications are life-saving for many patients, they are certain risks associated with many chemotherapy drugs. Whilst these medicines may increase the patient’s risk of developing additional health problems, the benefits of using the drug tend to vastly outweigh the possible risks.

By using medications, such as Dexrazoxane, physicians can help to reduce the risk of complications occurring when the patient is treated with chemotherapy. Due to this, drug-induced cardiomyopathy is now less common in patients who have undergone chemotherapy.

Furthermore, Dexrazoxane can effectively treat patients who are suffering from tissue damage as a result of chemotherapy drugs leaking from their blood vessel into surrounding tissue. With both issues presenting serious health problems for patients, Dexrazoxane has revolutionized treatment for chemotherapy patients and greatly reduced the risks associated with cancer treatments.

 

Resources
Last Reviewed:
February 01, 2018
Last Updated:
January 27, 2018