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
Dexrazoxane hydrochloride is approved to treat severe side effects caused by certain types of chemotherapy. It is used to treat the following:
- Cardiac (heart) side effects caused by doxorubicin hydrochloride in women being treated for metastatic breast cancer. Dexrazoxane hydrochloride helps make the side effects happen less often and makes them less severe when they do occur. It is used only in women who have already received high doses of doxorubicin and continue to be treated with it. This use is approved for the Totect and Zinecard brands of dexrazoxane hydrochloride.
- Extravasation caused by intravenous anthracyclines. Extravasation occurs when injected drugs leak out of the vein, into the surrounding tissue. This can cause redness, pain, and swelling, and may damage the tissue. This use is approved for the Totect brand of dexrazoxane hydrochloride.
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
Synonyms
Totect, Zinecard