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(dex-ray-ZOX-ane)
Zinecard
Powder for injection
250 mg and 500 mg single-use vials with 0.167 molar sodium lactate diluent
Class: Cardioprotectant

 Actions Dexrazoxane is a potent intracellular chelating agent. The mechanism by which dexrazoxane exerts its cardioprotective activity is not fully understood.

 Indications Reduce incidence and severity of cardiomyopathy in female breast cancer patients who have received a cumulative doxorubicin dose of 300 mg/m2 and who may benefit from additional doxorubicin therapy. It is not recommended for use with the initiation of doxorubicin therapy.

Cardioprotectant for other anthracyclines.

 Contraindications Do not use with chemotherapy regimens that do not contain an anthracycline.

 Route/Dosage

Cardiomyopathy

ADULTS: IV The recommended IV dosage ratio of dexrazoxane:doxorubicin is 10:1 (eg, 500 mg/m2 dexrazoxane would be given with 50 mg/m2 doxorubicin). Doxorubicin must be administered within 30 min of starting the dexrazoxane infusion.

Interactions

Other chemotherapeutic agents

May increase the myelosuppressive effects of other chemotherapeutic agents.

 Adverse Reactions

DERMATOLOGIC: Alopecia; urticaria. GI: Nausea; vomiting; dysphagia; stomatitis; diarrhea; elevated transaminases. HEMATOLOGIC: Dose-related additive myelosuppression; leukopenia; thrombocytopenia. METABOLIC: Elevated blood iron concentration; decreased blood zinc concentration; low-grade fever; hypertriglyceridemia.

 Precautions

Pregnancy: Category C. Lactation: Advise mothers to discontinue nursing during dexrazoxane therapy. Chldren: Safety and efficacy not established. Antitumor interference: The use of dexrazoxane concurrently with the initiation of FAC therapy may interfere with the antitumor efficacy of the regimen; this use is not recommended. Carcinogenesis: Secondary malignancies have been reported in patients treated chronically with razoxane. Extravasation risk: Local irritation or phlebitis may occur. Refer to the institution’s specific protocol. Fertility impairment: Testicular atrophy. Myelosuppression: Dexrazoxane may add to the myelosuppression caused by chemotherapeutic agents.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Store at controlled room temperature 15° to 30°C (59° to 86°F). Discard unused solutions.
  • Reconstitute each vial with the provided sodium lactate solution to give a dexrazoxane concentration of 10 mg/mL. This solution may be injected without further dilution.
  • May be diluted further with 5% Dextrose or 0.9% Sodium Chloride to a final dexrazoxane concentration of 1.3 to 5 mg/mL.
  • Dexrazoxane is stable for up to 6 hr after reconstitution, at room temperature, or under refrigeration. Diluted dexrazoxane solutions are also stable for up to 6 hr.
  • Administer by slow IV push or rapid IV infusion.
  • Do not give doxorubicin prior to the dexrazoxane IV injection. Give doxorubicin within 30 min after beginning the infusion with dexrazoxane.
  • Do not mix dexrazoxane with other drugs.
  • Exercise caution in the handling and preparation of the reconstituted solution; the use of gloves is recommended. If dexrazoxane powder or solutions contact the skin or mucosae, immediatly wash with soap and water.

 Assessment/Interventions

  • Give dexrazoxane only with chemotherapy regimens containing anthracyclines.
  • Monitor patients for cardiotoxicity during therapy with dexrazoxane and an anthracycline.
  • Monitor patients long-term for secondary malignancies.
  • Frequent complete blood counts are recommended.

 Patient/Family Education

  • Explain name, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by the health care provider in a health care setting.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver to immediately report any of the following to the health care provider: rash; hives; flushing; fever, chills, or other signs of infection; sores in mouth; unuusal bleeding or bruising.
  • Advise patient, family, or caregiver to report any of the following to the health care provider: persistent nausea, vomiting, diarrhea, or appetite loss; persistent or worsening general body weakness; pain; redness or swelling at injection site.
  • Instruct patient to not take prescription or otc medication or dietary supplements unless advised by health care provider.
  • Instruct women of childbearing potential to notify the health care provider if becoming pregnant, planning on becoming pregnant, or are breastfeeding.
  • Advise patient that frequent follow-up visits and laboratory tests will be required to monitor therapy and to keep appointments.

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