Mitoxantrone belongs to the group of cancer-fighting medications known as antineoplastics. It kills cancer cells by interfering with their growth and reproduction. It is used alone or in combination with other antineoplastic medications to treat many types of cancer. These include certain types of leukemia (cancer of the white blood cells), breast cancer, lymphoma (cancer of the lymph cells), and hepatoma (cancer of the liver).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop receiving this medication without consulting your doctor.

The recommended dose and dosing schedule of mitoxantrone varies according to the specific condition being treated, the response to therapy, the other medications or treatments being used and the body size of the person receiving treatment.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications.

Mitoxantrone is usually injected into a vein through a specially prepared site on your skin. Very careful handling of this medication is required. Mitoxantrone is always given under the supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

While you are receiving mitoxantrone, your doctor may want you to drink extra fluids to help prevent kidney problems.

As well as interfering with the genetic material DNA of cancer cells, mitoxantrone can interfere with some of your normal cells. This can cause a number of side effects such as hair loss and mouth sores. Mitoxantrone can cause nausea and vomiting, but it is important to keep using this medication even if you feel ill. Your doctor, nurse, or pharmacist can advise you on how to reduce the effects of nausea and vomiting. Keep track of any side effects and report them to your doctor as suggested in the section, "What side effects are possible with this medication?"

It is important to receive this medication exactly as recommended by your doctor. If you miss an appointment to receive mitoxantrone, contact your doctor as soon as possible to reschedule your appointment.

This medication is stored at the hospital or clinic where you receive treatment.

Mitoxantrone should not be used by anyone who:

• is allergic to mitoxantrone or to any of the ingredients of the medication
• is allergic to the class of medications known as anthracyclines
• is breast-feeding
• has low blood cell counts caused by previous treatment with cancer medications or radiation therapy
• has problems with heart function caused by previous treatment with cancer medications
• has severe liver problems and poor performance status

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• blue-green-coloured urine (usually lasts 1 to 2 days after each dose)
• body aches or pains
• congestion
• constipation
• diarrhea
• fatigue
• headache
• loss of appetite
• nausea
• sore throat
• sore or red eyes
• temporary loss of hair
• vomiting
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety
• bluish discoloration of the white of the eye
• confusion
• reduction in urine output
• seizures
• signs of bleeding (e.g., bloody nose; blood in urine or stools; coughing blood; cuts that don't stop bleeding; unusual bleeding or bruising; black, tarry stools)
• signs of gout (e.g., joint pain, swelling and warmth of joints)
• signs of heart disease (e.g., fast or irregular heartbeat; swelling of lower legs, feet, and abdomen; wheezing, trouble breathing, or shortness of breath)
• signs of kidney stones (e.g., lower back or side pain, painful or difficult urination)
• sores in mouth and on lips
• stomach pain
• swelling of the feet or lower legs
• yellow eyes or skin

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• seizures
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of a skin reaction at the injection site (e.g., red streaks along vein where medication was injected, pain at injection site, redness or warmth at site of injection)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of infection (e.g., cough, fever, or chills; severe diarrhea; shortness of breath; prolonged dizziness; headache; stiff neck; weight loss; or listlessness)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Gout and kidney stones: Mitoxantrone may increase the levels of uric acid in the body, increasing the risk of developing gout or kidney stones. If you develop painful, warm, and swollen joints or difficulty with urination, contact your doctor as soon as possible. People with a history of gout or kidney stones should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart disease: Mitoxantrone may cause heart failure during treatment or after treatment has finished. The risk of abnormal heart rhythm, congestive heart failure, and a weakened heart (cardiomyopathy) is increased for people with preexisting heart disease. People with heart disease or an increased risk of heart disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infection: As well as killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). Avoid contact with people with contagious infections and tell your doctor if you begin to notice signs of an infection, such as fever or chills.

Liver function: Mitoxantrone may cause decreased liver function. If you experience symptoms of liver problems (itchy rash, yellowing of the eyes or skin, dark urine, vomiting, upper right abdominal pain), contact your doctor as soon as possible. People with reduced liver function or liver disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Secondary leukemia: There is some evidence to suggest that people who receive treatment with mitoxantrone are at an increased risk of developing acute myeloid leukemia (AML). Talk to your doctor if you have concerns.

Pregnancy: There is a possibility of birth defect if either the man or the woman is using mitoxantrone at the time of conception, or if it is taken during pregnancy. Effective birth control should be practiced while using this medication. This medication may harm the baby if used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are breast-feeding and are taking mitoxantrone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

There may be an interaction between mitoxantrone and any of the following:

• 5-aminosalicyic acid medications (e.g., mesalamine, sulfasalazine)
• baricitinib
• BCG vaccine
• other cancer medications
• clozapine
• denosumab
• echinacea
• leflunomide
• natalizumab
• ocrelizumab
• pimecrolimus
• sphingosine 1-phosphate receptor modulators (e.g., fingolimod, ozanimod, siponimod)
• tacrolimus
• tofacitinib
• upadacitinib
• vaccines

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.