DEXRAZOXANE
(Zinecard)Standard Prescription
Dexrazoxane ___ mg IV {frequency} (__ mg/m2/day) x __ days
Dosages
Cardioprotectant for doxorubicin or daunorubicin:
Cardioprotectant for other anthracyclines:
40 x the mitoxantrone dose
50 x the idarubicin dose
Extravasation of anthracyclines:
1000 mg/m2/day (max 2000 mg) IV over 1-2 hours x 2 days followed by 500 mg/m2/day x 1 day.
10 x the doxorubicin or daunorubicin dose (eg if doxorubicin dose is 30 mg/m2, dexrazoxane dose is 300 mg/m2)
40 x the mitoxantrone dose
50 x the idarubicin dose
10 x the epirubicin dose
1000 mg/m2/day (max 2000 mg) IV over 1-2 hours x 2 days followed by 500 mg/m2/day x 1 day.
Mechanism of Action
Cardioprotectant for doxorubicin. Chelates iron, reducing the number of metal ions complexed with anthracycline
Forms Supplied
Injection: 250 mg and 500 mg vials
Comments
Cardioprotectant doses are to be given immediately prior to anthracycline. Total infusion time of dexrazoxane and anthracycline not to exceed 30 minutes.
Dexrazoxane doses no longer based on anthracycline equivalent dose. May use chemotherapy protocol-specified dosing
Administer as soon as possible and within 6 hours of extravasation; do not use DMSO in combination with dexrazoxane; this may increase tissue damage.
The BC Cancer agency recommends DMSO as the standard of care for anthracycline extravasation as of January, 2016.
Dose reduction required in renal impairment (CrCl < 40 mL/min)
Dexrazoxane doses no longer based on anthracycline equivalent dose. May use chemotherapy protocol-specified dosing
Administer as soon as possible and within 6 hours of extravasation; do not use DMSO in combination with dexrazoxane; this may increase tissue damage.
The BC Cancer agency recommends DMSO as the standard of care for anthracycline extravasation as of January, 2016.
See ePOPS for Guidelines for Antidote Administration
Dose reduction required in renal impairment (CrCl < 40 mL/min)
References
44, 350, 351, 352, 528-32
Children’s Oncology Group Leukemia Guidelines
Children’s Oncology Group Long-Term Follow-up Guidelines
Sun et al. Dexrazoxane improves cardiac autonomic function in epirubicin-treated breast cancer patients with type 2 diabetes. Medicine (Baltimore) 2016;95:e5228
De Giorgi U et al. High-dose epirubicin, preceded by dexrazoxane, given in combination with paclitaxel plus filgrastim provides an effective mobilizing regimen to support three courses of high-dose dense chemotherapy in patient with high-risk stage II-IIIa breast cancer. Bone Marrow Transplant 2003;32:251-5
Vachhani P et al. Dexrazoxane for cardioprotection in older adults with acute myeloid leukemia. Leuk Res Rep. 2017; 7: 36–39
Last Edited
2021-12-03 08:50:12