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Mitoxantrone Coupon - Mitoxantrone 10ml of 20mg/10ml vial

mitoxantrone

Generic Novantrone
Used for Multiple Sclerosis
Used for Multiple Sclerosis

Mitoxantrone is a topoisomerase inhibitor, which is a type of chemotherapy. It's FDA-approved to treat multiple sclerosis (MS), prostate cancer, and acute myeloid leukemia (AML). But it's not a first-choice medication for these conditions. Mitoxantrone is given as an infusion into the veins; how often you receive it depends on your medical condition. Some common side effects of mitoxantrone include nausea and hair loss. It can also cause serious heart-related problems (cardiotoxicity). Brand name Novantrone is no longer available.

Reviewed by:
reviewer
Connie Zheng, PharmD
reviewer
Sonja Jacobsen, PharmD, BCPS, BCOP
Last reviewed on January 18, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesImagesReferencesPricesMedicare
basics-icon

What is Mitoxantrone?

What is Mitoxantrone used for?

How Mitoxantrone works

Mitoxantrone is a topoisomerase inhibitor. It blocks proteins called topoisomerases that typically help cells make copies of themselves. By blocking these proteins, cells (including cancer cells) aren't able to grow and divide.

Mitoxantrone also affects your immune system. It's thought to slow down the worsening of MS by blocking certain immune cells from attacking your nerves.

Drug Facts

Common BrandsNovantrone (brand name no longer available)
Drug ClassTopoisomerase inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Mitoxantrone?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Multiple sclerosisProstate cancer
  • Changes in blood cell counts (up to 87%)
  • Nausea (up to 61%)
  • Changes in alkaline phosphatase (up to 37%)
  • Tiredness (up to 34%)
  • Higher blood sugar levels (up to 31%)
  • Swelling (up to 30%)
  • Hair thinning (up to 29%)
  • Poor appetite (up to 25%)
Leukemia
  • Fever (up to 78%)
  • Nausea or vomiting (up to 72%)
  • Diarrhea (up to 47%)
  • Hair thinning (up to 37%)
  • Sepsis (up to 34%)
  • Sores or inflammation inside the mouth or gut (up to 29%)

Other Side Effects

  • Weakness
  • Headache
  • Irregular heartbeat
  • Constipation
  • Stomach pain
  • Stomach bleeds
  • Bleeding under the skin (small red or purple dots; bruise)
  • Nail bed changes
  • Cough
  • Shortness of breath
  • Throat infection
  • Fungal infections
  • Changes in weight
Please note: Side effects listed might not be from mitoxantrone alone. Some people who took mitoxantrone in clinical trials also took other anticancer medications.

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Low blood cell counts (myelosuppression): feeling tired, getting infections more often, bruising and bleeding easily
  • Heart problems: shortness of breath, swelling of your ankles or feet, sudden weight gain, fast heartbeat, pounding in your chest

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

bladder pain

bloody or cloudy urine

cough or shortness of breath

difficult, burning, or painful urination

dizziness

fainting

fast, slow, or irregular heartbeat

frequent urge to urinate

lower back or side pain

pale skin

stomach pain

swelling or inflammation of the mouth

troubled breathing with exertion

ulcers, sores, or white spots in the mouth

unusual bleeding or bruising

unusual tiredness or weakness

Less common

Blood in the urine or stools

decrease in urination

fever or chills

pinpoint red spots on the skin

seizures

sore, red eyes

swelling of the feet and lower legs

yellow eyes or skin

Rare

Blue skin at the place of injection

pain or redness at the place of injection

skin rash

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Absent, missed, or irregular menstrual periods

back pain

body aches or pains

congestion

constipation

diarrhea

dryness or soreness of the throat

hair loss

headache

longer or heavier menstrual periods

nausea or vomiting

oral bleeding

pain or tenderness around the eyes and cheekbones

runny nose

sneezing

stopping of menstrual bleeding

stuffy nose

tender, swollen glands in the neck

thinning of the hair

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Mitoxantrone

thumbs-up

Pros

Given once every few weeks or months, depending on condition being treated

Available as a lower-cost generic

thumbs-down

Cons

Not a first-choice medication for MS, prostate cancer, or leukemia

Risk of serious heart-problems

pharmacist-tips

Pharmacist tips for Mitoxantrone

pharmacist

  • Let your provider know before you start mitoxantrone if you're taking any medications. Also let them know if you've taken heart medications or cancer medications in the past. Your provider can determine if your medications can affect your treatment or cause serious side effects.

    • Your urine might have a blue-green color for 24 hours after your mitoxantrone dose. You might also experience a temporary bluish color in the whites of your eyes. This color change isn't harmful; the medication itself is a dark blue color.

      • Mitoxantrone can cause myelosuppression, which is when your bone marrow makes fewer blood cells. Let your provider know immediately if you experience any signs and symptoms of myelosuppression, such as feeling tired, getting infections more often, and bruising and bleeding easily.

        • Mitoxantrone can cause congestive heart failure (CHF), which happens when your heart can't pump blood the way it should. Let your provider know right away if you experience signs of heart problems, such as shortness of breath, swelling of your ankles or feet, sudden weight gain, fast heartbeat, or pounding in your chest.

          • Mitoxantrone can sometimes leak out of the infusion area and cause redness, swelling, pain, burning, or a bluish skin color. The leakage can cause damage to the skin tissues. If you notice these symptoms during an infusion, alert your care team right away.

            faqs

            Frequently asked questions about Mitoxantrone

            Is mitoxantrone a form of chemotherapy?
            Yes, mitoxantrone is a chemotherapy. Chemotherapies are medications that kill fast-growing cells, such as cancer cells. Specifically, mitoxantrone is a topoisomerase inhibitor that works by preventing cells from making copies of itself. In doing so, cells, like cancer cells, can't grow and spread.
            Is mitoxantrone an anthracycline?
            Anthracycline is a class of chemotherapy medications that prevent cells from making copies of themselves. Mitoxantrone is very similar to anthracyclines and it's sometimes referred to as an anthracycline in the broad sense of the term. But mitoxantrone differ slightly from anthracyclines in its chemical structure and how it works. Both mitoxantrone and anthracyclines treat cancer by preventing cells from making copies of themselves.
            What color is mitoxantrone?
            Mitoxantrone is a dark blue medication that's infused into the veins. Be aware that this medication can cause your urine to turn blue-ish green for up to 24 hours after an infusion. Some people also noted the whites of their eyes turning blue. This side effect is temporary and should go away with time.
            Is mitoxantrone used for cancer?
            While mitoxantrone is FDA-approved for to relieve pain in advanced prostate cancer and to treat acute myeloid leukemia (AML), it's not a first-choice medication for either of these conditions because there are other options that work better. If you need chemotherapy, your provider will consider other medications first based on treatment guidelines. Talk with your provider if you have questions about mitoxantrone and cancer.
            Is mitoxantrone used for multiple sclerosis (MS)?
            Mitoxantrone is FDA-approved to treat MS. Studies suggest that it can help with MS by calming down certain immune cells from attacking the nerves. But recent guidelines don't recommend this medication as a first-choice option because it can cause serious side effects, such as cardiotoxicity (serious heart problem), fertility problems, and risk of cancer. Ask your provider if you have concerns about mitoxantrone and MS.
            What tests do I need to do before mitoxantrone treatments?
            You might be required to get a few blood tests before and at certain times during treatment. Your provider will check your blood cell counts before each dose of mitoxantrone and when you experience signs and symptoms of an infection. They'll also check your liver function before each treatment course to make sure your liver is working properly. In addition, since mitoxantrone can affect the heart, your provider will perform tests on your heart before each dose and when you experience signs and symptoms of heart problems anytime during your treatment. Lastly, females who are able to have a baby will need to get a pregnancy test before each dose of mitoxantrone to make sure this medication isn't given during pregnancy.
            Can I receive mitoxantrone if I'm breastfeeding?
            Mitoxantrone can pass into your breast milk for up to 28 days or longer after your last dose. Since there's a risk that mitoxantrone might cause harm to your baby, stop breastfeeding before you start your treatment. Speak with your provider about the best way to feed your baby while you're getting mitoxantrone.
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            warings-icon

            What are the risks and warnings for Mitoxantrone?

            Mitoxantrone can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

            risk-warning

            Only given by an experienced provider

            Mitoxantrone should only be injected slowly as an intravenous (into the vein) infusion by a healthcare provider experienced in cancer chemotherapy. This will make sure that you're monitored and treated properly for any severe side effects. This medication should never be given subcutaneously (under the skin), intramuscularly (into the muscle), intra-arterially (into an artery), or intrathecally (into the spinal canal), because it can cause serious problems.

            risk-warning

            Low blood cell count

            Mitoxantrone shouldn't be given to people with a low white blood cell (WBC) count, unless it's used for the treatment of leukemia. Mitoxantrone can cause your WBCs to drop dangerously low and raise your risk for serious infection. Regardless of why you're receiving this medication, your provider will check your blood count often during treatment. Let your provider know if you have a history of low blood cell counts, and they'll determine if you should still receive this medication.

            risk-warning

            Risk of heart problems

            • Risk factors: Multiple doses of mitoxantrone | History of heart disease | Radiotherapy to the lungs or heart area | Previous therapy with mitoxantrone or other medications classified as anthracyclines (e.g., doxorubicin) | Taking other medications that are harmful to the heart

              Mitoxantrone can raise the risk of heart problems, such as congestive heart failure. This can happen during your treatment with mitoxantrone or months to years after stopping this medication. The more mitoxantrone you receive, the higher your risk will be for heart failure. Before starting mitoxantrone, your provider will check your heart through ultrasound to determine if you can receive this medication. If you're being treated for multiple sclerosis, your provider will check your heart before each dose, and yearly after stopping treatment.

              risk-warning

              Possible risk of leukemia (in people who have MS)

              People with multiple sclerosis or cancer who receive mitoxantrone have a higher risk of developing secondary leukemia. This is when a new blood cancer develops during the treatment of a condition that you already have. The most common types are acute promyelocytic leukemia and acute myeloid leukemia. Let your provider know right away if you experience signs and symptoms of acute leukemia, such as feeling usually tired and weak, getting infections more often, bruising and bleeding easily, fever, unexplained weight loss, or night sweats.

              risk-warning

              Harm to unborn baby

              • Risk factors: Pregnancy

                Based on the way it works, mitoxantrone might cause harm to your unborn baby if you're getting this medication while you're pregnant. If you're a female who's able to become pregnant, speak with your provider about ways to avoid becoming pregnant and options for birth control during your treatment. You might need to take a pregnancy test before each dose to make sure you're not pregnant when you receive the medication. Discuss the risks and benefits of this medication with your provider.

                risk-warning

                Allergic reaction

                Mitoxantrone contains a chemical compound called a sulfite, and although it's rare, it might cause serious allergic reactions, including anaphylaxis. You'll be monitored carefully during and after your treatment with mitoxantrone. Get medical help right away if you experience signs and symptoms of an allergic reaction, such as dizziness, hives, rash, difficulty breathing, or swelling of the mouth or throat.

                dosage

                Mitoxantrone dosage forms

                Typical dosing for Mitoxantrone

                Your provider will calculate the dose based on your body surface area (BSA, in units of m2), which takes into account your weight and height.

                Dosing from manufacturer is listed below:

                • Multiple sclerosis (MS): The typical dose is 12 mg/m2 given as a short infusion into the vein (intravenous, IV) every 3 months.

                • Prostate cancer: The typical dose is 12 mg/m2 to 14 mg/m2 given as a short infusion into the vein every 3 weeks.

                • Acute myeloid leukemia (AML): Your dose can differ depending on what stage of treatment you're in. The typical dose for induction is 12 mg/m2 given as an infusion into the vein once daily on days 1 to 3. Your provider will also give you other anticancer medications as part of treatment.

                interactions

                Interactions between Mitoxantrone and other drugs

                Mitoxantrone may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Mitoxantrone. Please note that only the generic name of each medication is listed below.

                Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                • Eltrombopag
                alternatives

                What are alternatives to Mitoxantrone?

                There are a number of medications that your doctor can prescribe in place of Mitoxantrone. Compare a few possible alternatives below.
                Mitoxantrone
                Used for:
                View Prices
                Fingolimod (Gilenya)
                Used for:

                • Relapsing forms of multiple sclerosis (MS)

                $169.88 Lowest GoodRx priceView Prices
                Ocrevus (ocrelizumab)
                Used for:

                • All types of multiple sclerosis (MS)

                View Prices
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                References

                Best studies we found

                American Cancer Society. (2018). What is acute myeloid leukemia (AML)?

                American Cancer Society. (2019). How chemotherapy drugs work.

                American Cancer Society. (2023). Typical treatment of acute myeloid leukemia (except APL).

                View All References (13)

                Centers for Disease Control and Prevention. (2024). Know the signs and symptoms of infection.

                Chang, A. (2020). A case of mitoxantrone extravasation. Journal of Oncology Pharmacy Practice.

                Genetic and Rare Diseases Information Center. (2024). Acute promyelocytic leukemia.

                Gonsette, R. E., et al. (2003). Mitoxantrone in progressive multiple sclerosis: When and how to treat? Journal of the Neurological Sciences.

                Hospira, Inc. (2022). Mitoxantrone injection, solution, concentrate [package insert]. DailyMed.

                Koeller, J., et al. (1988). Mitoxantrone: A novel anthracycline derivative. Clinical Pharmacy.

                Leone, G., et al. (1999). The incidence of secondary leukemias. Haematologica.

                National Cancer Institute. (n.d.). Myelosuppression.

                National Comprehensive Cancer Network. (2024). Acute myeloid leukemia.

                National Comprehensive Cancer Network. (2024). Advanced-stage prostate cancer.

                National Multiple Sclerosis Society. (n.d.). Primary progressive multiple sclerosis (PPMS).

                Rae-Grant, A., et al. (2018). Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis. Neurology.

                Scott, L. J., et al. (2004). Mitoxantrone: A review of its use in multiple sclerosis. Central Nervous System Drugs.

                GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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