How to Prescribe Mitoxantrone: Novantrone®
James Bowen, MD
Medical Director, Multiple Sclerosis Center
Swedish Neuroscience Institute
Generic name: mitoxantrone
How supplied: NovantroneÒ is supplied in vials for multidose use which contain 20, 25, or 30 mg/vial
Initial dose: Dose titration is not required.
Maintenance dose: NovantroneÒ must be administered in a chemotherapy-certified infusion center. Patients receive premedication with an antiemetic such as ondansetron 8 mg po 30 minutes before infusion. A free-flowing peripheral IV is started. Novantrone is then infused at a dose of 12 mg/M2 IV diluted in 50-100mg normal saline or D5W. The medication is infused over 15-30 minutes.
The dose is repeated once every three months up to a maximum cumulative total of 140 mg/M2.
Doses may need to be decreased in those with leucopenia.
Laboratory testing: Basic chemistry panels, transaminases, and CBCs should be monitored just prior to each infusion. Those with liver abnormalities or neutrophil counts of less than 1500 cells/mm3 should not receive NovantroneÒ.
A urinalysis should be monitored just prior to each infusion. Those with urinary tract infections should not receive NovantroneÒ until the infection has resolved.
Patients with evidence of other infections should not receive the medication until the infection has resolved.
Cardiac ejection fraction should be measured by echocardiogram or nuclear medicine scanning. This monitoring should be done at baseline and before all doses. The medication should not be given to those with ejection fractions <50% or those with a clinically significant reduction in ejection fraction. Annual measurement of ejection fraction is recommended in patients who have finished receiving NovantroneÒ treatment.
Most common side effects:
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Last Updated: November 2009