|Trade names||Novantrone, Onkotrone, others|
|Drug class||Antineoplastic (anthracenedione)|
|Main uses||Cancer, multiple sclerosis|
|Side effects||Nausea, diarrhea, hair loss, infection, fever, swelling, shortness of breath|
|Elimination half-life||75 hours|
|Chemical and physical data|
|Molar mass||444.488 g·mol−1|
|3D model (JSmol)|
Mitoxantrone, also known as mitozantrone, is a medication used to treat cancer and multiple sclerosis. Types of cancer it is used for include acute myeloid leukemia, prostate cancer, breast cancer, and non-Hodgkin's lymphoma. It is given by gradual injection into a vein.
Common side effects include nausea, diarrhea, hair loss, infection, fever, swelling, and shortness of breath. Other side effects may include tumor lysis syndrome, neuropathy, bone marrow suppression, and heart damage. Use in pregnancy may harm the baby. It is an anthracenedione antineoplastic agent.
Mitoxantrone was approved for medical use in the United States in 1987. It is available as a generic medication. In the United Kingdom it costs the NHS about £51 per 20 mg vial as of 2021. This amount in the United States costs about 180 USD.
The combination of mitoxantrone and prednisone is approved as a second-line treatment for metastatic hormone-refractory prostate cancer. Until recently this combination was the first line of treatment; however, a combination of docetaxel and prednisone improves survival rates and lengthens the disease-free period.
Mitoxantrone is also used to treat multiple sclerosis (MS), most notably the subset of the disease known as secondary-progressive MS. In the absence of a cure, mitoxantrone is effective in slowing the progression of secondary-progressive MS and extending the time between relapses in both relapsing-remitting MS and progressive-relapsing MS.
Mitoxantrone, as with other drugs in its class, may cause adverse reactions of varying severity, including nausea, vomiting, hair loss, heart damage and immunosuppression, possibly with delayed onset. Cardiomyopathy is a particularly concerning effect as it is irreversible; thus regular monitoring with echocardiograms or MUGA scans is recommended for patients.
Because of the risk of cardiomyopathy, mitoxantrone carries a limit on the cumulative lifetime dose (based on body surface area) in MS patients.
Mechanism of action
Mitoxantrone is a type II topoisomerase inhibitor; it disrupts DNA synthesis and DNA repair in both healthy cells and cancer cells by intercalation between DNA bases. It is also classified as an antibiotic.
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