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dexrazoxane (deks-ra-zoks-ane)
Totect, Zinecard
Classification
Therapeutic: cardioprotective agents
Pharmacologic: chelating agents
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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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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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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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Absorption: IV administration results in complete bioavailability.
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Metabolism and Excretion: Some metabolism occurs; 42% eliminated in urine.
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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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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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IV (Adults): 10 mg of dexrazoxane/1 mg doxorubicin.
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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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IV (Adults CCr <40 mL/min): decrease ...