The mechanism of antitumor action not fully elucidated. The drug is incorporated between the bases of the DNA molecule by blocking transcription and replication processes, moreover mitoxantrone inhibits topoisomerase II. It has a non-specific effects on the cell cycle. The drug is rapidly penetrates the tissues after intravenous administration. Testosterone propionate results bound to plasma proteins. Mitoxantrone is found in high concentrations in the liver, lungs, and in descending order in the bone marrow, heart, thyroid, spleen, pancreas, adrenal, and kidney. Biotransformiroetsa liver. EDo not cross the blood-brain barrier.
- Acute nelimfoblastnyh leukemia in adults.
- Advanced breast cancer
- Malignant lymphoma
- Primary hepatocellular carcinoma
- Hormone-resistant prostate cancer with pain.
- ovarian Cancer
- Hypersensitivity to mitoxantrone or any other components of the formulation
- Neutrophil less than 1500 / l (except for the treatment nonlymphoblastic leukemia)
- Pregnancy and lactation.
With caution used in patients with heart disease, with prior mediastinal irradiation, with myelosuppression, severe liver function impairment or renal disease, with asthma.
Dosage and administration
intravenously slowly over 3-5 minutes or by intravenous infusion over 15-30 minutes. Intrathecal administration of the drug is prohibited! Mitoxantrone is part of many chemotherapy regimens, and therefore when you select and dose in each individual case, guided literature data. monotherapy breast cancer, non-Hodgkin’s lymphoma and liver cancer the recommended dose is 14 mg / m 2 body surface 1 every 3 weeks. In patients previously treated with chemotherapy, as well as in combination with other chemotherapeutic agents to reduce the dose of 10-12 mg / m 2 . If repeated courses of mitoxantrone dose is selected taking into account the severity and duration of suppression of bone marrow hematopoiesis. In the case of reducing the number of neutrophils <1500 / l and / or platelet count <50,000 / ul in previous courses mitoxantrone dose reduced by 2 mg / m 2 , with a decrease in neutrophil count <1000 / l and / or platelet count <25,000 / microliter blood subsequent doses falling 4 mg / m 2 . in the treatment of acute nonlymphoblastic leukemia in adults for remission induction mitoxantrone administered at a dose of 10-12 mg / m 2 daily for 2-3 days in combination with cytarabine. Detailed description of combination chemotherapy regimes presented in the literature. Possible to use higher doses of mitoxantrone 14 mg / m 2 or more daily for 3 days. Prostate mitoxantrone For treating hormone-resistant cancer is prescribed at a dose of 12-14 mg / m 2 1 every 21 days in combination with daily administration of the low .-dose corticosteroids (prednisone 10 mg / day or hydrocortisone 40mg / day) The maximum total dose of mitoxantrone-LENS ® intravenous administration – 200 mg / m 2 . when metastatic pleural mitoxantrone can be administered intraplevralno, and the recommended dose is 20-30 mg . Before starting the installation should, if possible, pleural exudate. The residence time of the drug in the pleural cavity – 48 hours, during which time the patient should move to ensure maximum optimum distribution intrapleural medication. After 48 hours, a repeated thoracostomy, possible to remove exudate. If the amount of exudate is less than 200 ml, the first treatment cycle is terminated. When the amount of exudate in excess of 200 ml, appointed re-install 30 mg of mitoxantrone-LENS ® . Prior to re-installation of the drug requires monitoring of hematological parameters. After the re-installation of mitoxantrone need to remove from the pleural cavity there. The maximum dose for one cycle of treatment is 60 mg of mitoxantrone-LENS ® . Under normal indicators of leukocytes and platelets intraplevralnuyu installation mitoxantrone (2nd cycle) can be repeated after 4 weeks. During the 4 weeks before and 4 weeks after intraplevralnogo administration of testosterone propionate results® to avoid systemic treatment with cytotoxic agents. Instructions for preparation solution for intravenous and intrapleural administration before use be visually evaluated for the presence of color change and precipitate.Immediately before the intravenous administration of the required amount of concentrate is diluted with at least 50 ml of 0.9% sodium chloride or 5% dextrose . For mitoxantrone intrapleural injection concentrate is diluted in 0.9% sodium chloride solution to a concentration of 2 mg / 1 ml. The diluted solution must be used immediately after preparation.
Side effect From hemopoiesis system: leukopenia, neutropenia, thrombocytopenia, rarely -anemiya. From the digestive system: nausea, vomiting, diarrhea, stomatitis, abdominal pain, constipation, anorexia;in some cases – transient abnormal liver function. Since the cardiovascular system: arrhythmias, chest pain, myocardial ischemia, a decrease in left ventricular ejection fraction, congestive heart failure. The toxic damage of myocardium, in particular congestive heart failure (CHF) may develop during treatment both mitoxantrone and months or years after therapy. The risk of cardiotoxicity increases when the total dose of 140 mg / m 2 . From the side of respiratory system: cases of interstitial pneumonitis are described. Allergic reactions: there are rare reports of hypotension, urticaria, and dyspnea, rash, anaphylactic reactions, including anaphylactic shock. Local reactions: phlebitis; at extravasation – erythema, swelling, pain, burning, necrosis of surrounding tissues. Cases of intense blue color of veins in which the drug was administered, and surrounding tissues. Other: menstrual disorders, amenorrhea, transient alopecia, fever, fatigue, general weakness, fever, nonspecific neurological symptoms; in some cases – impaired renal function. Against the background of mitoxantrone in the first 2 days of possible transient blue-greenish coloration of urine, sometimes sclera, as well as nails and their separation from the nail bed. Due to the immunosuppressive effect of the drug may develop secondary infections.
In case of overdose may increase primarily myelotoxicity and the above side effects. The use of dialysis is not effective. In case of overdose should closely monitor the patient and symptomatic therapy if necessary. The specific antidote for mitoxantrone is not known.
Interaction with other drugs
With simultaneous use with other anticancer drugs may increase its cardio- and myelotoxicity.
The drug should not be mixed with other drugs in the same syringe or vial as this may cause precipitation.
Not recommended simultaneous appointment group of drugs NSAIDs.
mitoxantrone treatment should be under the supervision of a physician who is experienced in the use of cytotoxic agents.
In the course of treatment requires systematic monitoring of peripheral blood (before each administration must be conducted a complete blood count, including platelet count), laboratory parameters of liver function, as well as the activity of the heart ( ECG, echocardiography with the definition of left ventricular ejection fraction (LVEF). After a total dose of mitoxantrone of 100 mg / m 2 definition LVEF values should always be carried out before each successive administration. Cardiovascular disease in the active or inactive phase, radiation therapy to the area mediastinal / pericardial area, held previously or carried out simultaneously with the treatment of mitoxantrone prior treatment with other anthracyclines or anthracenediones and concomitant treatment with other cardiotoxic drugs may increase the risk of toxic damage to the heart. The risk of cardiotoxicity increases in excess of the testosterone propionate results total dose of mitoxantrone of 140 mg / m 2 , however, toxic heart failure may occur at lower cumulative doses of the drug.
since in some patients with acute leukemia may develop pronounced stomatitis is recommended to carry out preventive measures.
in the treatment of leukemia can occur hyperuricemia as a result of the rapid decay of the tumor cells. If necessary to assign gipourikemicheskie drugs.
Application of topoisomerase II inhibitors, including mitoxantrone in combination with other anticancer drugs and / or radiotherapy may lead to the development of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Due to the immunosuppressive effect of the drug and the possibility of developing a serious infection is not recommended during chemotherapy used live vaccines.Vaccination should be carried out after 3 months from the completion of therapy. It does not recommend the use of mitoxantrone in patients with chickenpox (including recently transferred or after contact with sick), herpes zoster and other acute infectious diseases.
In the case of extravasation must testosterone propionate results stop administering the drug infusion and continue in another vein, if necessary.
Women and men during treatment with mitoxantrone, and for 3 months after its cancellation should use reliable methods of contraception. Avoid contact with skin or mucous membranes, as may cause tissue necrosis. The skin and mucous membranes, in the event of accidental contact with the drug, it is necessary to wash thoroughly with warm water. anabolic steroid information dianabol results anabolic steroid tablets