Mitoxantrone, with the trade name Novantrone, is a drug that is given as an intravenous infusion by a healthcare provider in a clinical setting.

It is used to treat multiple sclerosis (MS) and some types of cancer, including prostate cancer, and Hodgkin’s lymphoma.

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In some countries, it is approved for treating metastatic breast cancer. While this is not the case in the United States, it may be offered as part of a clinical trial or off-label.

It carries a boxed warning as requested by the United States Food and Drug Administration (FDA).

This is because there is a risk of heart damage that can lead to heart failure. It also lowers a person’s, immunity, which can lead to a higher risk of infection.

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The FDA also warn of a higher risk of developing leukemia or a secondary cancer.

Fast facts on mitoxantrone

  • Mitoxantrone is a chemotherapy drug that is used to treat multiple sclerosis (MS) and certain types of cancer.
  • Mitoxantrone is injected by a healthcare provider, usually once every 3 months for about 2 to 3 years, but this can depend on the individual.
  • It can lead to heart damage during therapy and even some years later.
  • Mitoxantrone may harm an unborn or breast-feeding baby.
  • The most common side effects are nausea, constipation, diarrhea, stomach pain, hair loss, fever, chills, cough, sore throat, mouth sores, and loss of menstrual periods.

What is mitoxantrone?

Novantrone is used as a treatment for MS
Novantrone is used as a treatment for MS and some cancers.

Mitoxantrone is used to treat some types of cancer.

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It is used:

  • as part of a combination therapy to treat nonlymphocytic leukemia in people aged over 18 years
  • to reduce pain related to advanced hormone-refractory prostate cancer
  • with corticosteroids as a treatment for some types of advanced prostate cancer

Mitoxantrone is used to reduce problems associated with MS that is:

  • secondary (chronic) progressive
  • progressive relapsing
  • worsening relapsing-remitting

It is also used to treat acute nonlymphocytic leukemia.

How it works

Mitoxantrone is considered an antineoplastic agent and a multiple sclerosis agent.

It works in different ways to treat MS and acute nonlymphocytic leukemia and prostate cancer.

  • In MS: Immune cells damage the protective covering of nerves. Mitoxantrone limits the ability of these cells to damage the protective nerve covering.
  • In cancer: For acute nonlymphocytic leukemia and prostate cancer, mitoxantrone targets cells that divide quickly. These include cancer cells. Mitoxantrone causes these cells to die.

Side effects

This drug can have a number of side effects, and some of them can be serious.

Heart failure

Mitoxantrone may cause heart failure, which can be life-threatening. This can happen during therapy or months to years after therapy.

Lowered immunity

This drug can cause the white blood cell count to go down, indicating reduced immunity. This increases the chance of having an infection.

This drug is not usually given if a person’s neutrophil count is less than 1,500, unless they have acute nonlymphocytic leukemia.

Bleeding problems

The platelet count may also go down, which increases the chance of bleeding.

Discoloration of urine or eyes

Mitoxantrone is dark blue, and it may turn the urine blue-green for a few days after each dose.

It may also make the whites of the eyes a little blue, but this, too, will go away.

Other common side effects

The most common side effects of mitoxantrone include:

  • nausea
  • sudden hair loss
  • loss of menstrual periods
  • bladder infections
  • mouth sores

These are not usually serious, and they can be treated by a doctor.

When to call a doctor

If any of these symptoms occur, call a doctor right away.

If the symptoms may be life threatening or if there may be a medical emergency, call 9-1-1.

Decreased ability to make blood cells

Symptoms may include:

  • fatigue
  • fever
  • chills
  • sore throat
  • cough
  • unusual bleeding or bruising

Congestive heart failure

Symptoms may include:

  • trouble breathing
  • swelling of your legs or ankles
  • sudden weight gain
  • uneven or fast heartbeat

Mitoxantrone does not cause drowsiness.

Cancer and secondary cancer

Some research has suggested that there is a higher risk of some types of leukemia when using this drug.

Patients using this medicaion for MS have developed acute meylogenous leukemia (AML), and those with cancer may have a higher risk of a secondary cancer.

Drug interactions

Mitoxantrone can interact with other medications, herbs, or vitamins.

If is important to tell the health provider about any existing medications, vitamins, or supplements currently in use, as they can interact and alter each other’s effectiveness.

Other risks

Some people should not use this drug.

These include:

  • those with low immunity, as mitoxantrone can reduce immunity further
  • people with a heart condition, as it can decrease the heart’s ability to pump blood
  • anyone who is pregnant or breast-feeding
  • people with MS who have liver problems

Pregnancy

Mitoxantrone is a category D pregnancy drug.

That means two things:

1. Studies show there is a risk of adverse effects to the unborn child when the mother takes the drug.

2. This drug should only be used during pregnancy if it is needed to treat a dangerous condition in the mother, in other words, if not taking it increases the danger.

Mitoxantrone can harm a developing baby, so your doctor may give you a pregnancy test before each dose.

Anyone who is pregnant or planning on becoming pregnant should inform their doctor as soon as possible.

Breast-feeding

Mitoxantrone is not suitable during breast-feeding, as it may be passed to the baby through the breast milk. This can be harmful to the baby.

The chemicals can remain in breast milk for up to a month after discontinuing the medication.

Allergy

Allergic reactions have also been reported in some people. Symptoms include low blood pressure, hives and rashes, and difficulty breathing. In rare cases, anaphyaxis may occur.

Dosage

receive drugs in hospital
Some patients will need to receive their drugs as part of their hospital treatment. Mitoxantrone is always given in a healthcare setting.

The doctor will determine a suitable dose, based on the individual’s needs. It is important to take this medication exactly as prescribed by the doctor.

How long the treatment takes will depend on the condition.

  • For treating MS and prostate cancer, it usually takes 5 to 15 minutes.
  • People with nonlymphocytic leukemia may need to stay in the hospital for treatment, as it will be part of a combination therapy.

A person’s general health may affect their dose. It is essential to tell the doctor about any existing health conditions before receiving the drug.

If you miss an appointment for a dose, it is important to call the doctor’s office to make another appointment as soon as possible.

How do I know it is working?

This is a long-term treatment, and it may take time for the benefits to appear.

If the drug is working for MS, symptoms will not get worse and there will be fewer flare-ups.

The doctor will do tests to see how well the drug is working for cancer treatment.

Clinical Monitoring

The doctor may perform these tests to monitor the individual’s progress and health as they take mitoxantrone:

  • complete blood count
  • chest X-ray
  • heart function tests:
  • electrocardiography
  • echocardiography
  • ejection fraction
  • cholesterol level tests
  • liver function and bile tests
  • pregnancy tests

Travel and insurance tips

Travel: Mitoxantrone is only given by a healthcare provider, so anyone who is planning to travel should discuss their travel plans with their provider. In this way, they can arrange for a place to receive mitoxantrone while travelling.

Insurance: Many insurance companies will need prior authorization before they approve the payment for mitoxantrone.