Class:
- Cardioprotective agent (iron-chelating)
- Used primarily to prevent anthracycline-induced cardiotoxicity
Mechanism of Action
- Iron chelation → prevents formation of anthracycline-iron complexes that generate reactive oxygen species (ROS)
- Reduces oxidative damage to cardiac myocytes
- Does not interfere with antitumor efficacy of anthracyclines
Indications
- Primary prevention of cardiotoxicity in patients receiving high cumulative doses of doxorubicin or other anthracyclines
- Treatment of extravasation of anthracyclines (less common use)
Dosing
- Dexrazoxane IV: Administered 10–30 minutes prior to anthracycline infusion
- Dose ratio: Often 10:1 (Dexrazoxane: Doxorubicin)
- Dose adjustment required for renal impairment
- Route: IV
- Metabolism: Rapid hydrolysis to active chelating metabolites
- Excretion: Primarily renal
Adverse Effects
- Hematologic: neutropenia, thrombocytopenia
- GI: nausea, vomiting
- Injection site reactions
- Rare: transient liver enzyme elevations
Pharmacist Considerations
- Timing is critical: must be given before anthracycline to ensure cardioprotection
- Renal dose adjustment needed
- Monitor: CBC, LFTs, cardiac function (echocardiography)
- Patient counseling: may increase myelosuppression; does not reduce efficacy of chemo
High-Yield BPS Pearls
- Used mainly in pediatrics and adults at high cumulative anthracycline exposure
- Protects against irreversible cardiomyopathy
- IV infusion 10–30 minutes before anthracycline is essential for efficacy
- Often considered when doxorubicin cumulative dose approaches 300–400 mg/m²