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INTRODUCTION

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dexrazoxane (deks-ra-zoks-ane)

Totect, Zinecard

Classification

Therapeutic: cardioprotective agents

Pharmacologic: chelating agents

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

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Action
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Acts as an intracellular chelating agent. Therapeutic Effects: Diminishes the cardiotoxic effects of doxorubicin. Decreased damage from extravasation of anthracyclines.

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Adverse Reactions/Side Effects
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Hemat: myelosuppression. Local: pain at injection site.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of cardiomyopathy such as shortness of breath, dizziness, fatigue, fainting, palpitations, and peripheral/abdominal edema due to fluid accumulation. Increased signs may indicate a lack of drug effects in protecting the heart; notify the physician or nursing staff immediately.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

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Interventions
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  • For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

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Patient/Client-Related Instruction
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  • Because of myelosuppression, advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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

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Half-life: 2.1–2.5 hr.

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TIME/ACTION PROFILE (cardioprotective effect)

ROUTE ONSET PEAK DURATION
IV rapid unknown unknown

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Contraindications/Precautions
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Contraindicated in: Any other type of chemotherapy except other anthracyclines (doxorubicin-like agents).

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Use Cautiously in: CCr <40 mL/min (dose reduction required); OB: Pregnancy, lactation, or children (safety not established).

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Interactions
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Drug-Drug: Myelosuppression may be ↑ by antineoplastics or radiation therapy. Antitumor effects of concurrent combination chemotherapy with fluorouracil and cyclophosphamide may be ↓ by dexrazoxane.

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Route/Dosage
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Cardioprotective
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IV (Adults): 10 mg of dexrazoxane/1 mg doxorubicin.

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Renal Impairment
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IV (Adults): decrease dose by 50%.

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Extravasation protection
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IV (Adults): 1000 mg/m2 (maximum 2000 mg) given on days 1 and 2, and followed by a dose of 500 mg/m2 (maximum 1000 mg) on day 3.

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Renal Impairment
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IV (Adults CCr <40 mL/min): decrease dose by 50%.

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Availability (generic available)
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Injection (Zinecard): 250-mg vial, 500-mg vial. Injection (Totect):...

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