Mitoxantrone (Novantrone )  

Brand name: Ovantrone ^® 

Generic name:Mitoxantrone  

Other names: DHAD, Mitoxantrone hydrochloride 

Therapeutic Class: antitumor antibiotic 

Availability: Mitoxantrone is available by prescription only  

Indications : Mitoxantrone is, often in combination with other antineoplastic drugs, used to treat various cancers, mainly: 

• liver cancer 
• breast cancer 
• non-Hodgkin's lymphoma (cancer of lymph cells) 
• some types of leukemia (cancer of white blood cells)  
• Advanced hormone-resistant prostate cancer, in combination with low doses of oral corticosteroids.   

Mitoxantrone is also used to treat Multiple sclerosis (MS). In addition to the conditions mentioned in the article, Mitoxantrone can be prescribed for other health problems. Talk to your doctor or pharmacist for more information.  

Dosage form: Mitoxantrone is given by injection into a vein  

Dosage: Mitoxantrone is used in the treatment of a variety of diseases. The recommended dosage varies from one patient to another and the condition being treated. However, If you are taking other drugs, you may receive a lower dose. In addition, your body's reaction to the drug can require your oncologist to modify the dosage. Based on these criteria, your oncologist will recommend the dosage most capable of combating the cancer. It is very important that you complete as indicated by your health care provider or pharmacist; misusing of Mitoxantrone can cause serious health problems.  

Usually, Mitoxantrone is injected into a vein through an intravenous site on the skin. In the treatment of multiple sclerosis (MS), Mitoxantrone is administered once every 3 months for 2 to 3 years; the total doses are usually 8 to 12. When Mitoxantrone is used to treat prostate cancer, the drug is given once every 21 days. In the case of leukemia and other cancers, your doctor will recommend a dosage based on your condition and how your body reacts to the therapy.  

Mitoxantrone should be administered under the supervision of an oncologist or a physician having experience in chemotherapy medications. The medication must be administered with care, in a hospital or health center that has equipment available for its preparation and administration. 

Overdose:  As with any drug, Mitoxantrone overdose can be dangerous. Even at normal dose, Mitoxantrone can severely damage the bone marrow, and cause a decrease in white blood cells and platelets. Mitoxantrone may also cause kidney damage and /or serious heart problems, even years after the treatment has ended. In fragile patients, Mitoxantrone can lead to death. Although rare, Mitoxantrone increase the risk for developing leukemia in some patients. The risk is higher when the drug is taken in high dose or in combination with other chemotherapy medications.  

Those adverse effects vary from one patient to another; no physician can tell how your body is going to react to Mitoxantrone. Therefore, to reduce the risk of complications, avoid anything that might weaken your immune system and the risk of infection. During the treatment, keep all appointments with your doctor. Contact your doctor immediately if you experience any symptom that indicates complications (see side effects below).  

Missing dose: the fact that Mitoxantrone is given in hospital, it is basically difficult for you to miss any dose if you are present in the hospital for the treatment. Therefore, it is very important to keep all appointments with your doctor . If for some reasons you cannot go to the hospital, contact your oncologist before the date scheduled for the therapy.    

Contraindication : Mitoxantrone is contraindicated in the following conditions : 

• allergy to Mitoxantrone or any of its ingredients  
• allergy to anthracyclines  
• reduced blood cells count 
• severe heart disorder 
• pregnancy/breastfeeding  
• severe liver disorder  
• having a very poor health  
• Past or present administration of some chemotherapy drugs.   

Mechanism of action (MOA): Mitoxantrone causes cancer cells to die by acting on their DNA, thus interrupting their growth and reproduction.  

Interactions: talk to your doctor before taking vitamins, nutritional supplements or prescription/ non prescription medications. The following drugs can alter the effects of Mitoxantrone or increase the risk of developing side effects:  

• Interferons (Actimmune, Avonex, Betaseron, Rebif,…) 
• Aids/HIV medications such as didanosine (Videx) and stavudine (Zerit)  
• sulfinpyrazone (Anturane)
• Probenecid (Benuryl) 
• Live vaccins
• Ganciclovir, an antiviral drug
• Azathioprine, an immune system inhibitor 
• Barbiturates, depressant drug that causes relaxation and sleepiness
• Cimetidine , a drug used to inhibit the production of acid in the stomach
• Colchicines , a medication used to treat pain of gouty arthritis
• Cyclophosphamide (Cytoxan), a medication of the alkylating agent family used to treat a variety of cancers 

Side effects: Mitoxantrone not only attack cancer cells but also non malignant cells, which often leads to adverse effects in most patients; most common Mitoxantrone side effects include:       

• diarrhea  
• blue-green discoloration of urine 
• headache  
• nausea and vomiting 
• temporary hair loss 
• ulcers in the mouth and lips 
• bluish whites of the eyes 
• reduced urine volume  
• Stomach pain.  

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor immediately if you experience any of these symptoms: 

• fainting 
• dizziness 
• pale skin 
• seizures 
• unusual bleeding or bruising 
• small red or purple dots on the skin 
• infection signs: hives, itching, rash, etc. 
• difficulty swallowing
• shortness of breath 
• yellowing of the skin or eyes 
• Redness, pain, swelling, burning, or blue discoloration at the site where the injection was given