Generic Name: dexrazoxane (dex ray ZOX ane)
Brand Name: Totect, Zinecard
What is dexrazoxane?
Dexrazoxane is used to protect the heart and other tissues from harmful side effects caused by certain cancer medications.
The Zinecard brand of dexrazoxane is used in women who are receiving doxorubicin for metastatic breast cancer.
The Totect brand of dexrazoxane is used in men or women to treat a condition called extravasation (es-TRA-va-ZAY-shun). Extravasation happens when an injected medicine escapes from the blood vessels and circulates into tissues in the body. Serious tissue damage can occur when extravasation happens during injection of certain cancer medications.
Dexrazoxane may also be used for purposes not listed in this medication guide.
What is the most important information I should know about dexrazoxane?
You should not receive Totect if you are pregnant. It could harm the unborn baby. If possible before you receive Totect, tell your doctor if you are pregnant. It is not known whether Zinecard will harm an unborn baby.
You should not receive this medication if your chemotherapy does not include doxorubicin or a similar medication such as daunorubicin (Cerubidine), epirubicin (Ellence), idarubicin (Idamycin), or mitoxantrone (Novantrone).
Before you receive dexrazoxane, tell your doctor if you have liver or kidney disease, or if you are pregnant or breast-feeding.
Tell your doctor at once if you have serious side effects such as fever, chills, body aches, flu symptoms, easy bruising or bleeding, or sores your mouth or throat.
In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received Totect.
What should I discuss with my health care provider before receiving dexrazoxane?
You should not receive Zinecard if your chemotherapy does not include doxorubicin or a similar medication such as:
idarubicin (Idamycin); or
If possible before you receive dexrazoxane, tell your doctor if you have:
kidney disease; or
if you are pregnant or breast-feeding.
Zinecard is rated as FDA pregnancy category C. It is not known whether Zinecard will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
Totect is rated as FDA pregnancy category D. Do not use Totect if you are pregnant. It could harm the unborn baby. If possible before you receive Zinecard, tell your doctor if you are pregnant.
It is not known whether dexrazoxane passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using dexrazoxane.
In an emergency situation, it may not be possible before you are treated with Totect to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.
How is dexrazoxane given?
Dexrazoxane is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting.
Totect is usually started within 6 hours after extravasation, and continued once daily for 3 days.
Zinecard is usually started 30 minutes before you receive your doxorubicin injection.
Dexrazoxane can add to the bone marrow lowering effects of chemotherapy. This can weaken your immune system, making it easier for you to get sick from being around others who are ill.
To be sure this medication is not causing harmful effects, your blood cells and kidney function will need to be tested often. Do not miss any follow up visits to your doctor for blood or urine tests.
What happens if I miss a dose?
Since dexrazoxane is given by a healthcare professional as part of your chemotherapy treatment, you are not likely to miss a dose.
Call your doctor if you miss a chemotherapy appointment.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid after receiving dexrazoxane?
Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.
Dexrazoxane side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Tell your doctor at once if you have any of these serious side effects:
fever, chills, body aches, flu symptoms, sores in your mouth and throat;
easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; or
bruising, swelling, warmth, redness, oozing, or bleeding of any surgical incision.
Less serious side effects may include:
swelling in your hands or feet;
nausea, vomiting, diarrhea, loss of appetite;
sore throat, trouble swallowing;
dizziness, tired feeling; or
pain, swelling, or redness where the medicine was injected.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: dexrazoxane side effects (in more detail)
Dexrazoxane Dosing Information
Usual Adult Dose for Cardiomyopathy Prophylaxis:
Dexrazoxane (marketed as Zinecard)
For use in reducing the incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer who have received a cumulative doxorubicin dose of 300 mg/m2 and who will continue to receive doxorubicin therapy to maintain tumor control:
The recommended dosage ratio of dexrazoxane:doxorubicin is 10:1 (for example: 500 mg/m2 dexrazoxane:50 mg/m2 doxorubicin).
After completing the infusion of dexrazoxane, and prior to a total elapsed time of 30 minutes (from the beginning of the dexrazoxane infusion), the intravenous injection of doxorubicin should be given.
Usual Adult Dose for Extravasation:
Dexrazoxane (marketed as Totect)
For use in the treatment of extravasation resulting from IV anthracycline chemotherapy:
Dexrazoxane should be given once daily for three consecutive days. The first infusion should be initiated as soon as possible and within the first six hours after extravasation.
The recommended doses are:
Day one: 1000 mg/m2
Day two: 1000 mg/m2
Day three: 500 mg/m2
The maximum recommended doses are:
Day one: 2000 mg
Day two: 2000 mg
Day three: 1000 mg
The dose should be administered as an intravenous infusion over 1 to 2 hours in a large caliber vein in an extremity/area other than the one affected by the extravasation.
Cooling procedures such as ice packs, if used, should be removed from the area at least 15 minutes before dexrazoxane administration in order to allow sufficient blood flow to the area of extravasation. Treatment on day 2 and day 3 should start at the same hour (plus or minus 3 hours) as on the first day.
Usual Pediatric Dose for Cardiomyopathy Prophylaxis:
Dexrazoxane dose is based on a 10:1 ratio of the doxorubicin dose (example: 300 mg/m2 dexrazoxane; 30 mg/m2 doxorubicin)
Dexrazoxane should be administered 30 minutes before doxorubicin.
This regimen has been used in patients with high-risk acute lymphoblastic leukemia.
What other drugs will affect dexrazoxane?
Some cancer medications may be less effective if they are used with dexrazoxane. Tell your doctor if your chemotherapy medications include:
fluorouracil (5-FU, Adrucil);
cyclophosphamide (Cytoxan, Neosar).
This list is not complete and other drugs may interact with dexrazoxane. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More dexrazoxane resources
- dexrazoxane Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information
- dexrazoxane MedFacts Consumer Leaflet (Wolters Kluwer)
- Dexrazoxane Prescribing Information (FDA)
- Dexrazoxane Professional Patient Advice (Wolters Kluwer)
- Dexrazoxane Hydrochloride Monograph (AHFS DI)
- Totect Consumer Overview
- Totect Prescribing Information (FDA)
- Zinecard Prescribing Information (FDA)
Where can I get more information?
- Your doctor or pharmacist can provide more information about dexrazoxane.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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