Dexrazoxane — Drug Monograph

Brand names: Zinecard, Totect

Drug class: Supportive Care Agent

Mechanism of Action

An intracellular chelating agent that diffuses into cells and undergoes conversion to a ring-opened chelating metabolite. It binds intracellular iron, preventing the formation of anthracycline-iron complexes and the subsequent iron-mediated free-radical generation that causes myocardial tissue damage. It also acts as a reversible topoisomerase II inhibitor, shielding cells from anthracycline-mediated tissue necrosis during extravasation.

FDA Indications

• Reducing the incidence and severity of cardiomyopathy associated with doxorubicin administration in women with metastatic breast cancer who have received a cumulative doxorubicin dose of 300 mg/m² and who will continue to receive doxorubicin (Zinecard)
• Treatment of extravasation resulting from intravenous anthracycline chemotherapy (Totect)

Common Side Effects

• Injection site pain
• Nausea
• Vomiting
• Alopecia
• Diarrhea
• Fever

Clinical Pearl

A dual-purpose intracellular iron chelator that reduces free-radical formation to protect host tissue from anthracyclines. CRITICAL DISTINCTION: marketed as Zinecard to reduce cumulative anthracycline-induced cardiomyopathy (10:1 ratio to doxorubicin, indicated once cumulative doxorubicin reaches 300 mg/m²), and as Totect as the emergency systemic antidote for anthracycline extravasation (3-day IV schedule, start within 6 hours, remove ice ≥15 minutes before infusing). The dosing schedules,…

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