Mitoxantrone Dosage
This dosage information may not include all the information needed to use Mitoxantrone safely and effectively. See additional information for Mitoxantrone.
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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Acute Nonlymphocytic Leukemia
The benefit to risk ratio of mitoxantrone in patients previously treated with daunorubicin or doxorubicin should be considered prior to treatment due to the possible additive risk of cardiotoxicity. Patients with preexisting myelosuppression as the result of prior drug therapy should not receive this drug unless the benefit exceeds the risk of further and possibly profound myelosuppression.
For induction, the initial dosage of mitoxantrone recommended for this patient with acute nonlymphocytic leukemia (ANLL) is 12 mg/m2 intravenously once a day on days 1 through 3 (in combination with cytosine arabinoside for 7 days).
ANLL includes myelogenous, promyelocytic, monocytic, and erythroid acute leukemias.
The recommended dose of mitoxantrone may depend on whether other cytotoxic agents are coadministered. Reference to specific protocols is recommended.
Most complete remissions from ANLL occur during initial induction therapy. In the event of an incomplete antileukemic response, a second induction course (usually with cytosine arabinoside) may be administered. Second inductions should be withheld until severe or life-threatening nonhematologic toxicity associated with the first induction dose is cleared. Mitoxantrone should be given for 2 days and cytarabine for 5 days using the same dosage levels.
Consolidation therapy consists of mitoxantrone 12 mg/m2 given by intravenous infusion daily on days 1 and 2 (in combination with cytosine arabinoside for 5 days). The first course is given approximately 6 weeks after the final induction course, the second was generally administered 4 weeks after the first.
Usual Adult Dose for Multiple Sclerosis
12 mg/m2 given as a short (approximately 5 to 15 minute) intravenous infusion every 3 months.
Evaluation of left ventricular ejection fraction (LVEF) by echocardiogram or multiple gated acquisition (MUGA) scan is recommended prior to administration of the initial dose of mitoxantrone.
Subsequent LVEF evaluations are recommended if signs or symptoms of congestive heart failure develop, and prior to all doses administered to patients who have received a cumulative dose of 100 mg/m2 or more. Mitoxantrone should not ordinarily be administered to multiple sclerosis patients who have received a cumulative lifetime dose of 140 mg/m2 or more, or those with either an LVEF less than 50% or a clinically significant reduction in LVEF.
Complete blood counts, including platelets, should be monitored prior to each course of mitoxantrone and in the event that signs or symptoms of infection develop. Mitoxantrone generally should not be administered to multiple sclerosis patients with neutrophil counts less than 1500 cells/mm3. Liver function tests should also be monitored prior to each course.
Usual Adult Dose for Prostate Cancer
12 to 14 mg/m2 given as a short intravenous infusion every 21 days in combination with corticosteroids.
Usual Adult Dose for non-Hodgkin's Lymphoma
8 to 10 mg/m2 given as an intravenous infusion every 21 to 28 days as a part of a combination chemotherapy regimen.
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Patients with multiple sclerosis who have liver dysfunction should ordinarily not be treated with mitoxantrone. (The drug may be administered with caution to other patients with liver dysfunction.)
Dose Adjustments
The recommended dose may depend on whether other cytotoxic agents are coadministered. Reference to specific protocols is recommended. In the event of an incomplete response, a similar induction dose (usually with cytosine arabinoside) may be administered. Second inductions should be withheld until severe or life-threatening nonhematologic toxicity associated with the first induction dose is cleared. Consolidation therapy is often given 4 to 6 weeks after induction therapy.
Precautions
Patients with preexisting myelosuppression as the result of prior drug therapy should not receive mitoxantrone unless the benefit exceeds the risk of further and possibly profound myelosuppression.
Dialysis
A supplemental dose is not necessary with hemo- or peritoneal dialysis.
Other Comments
Most complete remissions occur during initial induction therapy. After baseline CBC, serum electrolyte, and (optional) cardiac ejection studies (MUGA scanning is probably most accurate), appropriate monitoring of the CBC and serum electrolytes is recommended. The leukocyte count usually reaches a nadir by day 10 to 14 and recovers by day 21. Follow-up LV ejection studies depend on the prevalence of heart failure, the cumulative dose of mitoxantrone, and whether the treatment would be altered by the results of such testing.
