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mitoxantrone (Novantrone)
Chemotherapy Agents
Administration: iv

How it is administered

Mitoxantrone is given as an intravenous (IV) infusion. The medication comes as a concentrated solution that must be diluted before use. It is administered by a healthcare professional, usually over 5 to 15 minutes, directly into a vein. The dose and schedule depend on the condition being treated, such as blood cancers like acute nonlymphocytic leukemia (ANLL).

How it works

Mitoxantrone works by interfering with the DNA in cancer cells. It is a DNA-reactive agent that binds to DNA, causing crosslinks and strand breaks, which disrupts the cell’s ability to replicate and repair itself. It also inhibits an enzyme called topoisomerase II, which is necessary for DNA uncoiling and repair. This action leads to cell death in both actively dividing and resting cells, making it effective against rapidly growing cancer cells as well as some that are not currently dividing. In addition to its effects on cancer cells, mitoxantrone can also suppress the immune system by inhibiting the proliferation of certain immune cells, which is why it is also used in some autoimmune conditions.

Common side effects

  • Nausea and vomiting
  • Hair thinning or loss (alopecia)
  • Infections (due to low white blood cell counts)
  • Menstrual disorders, including missed periods (amenorrhea)
  • Urinary tract infections
  • Stomatitis (mouth sores)
  • Diarrhea or constipation
  • Fatigue
  • Abnormal liver function tests
  • Decreased heart function (rare but serious)
  • Blue-green discoloration of urine (temporary)

Other side effects may include low red blood cell or platelet counts, which can increase the risk of anemia or bleeding.

Who Should take it

Mitoxantrone is used in combination with other approved drugs as initial therapy for adults with acute nonlymphocytic leukemia (ANLL), which includes myelogenous, promyelocytic, monocytic, and erythroid acute leukemias. It may also be used in other settings, such as advanced hormone-refractory prostate cancer (in combination with corticosteroids) and certain forms of multiple sclerosis, but its primary use in blood cancers is for ANLL. Your doctor will determine if mitoxantrone is appropriate based on your specific diagnosis and health status.

Who should not take it

Mitoxantrone should not be used in patients who have had a previous allergic reaction (hypersensitivity) to the drug. It should also be avoided in patients with severe preexisting myelosuppression (low blood counts) unless the benefits outweigh the risks. Patients with severe liver impairment should not receive mitoxantrone, as the drug is cleared more slowly and may accumulate to harmful levels. It is not recommended for use in pregnant women, as it may cause harm to the unborn baby. Patients with significant heart problems or those who have received high cumulative doses of similar drugs should discuss the risks with their doctor.

Commonly used with

For blood cancers like acute nonlymphocytic leukemia, mitoxantrone is commonly used in combination with cytarabine. In other settings, it may be used with corticosteroids such as prednisone or hydrocortisone, especially in prostate cancer or multiple sclerosis. The specific combination depends on the disease being treated.

Commonly tested with

Mitoxantrone has been tested in combination with cytarabine for acute nonlymphocytic leukemia. It has also been studied with corticosteroids (prednisone or hydrocortisone) in prostate cancer and multiple sclerosis. Clinical trials may combine mitoxantrone with other chemotherapy agents or supportive medications to manage side effects or enhance effectiveness.

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