dexrazoxane(redirected from Totect)
Pregnancy Category: D
ClassificationTherapeutic: cardioprotective agents
Reducing incidence and severity of cardiomyopathy from doxorubicin in women with metastatic breast cancer who have already received a cumulative dose of doxorubicin >300 m g/m2.Treatment of extravasation resulting from IV anthracycline chemotherapy.
Acts as an intracellular chelating agent.
Diminishes the cardiotoxic effects of doxorubicin.
Decreased damage from extravasation of anthracyclines.
Absorption: IV administration results in complete bioavailability.
Metabolism and Excretion: Some metabolism occurs; 42% eliminated in urine.
Half-life: 2.1–2.5 hr.
Time/action profile (cardioprotective effect)
Contraindicated in: Any other type of chemotherapy except other anthracyclines (doxorubicin-like agents);May cause fetal harm
Use Cautiously in: CCr <40 mL/min (dose ↓required); Lactation: Lactation Pediatric: Safety and effectiveness not established
Adverse Reactions/Side Effects
- pain at injection site
- malignancy (life-threatening)
Drug-Drug interactionMyelosuppression may be ↑ by antineoplastics or radiation therapy.Antitumor effects of concurrent combination chemotherapy with fluorouracil and cyclophosphamide may be ↓ by dexrazoxane.
Intravenous (Adults) 10 mg of dexrazoxane/1 mg doxorubicin.
Renal ImpairmentIntravenous (Adults) ↓ dose by 50%.
Intravenous (Adults) 1000 mg/m2 (maximum 2000 mg) given on days 1 and 2, and followed by a dose of 500 mg/m2 (maximum 1000 mg) on day 3.
Renal ImpairmentIntravenous (Adults CCr <40 mL/min) ↓ dose by 50%.
Availability (generic available)
Injection (Zinecard): 250 mg/vial, 500 mg/vial
Injection (Totect): 500 mg/vial
- Cardioprotective: Assess extent of cardiomyopathy (cardiomegaly on x ray, basilar rales, S gallop, dyspnea, decline in left ventricular ejection fraction) prior to and periodically during therapy.
- Extravasation protection: Assess site of extravasation for pain, burning, swelling, and redness.
- Lab Test Considerations: Monitor CBC and platelet count frequently during therapy. Thrombocytopenia, leukopenia, neutropenia, and granulocytopenia from chemotherapy may be more severe at nadir with dexrazoxane therapy.
- Monitor liver function tests periodically during therapy. May cause reversible ↑ of liver enzymes.
Potential Nursing DiagnosesDecreased cardiac output (Indications)
Risk for impaired skin integrity (Indications)
- Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling IV medication. Discard IV equipment in specially designated containers (see ).
- Do not administer solutions that are discolored or contain particulate matter. Reconstituted solution and diluted solution are stable in an IV bag for 6 hr at room temperature or if refrigerated. Discard unused solutions.
- pH: 3.5–5.5.
- Cardioprotective: Doxorubicin should be administered within 30 min following dexrazoxane administration.
- Diluent: Reconstitute dexrazoxane with 0.167 molar (M/6) sodium lactate injection.Concentration: 10 mg/mL.
- Rate: Administer via slow IV push.
- Intermittent Infusion: Diluent: Reconstituted solution may also be diluted with 0.9% NaCl or D5W. Solution is stable for 6 hr at room temperature or refrigeratedConcentration: 1.3–5 mg/mL.
- Rate: May also be administered via rapid IV infusion over 15–30 min.
- Additive Incompatibility: Do not mix with other medications.
- Extravasation Protection: Administer as soon as possible within 6 hr of extravasation. Remove cooling procedures, such as ice packs, at least 15 min before administration to allow sufficient blood flow to area of extravasation.
- Intermittent Infusion: Diluent: Dilute each vial in 50 mL of diluent provided by manufacturer. Add contents of all vials into 1000 mL of 0.9% NaCl for further dilution. Solution is slightly yellow. Use diluted solutions within 2 hr of dilution. Store at room temperature.
- Rate: Administer over 1–2 hr.
- Y-Site Compatibility:
- arsenic trioxide
- calcium chloride
- calcium gluconate
- doxorubicin liposomal
- hydrocortisone sodium succinate
- magnesium sulfate
- polumyxin B
- potassium acetate
- potassium chloride
- potassium phosphates
- sodium acetate
- sodium bicarbonate
- zolendronic acid
- Additive Incompatibility:
- amphotericin B colloidal
- amphotericin B lipid complex
- amphotericin B liposome
- sodium phosphates
- Explain the purpose of the medication to the patient.
- Emphasize the need for continued monitoring of cardiac function.
- Advise patient to notify health care professional if pregnancy is suspected or planned or if breast feeding. Dexrazoxane may be teratogenic. Breast feeding should be avoided during therapy
- Reduction of incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer.
- Decrease in late sequalae (site pain, fibrosis, atrophy, and local sensory disturbance) following extravasation of anthracycline chemotherapeutic agents.