• Mitoxantrone Hydrochloride injection, Pfizer

• • Fresenius Kabi had mitoxantrone on shortage due to increased demand.¹
  • Pfizer has mitoxantrone injection on shortage due to manufacturing delays.²
  • Teva had mitoxantrone injection on allocation due to current market conditions.³
    

• Mitoxantrone Hydrochloride injection, Fresenius Kabi

Estimated Resupply Dates

• • Pfizer has all mitoxantrone presentations on long-term back order and the company estimates a release date of early-4th quarter 2017.²
  • Teva has mitoxantrone 10 mL vials temporarily unavailable and the company cannot estimate a release date.³
    

Implications for Patient Care

• • Mitoxantrone is an antineoplastic anthracenedione and a topoisomerase II inhibitor. It is labeled for use for the treatment of acute nonlymphocytic leukemia, multiple sclerosis, and prostate cancer.^4-6
  • Mitoxantrone is used off-label for the treatment of breast cancer, non-Hodgkin lymphoma, and autologous bone marrow transplantation. It has also been used off-label in children for the treatment of acute nonlymphocytic leukemia or solid tumors.^4-6
  • Refer to national guidelines such as those from the National Comprehensive Cancer Network or American Society of Clinical Oncology for additional information regarding therapeutic use.

Safety

• • Chemotherapy agents, such as mitoxantrone, pose additional safety risks both for patients and for healthcare workers handling these agents.^4-6
  • Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).^4-6

Alternative Agents & Management

• • The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for mitoxantrone.^4-6
  • Consider evaluating the health-care system's total supply of mitoxantrone before beginning patients on combination chemotherapy regimens containing mitoxatnrone. If adequate supplies are not available, select an alternative regimen.
  • Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
  • Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated.

References

• 1. Fresenius Kabi (personal communications). September 24, November 11, and December 9 and 15, 2015; February 3, March 2, April 5, May 12, June 8, August 3, September 2, November 7 and 21, 2016; January 28, February 10, March 5, and April 28, 2017.
  2. Pfizer (personal communications). September 24, November 11, and December 9 and 15, 2015; February 3, March 2, April 5, May 12, June 13, August 11, September 7, November 10 and 22, 2016; January 30, March 7, and May 3, 2017.
  3. Teva (personal communications). September 24, November 11, and December 9 and 15, 2015; February 3, March 2, April 5, May 12, August 10, November 10, 2016; January 13, and March 6, 2017.
  4. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2015 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2015: 839-1281.
  5. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. March 2015.
  6. Lexi-Drugs Online. Lexi-Comp, Inc.; 2015.