dexrazoxane

(dex-ra-zox-ane) ,

Totect

(trade name),

Zinecard

(trade name)

Classification

Therapeutic: cardioprotective agents

Pregnancy Category: D

Indications

Reducing incidence and severity of cardiomyopathy from doxorubicin in women with metastatic breast cancer who have already received a cumulative dose of doxorubicin >300 m g/m2.Treatment of extravasation resulting from IV anthracycline chemotherapy. 

Action

Acts as an intracellular chelating agent. 

Therapeutic effects

Diminishes the cardiotoxic effects of doxorubicin. 

Decreased damage from extravasation of anthracyclines. 

Pharmacokinetics

Absorption: IV administration results in complete bioavailability. 

Distribution: Unknown. 

Metabolism and Excretion: Some metabolism occurs; 42% eliminated in urine. 

Nursing assessment

Extravasation protection: Assess site of extravasation for pain, burning, swelling, and redness. 

Lab Test Considerations: Monitor CBC and platelet count frequently during therapy.  Thrombocytopenia, leukopenia, neutropenia, and granulocytopenia from chemotherapy may be more severe at nadir with dexrazoxane therapy. 

Implementation

Do not administer solutions that are discolored or contain particulate matter.  Reconstituted solution and diluted solution are stable in an IV bag for 6 hr at room temperature or if refrigerated.  Discard unused solutions. 

Intravenous Administration

pH: 3.5–5.5. 

Cardioprotective: Doxorubicin should be administered within 30 min following dexrazoxane administration. 

Intermittent Infusion: Diluent: Reconstituted solution may also be diluted with 0.9% NaCl or D5W. Solution is stable for 6 hr at room temperature or refrigeratedConcentration: 1.3–5 mg/mL.

Rate: May also be administered via rapid IV infusion over 15–30 min. 

Additive Incompatibility: Do not mix with other medications. 

Extravasation Protection: Administer as soon as possible within 6 hr of extravasation.  Remove cooling procedures, such as ice packs, at least 15 min before administration to allow sufficient blood flow to area of extravasation. 

Intermittent Infusion: Diluent: Dilute each vial in 50 mL of diluent provided by manufacturer.  Add contents of all vials into 1000 mL of 0.9% NaCl for further dilution.  Solution is slightly yellow.  Use diluted solutions within 2 hr of dilution.  Store at room temperature. 

Rate: Administer over 1–2 hr. 

Y-Site Compatibility:

alemtuzumab

alfentanil

amifostine

amikacin

amiodarone

ampicillin

ampicillin/sulbactam

anidulafungin

argatroban

arsenic trioxide

atracurium

azithromycin

aztreonam

bivalirudin

bleomycin

bumetanide

buprenorphine

busulfan

buprenorphine

calcium chloride

calcium gluconate

carboplatin

carmustine

caspofungin

cefazolin

cefotaxime

cefotetan

cefoxitin

ceftazidime

ceftriaxone

cefuroxime

chloramphenicol

chlorpromazine

ciprofloxacin

cisatracurium

cisplatin

clindamycin

cyclophosphamide

cyclosporine

cytarabine

dactinomycin

daptomycin

dexmedetomidine

digoxin

diltiazem

diphenhydramine

docetaxel

dolasetron

dopamine

doxacurium

doxorubicin

doxorubicin liposomal

doxycycline

droperidol

enalaprilat

ephedrine

epinephrine

epirubicin

eptifibatide

srtapenem

erythromycin

esmolol

stoposide

famotidine

fenoldopam

fentanyl

fluconazole

fludarabine

fluorouracil

foscarnet

fosphenytoin

gentamycin

glycopyrrolate

granisetron

haloperidol

heparin

hetastarch

hydralazine

hydrocortisone sodium succinate

hydromorphone

idarubicin

ifosfamide

imipenem/cilastatin

insulin

irinotecan

isoproterenol

ketorolac

leucovorin

levofloxacin

lidocaine

linezolid

lorazepam

magnesium sulfate

mannitol

mechlorethamine

melphalan

meperidine

meropenem

metaraminol

methyldopate

metoclopramide

metoprolol

metronidazole

midazolam

milrinone

minocycline

mitoxantrone

morphine

mycophenolate

nalbuphine

naloxone

nesiritide

nicardipine

nitroglycerin

nitroprusside

norepinephrine

octreotide

ondansetron

oxaliplatin

paclitaxel

palonosetron

pamidronate

pancuronium

pemetrexed

pentamidine

pentazocine

phenobarbital

phentolamine

phenylephrine

piperacillin/tazobactam

polumyxin B

potassium acetate

potassium chloride

potassium phosphates

procainamide

prochlorperazine

promethazine

propranolol

quinupristin/dalfopristin

ranitidine

remifentanil

rituximab

rocuronium

sodium acetate

sodium bicarbonate

streptozocin

succinylcholine

sufentanil

tacrolimus

teniposide

theophylline

thiotepa

ticarcillin/clavulanate

tigecycline

tirofiban

tobramycin

vancomycin

vasopressin

vecuronium

verapamil

vinblastine

vincristine

vinorelbine

voriconazole

zolendronic acid

Additive Incompatibility:

acyclovir

allopurinol

aminophylline

amphotericin B colloidal

amphotericin B lipid complex

amphotericin B liposome

cefepime

dantrolene

diazepam

dobutamine

furosemide

ganciclovir

methotrexate

methylprednisolone

nafcillin

pantoprazole

pentobarbital

phenytoin

sodium phosphates

thiopental

trimethoprim/sulfamethoxazole

zidovudine

Patient/Family Teaching

Explain the purpose of the medication to the patient. 

Emphasize the need for continued monitoring of cardiac function. 

Advise patient to notify health care professional if pregnancy is suspected or planned or if breast feeding.  Dexrazoxane may be teratogenic.  Breast feeding should be avoided during therapy

Evaluation/Desired Outcomes

Reduction of incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer. 

Decrease in late sequalae (site pain, fibrosis, atrophy, and local sensory disturbance) following extravasation of anthracycline chemotherapeutic agents. 

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