Browse the corpus

Dexrazoxane is a medication used in the management and treatment of anthracycline-induced cardiotoxicity and extravasation injuries. It is in the class of medications known as cardioprotectants. This activity reviews the indications, action, and contraindications for dexrazoxane as a valuable agent in the management of cardiotoxicity and anthracycline extravasation leading to tissue damage. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the care of patients with anthracycline-induced cardiotoxicity, extravasation injuries and related conditions. Objectives: Describe the mechanism of action of dexrazoxane. Review the administration of dexrazoxane including dosage adjustments in renal and hepatic impaired patients. Identify the adverse effects seen with dexrazoxane use along with the protocols in place as regards to the toxicity of this drug. Outline the importance of collaboration and coordination among the interprofessional team to enhance care delivery for patients receiving dexrazoxane. Access free multiple choice questions on this topic.

There is no data on toxicity in the trials of dexrazoxane, and no known antidote for a reversal exists in the literature. In cases of a suspected overdose, management using good supportive care is advisable. These interventions include targeting areas such as infection treatment and control and fluid management, with regular preservation of nutritional requirements.

Dexrazoxane is approved clinically for anthracycline-induced cardiotoxicity (reducing the incidence of congestive heart failure and LVEF dysfunction) and extravasation. This drug is only recommended for use intravenously. Healthcare providers comprising of physicians (ranging from the patient's primary care provider to the oncologist as well a psychologist to deal with any form of mental illness the patient could be going through), nurses, and pharmacists, need to be cognizant of the most common side effects of this drug which is myelosuppression and work together to assess dosage of this drug, adjusting doses if and when necessary to combat adverse consequences seen with myelosuppression, monitor hematological function, and tackle any early signs of infection or bleeding. It is also critical to note that dexrazoxane does not completely improve cardiac dysfunction associated with the use of anthracyclines; hence, constant monitoring of heart function should be advised. It is also important to get a cardio-oncologist specialist involved when heart failure or a significant decline of left ventricular ejection fraction (LVEF) occurs during chemotherapy. This assistance is critical for careful decision-making regarding further exposure to cardiotoxic cancer treatment. Oncology nurses will be administering this drug in most cases and need to be conversant with the adverse effects, which could mimic those seen with anthracyclines, reporting any issues to the physician team as well as assessing the patient's vitals and injection sites for any signs of inflammation. Patients should be made aware of the adverse reaction seen with dexrazoxane and advised to report any changes noted as soon as possible. Their obstetrician should also counsel patients on pregnancy planning and prevention, as this medication is a known teratogen and can cause fetal harm. Female patients should use effective contraception during treatment. It is unknown if dexrazoxane is secreted in breast milk and has any effect on milk production or the breastfed infant. Due to the unknown nature of this drug on milk production or secretion, women should halt breastfeeding while on dexrazoxane therapy and for two weeks after the last dose.