dexrazoxane hydrochloride: clinical use

Prescribing considerations

• Confirm that the patient meets the product-specific licensed indication; this is not routine cardioprotection for every anthracycline recipient.
• Review renal function because reduced clearance increases exposure.
• Consider liver, cardiac and thromboembolic history; evidence is lacking in several significant pre-existing cardiac conditions.
• Discuss additive myelosuppression, possible second primary malignancy and the uncertain contribution to adverse effects when combined with chemotherapy.
• Ensure effective contraception for sexually active men and women.

Contraindications and cautions

• Hypersensitivity to dexrazoxane
• Breastfeeding
• Concomitant yellow fever vaccination
• Children receiving lower cumulative anthracycline exposure, as defined in the product licence

Monitoring

• Full blood count for additive bone-marrow suppression
• Renal function before treatment and as clinically indicated
• Liver function before and during treatment in patients with known hepatic disorders
• Standard cardiac surveillance associated with doxorubicin or epirubicin
• Hypersensitivity, infusion-site reactions and thromboembolism

Clinical pharmacology

Dexrazoxane is a cytotoxic bisdioxopiperazine and catalytic topoisomerase II inhibitor. It distributes mainly in body water, has low protein binding and is substantially eliminated through the kidneys; ring-opened metabolites can chelate metal ions.

Formulation and product differences

• The selected product is a single-use, white to off-white lyophilised powder for intravenous infusion and contains no excipients.
• It requires reconstitution and further dilution by trained staff in a designated cytotoxic preparation area.
• It must not be mixed with other medicines during infusion and should not be handled by pregnant staff.

Solution for infusion

Route: Intravenous

Strengths: 500 mg