Mitoxantrone (Onkotrone)

This chemotherapy drug used to be called mitozantrone. It is used to treat breast cancer, non Hodgkin's lymphoma, leukaemia and prostate cancer. It blocks an enzyme (called topoisomerase 2), so the cancer cell's DNA gets tangled up and the cell can't divide. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything cells do.

Mitoxantrone is a dark blue liquid. You have it by drip (infusion) into a vein through a fine tube put into the vein (cannula). Or you may have it through a , a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have mitoxantrone chemotherapy as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. There is detailed information about planning chemotherapy in CancerHelp UK. 

The side effects associated with mitoxantrone are listed below. You can use the links to find out more about each side effect or click on 'search' at the top of the page or go to our section about cancer drug side effects.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these  effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Urine may become a blue or green colour for one or two days after treatment – this is nothing to worry about
• Feeling or being sick may happen but is generally well controlled with anti sickness injections and tablets – if you are still being sick, tell your doctor or nurse as you can try other anti sickness medicines
• Mitoxantrone may harm a baby developing in the womb so it is not advisable to become pregnant or father a child whilst taking this drug – talk about contraception with your doctor before having your treatment if there is any chance you or your partner could become pregnant
• You should not breastfeed while having this drug as it may come through in the breast milk

Between 1 and 10 in every 100 people have one or more of these.

• Changes in heart muscle, which are usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
• Mouth sores and ulcers
• Diarrhoea – if you have diarrhoea, drink plenty of fluids and tell your doctor if it is severe or lasts more than a couple of days
• Hair thinning and loss of body hair
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working

Fewer than 1 in 100 people have these.

• The whites of the eyes go slightly blue, but this is temporary – if it happens to you, you will need to stop wearing contact lenses for a while
• Loss of fertility may happen with this drug, so it is important to talk to your doctor before starting treatment if you are concerned
• Women may stop having periods (amenorrhoea) but this may only be temporary

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.