Kesimpta, Tysabri, and More: 8 Injections and Infusions for Multiple Sclerosis
For people living with multiple sclerosis (MS), many injectable medications are available to manage the condition. Here are eight MS injections and infusions to know.
mitoxantrone
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.
What is Mitoxantrone?
What is Mitoxantrone used for?
- Secondary progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (MS)
- Advanced prostate cancer that doesn't respond to hormone treatment
- Acute myeloid leukemia (AML) in adults
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 Brands | Novantrone |
|---|---|
| Drug Class | Topoisomerase inhibitor |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
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 sclerosis
- Nausea (up to 76%)
- Hair thinning (up to 61%)
- Changes to menstrual bleeding (up to 61%)
- Upper respiratory tract infection (up to 53%)
- Urinary tract infection (up to 32%)
- Diarrhea (up to 25%)
Prostate 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%)
Less Common 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.
Mitoxantrone 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
The following Mitoxantrone 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
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
dryness or soreness of the throat
headache
longer or heavier menstrual periods
nausea or vomiting
oral bleeding
pain or tenderness around the eyes and cheekbones
stopping of menstrual bleeding
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 of Mitoxantrone
Pros
- Given once every few weeks or months, depending on condition being treated
- Available as a lower-cost generic
Cons
- Not a first-choice medication for MS, prostate cancer, or leukemia
- Risk of serious heart-problems
Pharmacist tips for Mitoxantrone
- 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.
- Nausea and vomiting are common side effects of mitoxantrone and can lead to dehydration. Make sure to drink plenty of fluids to stay hydrated.
- Contact your provider if you have any signs or symptoms of an infection. Your infection should be treated before or during your treatment with mitoxantrone.
- 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.
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.
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.
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 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.
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.
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.
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.
Mitoxantrone dosage
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.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
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.
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine, Live
- Valspodar
- Yellow Fever Vaccine
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.
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.
News about Mitoxantrone
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