dexrazoxane: clinical use

Prescribing considerations

• Confirm that the extravasated agent is an anthracycline; dexrazoxane is not expected to protect against other vesicants leaking through the same access.
• Treat as a time-critical oncology emergency under a clinician experienced with anticancer medicines.
• Renal impairment increases systemic exposure; consult the product-specific SmPC and monitor closely for haematological toxicity.
• Use is not recommended in hepatic impairment or older people because supporting evidence is limited.
• The solvent has clinically relevant sodium and potassium content, particularly for patients with renal impairment, hyperkalaemia risk or restricted intake.

Contraindications and cautions

• Hypersensitivity to dexrazoxane or formulation excipients
• Childbearing potential without effective contraception
• Breastfeeding
• Concurrent yellow fever vaccination

Monitoring

• Regular local assessment until the extravasation injury resolves
• Full blood count because myelosuppression may add to chemotherapy toxicity
• Liver function, especially where hepatic dysfunction is known
• Renal function and signs of enhanced haematological toxicity
• Potassium in patients at risk of hyperkalaemia
• Clinical observation for anaphylaxis and other hypersensitivity reactions

Clinical pharmacology

Dexrazoxane is intracellularly hydrolysed to ring-opened metabolites, including an EDTA-like iron chelator, and also inhibits topoisomerase II. Distribution is rapid, protein binding is low, and renal elimination of unchanged dexrazoxane is clinically important.

Formulation and product differences

• The selected product is supplied as an emergency kit containing powder vials and bottles of dedicated solvent.
• The powder is reconstituted with the supplied solvent and then diluted further before intravenous infusion.
• The powder contains no excipients; the solvent contains sodium, potassium and other electrolytes.
• Preparation requires cytotoxic handling precautions. Pregnant staff should not handle it.

Solution for infusion

Route: Intravenous

Strengths: 20 mg/mL