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Dexrazoxane (Zinecard)
(dex-rah- ZOX-ayn)
Pregnancy Category: C Zinecard (Rx)

Classification: Antidote

Action/Kinetics: A derivative of EDTA that is a potent chelating agent. It readily penetrates cell membranes, although its mechanism of action as a cardioprotective agent when using anthracyclines (e.g., doxorubicin) is not known. May act by interfering with iron-mediated free-radical generation that may be responsible, in part, for anthracycline-induced cardiomyopathy. t 1/2, elimination: Approximately 2.5 hr. Metabolized in the liver and both unchanged drug and metabolites excreted through the urine. Not bound to plasma proteins.

Uses: To reduce the incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer and who have received a cumulated doxorubicin dose of 300 mg/m 2 and who need additional doxorubicin therapy.

Contraindications: Use with the initiation of doxorubicin therapy, as there is evidence it may interfere with the antitumor efficacy of the regimen (i.e., fluorouracil, doxorubicin, cyclophosphamide). Use with chemotherapy regimens that do not contain an anthracycline. Lactation.

Special Concerns: Safety and efficacy have not been determined in children.

Side Effects: NOTE: The side effects listed may be due to the fluorouracil, doxorubicin, cyclophosphamide regimen. GI: N&V, anorexia, stomatitis, diarrhea, esophagitis, dysphagia. CNS: Fatigue, malaise, fever, neurotoxicity. Dermatologic: Alopecia, streaking/erythema, extravasation, urticaria, recall skin reaction. CV: Hemorrhage phlebitis. Hematologic: Leukopenia, thrombocytopenia, granulocytopenia. Miscellaneous: Pain on injection, sepsis.

Laboratory Test Alterations: Marked interference with hepatic or renal function tests.

Overdose Management: Symptoms: Extensions of the side effects, including myelosuppression. Treatment: Supportive care, including treatment of infections, fluid regulation, maintenance of nutrition, treatment of myelosuppression. Peritoneal dialysis or hemodialysis may be helpful in removing the drug.

Drug Interactions: Dexrazoxane may increase the myelosuppression caused by chemotherapeutic drugs.

How Supplied: Powder for injection: 250 mg, 500 mg

?Slow IV Push or Rapid IV Infusion from a Bag Prevent doxorubicin cardiomyopathy.
The recommended dosage ratio of dexrazoxane-doxorubicin is 10:1 (i.e., 500 mg/m 2 dexrazoxane to 50 mg/m 2 doxorubicin).

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