dexrazoxane
dexrazoxane
[deks″ra-zok´sān]dexrazoxane
(dex-ra-zox-ane) dexrazoxane,Totect
(trade name),Zinecard
(trade name)Classification
Therapeutic: cardioprotective agentsIndications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (cardioprotective effect)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | rapid | unknown | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Hematologic
- myelosuppression
Local
- pain at injection site
Miscellaneous
- malignancy (life-threatening)
Interactions
Drug-Drug interaction
Myelosuppression may be ↑ by antineoplastics or radiation therapy.Antitumor effects of concurrent combination chemotherapy with fluorouracil and cyclophosphamide may be ↓ by dexrazoxane.Route/Dosage
Cardioprotective
Renal Impairment
Intravenous (Adults) ↓ dose by 50%.Extravasation Protection
Renal Impairment
Intravenous (Adults CCr <40 mL/min) ↓ dose by 50%.Availability (generic available)
Nursing implications
Nursing assessment
- Cardioprotective: Assess extent of cardiomyopathy (cardiomegaly on x ray, basilar rales, S gallop, dyspnea, decline in left ventricular ejection fraction) prior to and periodically during therapy.
- 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.
- Monitor liver function tests periodically during therapy. May cause reversible ↑ of liver enzymes.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)Risk for impaired skin integrity (Indications)
Implementation
- Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling IV medication. Discard IV equipment in specially designated containers (see ).
- 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.
- Diluent: Reconstitute dexrazoxane with 0.167 molar (M/6) sodium lactate injection.Concentration: 10 mg/mL.
- Rate: Administer via slow IV push.
- 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.