Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041WARNING Heart related problems: Mitoxantrone can cause heart problems, including congestive heart failure. The risk of developing this problem increases as the total amount of mitoxantrone used over time increases (see Who Should Not Take This Medication and Precautions To Be Aware Of Before Taking This Medication). Infusion related problems: Mitoxantrone is given by injection into a vein (IV) and can cause serious skin and tissue problems if it leaks out of the vein while being given. Your doctor or healthcare provider will monitor you carefully during the administration of mitoxantrone to make sure that this does not happen. Low white blood cell levels: Mitoxantrone should not be given to patients whose white blood cell levels are too low. Your doctor or healthcare provider will check your blood before starting mitoxantrone treatment to make sure that it is safe to start this medication. Secondary cancers: The development of leukemia has been reported in patients receiving mitoxantrone. The risk of developing leukemia is higher in patients 1) who are receiving other chemotherapy medications in combination with mitoxantrone, 2) who have received a lot of previous chemotherapy, or 3) who are receiving a high dose of mitoxantrone. Uses For This Medication
- Mitoxantrone is used alone or in combination with other chemotherapy medications to treat adults with prostate cancer and certain types of leukemia (acute myeloid leukemia).
- This medication may also be given for other conditions as determined by your doctor.
Blood related precautions
- This medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use aspirin, aspirin-containing medications, or aspirin-like medications (for example ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps and bruises.
- This medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands with soap and water well and often, and brush and floss your teeth daily.
- This medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
Organ related precautions
- Rarely, this medication can cause heart problems, including congestive heart failure. The risk of developing this problem increases as the total amount of mitoxantrone used over time increases. Heart problems can occur either during treatment or months to years after treatment is completed. Your doctor or healthcare provider will check your heart regularly while you are receiving mitoxantrone to make sure that your heart is working properly. Make sure that you tell your doctor or healthcare provider if:
- You already have heart related problems
- You have already received chemotherapy with a medication similar to mitoxantrone, including epirubicin, doxorubicin, daunorubicin, idarubicin
- You are receiving trastuzumab (Herceptin®)
- You have received radiation therapy to your chest area
- This medication is broken down by enzymes (chemicals) in the liver and cleared from the body. In patients with liver disease, mitoxantrone may not break down normally which can lead to high levels of this medication in the body and a greater chance of side effects. If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
- Mitoxantrone can cause the urine to become blue-green in color for one to two days following treatment. This change in urine color is not harmful.
- Mitoxantrone can temporarily cause the whites of the eyes to become blue in color. This change in color is not harmful.
- Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
Patient specific precautions
- It is not known if this medication is safe and effective in children, however it has been used to treat childhood cancers (or is it being used in clinical trials?).
- Older patients receiving mitoxantrone may be more likely than younger patients to experience side effects.
Pregnancy and breastfeeding precautions
- This medication may cause fetal harm. When taking this medication, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant.
- Mitoxantrone is excreted in breast milk. Significant levels of mitoxantrone have been found in breast milk for up to 28 days after receiving mitoxantrone Since this medication can cause serious harmful reactions in infants, breastfeeding should be avoided.
- Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future.
Medication and Food InteractionsBefore using this medication, tell your doctor or healthcare provider of all prescription or over-the- counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with mitoxantrone and the following medications:
- Amiodarone (Cordarone®)
- Trastuzumab (Herceptin®)
- Tamoxifen (Nolvadex®)
- All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
- You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
- Side effects can occur when mitoxantrone is given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with mitoxantrone alone.
More common side effects
- Decreased platelet, red blood cell, and/or white blood cell levels (see Precautions To Be Aware Of Before Taking This Medication)
- Tiredness (fatigue)
- Nausea, vomiting, diarrhea, loss of appetite, sores in your mouth or on lips
- Hair loss
- Fever, infection
- Shortness of breath
- Swelling in the legs and feet (edema)
- Urinary tract infections
Less common side effects
- Stomach pain, constipation
- Irritation of the eyes (conjunctivitis)
- Abnormal menstruation
Rare side effectsThis is not a complete list of the rare side effects reported with mitoxantrone. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
- Allergic reaction with rash, difficulty breathing, itching, flushed appearance, and dizziness
- Injection site reactions (see Warning)
- Heart damage with congestive heart failure (see Precautions To Be Aware Of Before Taking This Medication)
- Liver damage (see Precautions to be aware before taking this medication)
- This medication may only given by injection into a vein (IV) by a healthcare professional. This medication can be given in different doses depending on your weight, your type of condition and whether mitoxantrone is being given with other chemotherapy medications.
- Antiemetics, which are medications to help prevent and control nausea and vomiting, may be given before mitoxantrone either by mouth (orally) or by injection into a vein (IV). Following treatment, your doctor or healthcare provider may prescribe additional antiemetics which you may need to take for several days after treatment to prevent and control nausea and/or vomiting.
- In the unlikely event of an overdose of this medication contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
- It is unlikely that you will need to store this medication. However, in the event that you do, the unopened containers should be stored at controlled room temperature.
- Keep this medication out of the reach of children or pets.
- Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.