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Mitoxantrone (Mitozantrone)

Mitoxantrone is a type of chemotherapy. It works by stopping cancer cells growing and reproducing. It is a treatment for: 

  • breast cancer that has spread
  • non-Hodgkin lymphoma
  • leukaemia

Mitoxantrone may also be used:

  • to reduce symptoms in people with liver cancer
  • with steroids to reduce pain in advanced prostate cancer

Some people have mitoxantrone for other types of cancer as part of a clinical trial.

How mitoxantrone works

Mitoxantrone works by stopping cancer cells growing and reproducing. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything that cells do.

Mitoxantrone blocks an enzyme called topoisomerase 2 so the cancer cell's DNA gets tangled up and the cell can't divide.

How you have mitoxantrone

You have mitoxantrone into your bloodstream. It is a dark blue liquid.

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have mitoxantrone

You usually have mitoxantrone chemotherapy as a course of several cycles of treatment.

How often you have it depends on the type of cancer you have and what your treatment plan is. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people. You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and tiredness 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a low level of platelets in the blood causing an increased risk of bruising and bleeding
  • loss of appetite
  • lacking energy, feeling weak and tired (fatigue)
  • an increased risk of heart problems including congestive heart failure and heart attack
  • shortness of breath or difficulty breathing
  • constipation or diarrhoea
  • a sore, inflamed mouth
  • high temperature

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • a serious allergic reaction signs can include difficulty breathing, swelling of the hands, feet, throat, mouth, face or lips, sudden itchy rash (hives) or feeling faint - contact your advice line straight away if you have any of these symptoms
  • other cancers including leukaemia, myelodysplastic syndrome
  • your bone marrow not being able to make any blood cells
  • weight loss or weight gain
  • a sudden change to the chemicals in your blood (tumour lysis syndrome) that can cause kidney problems symptoms include restlessness, weakness, being sick, joint pain and muscle cramps. This is most common in people being treated for leukaemia or lymphoma
  • feelings of anxiety and confusion
  • headaches
  • nerve damage causing tingling and prickling (pins and needles)
  • colour changes to the white of the eyes
  • changes to your heart beat
  • low blood pressure (hypotension)
  • tummy (abdominal) pain
  • inflammation of the pancreas
  • bleeding in the gut
  • inflammation of the mouth, nose, throat, stomach, gut and bowels
  • damage to the liver
  • nail and skin changes
  • kidney problems
  • changes to the colour of your urine
  • pain, swelling and redness around the injection site
  • changes to how food and drink tastes

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Having immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help