Mitox­antrone for Mul­ti­ple Sclerosis

MUHC /​CUSM, 2004

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1. What is Mitox­antrone?
2. What should my doc­tor know before I use Mitox­antrone?
3. What can I expect dur­ing my treat­ment?
4. What can I expect after my treat­ment?
5. Will I have to have any tests while tak­ing Mitox­antrone?
6. How long will I take Mitox­antrone?
7. Who should not take Mitox­antrone?
8. Impor­tant infor­ma­tion about Mitox­antrone
9. Side Effects
10. How can the side effects of Mitox­antrone be man­aged?
11. What are other pos­si­ble side effects?
12. Preg­nancy
13. Addi­tional Resources & Information

1. What is Mitoxantrone?

Mitox­antrone is a drug used to treat cer­tain types of wors­en­ing MS. Mitox­antrone is not a cure, but it may help slow pro­gres­sion of the dis­ease. It may also decrease the num­ber of relapses that you have.

Mitox­antrone was first devel­oped over 10 years ago as a drug to treat can­cer. It is a drug that sup­presses the immune sys­tem (an immuno­sup­pres­sive drug). Sup­press­ing the immune sys­tem can be ben­e­fi­cial in the treat­ment of MS because, in MS, cer­tain cells in your immune sys­tem attack your brain and spinal cord. By sup­press­ing the immune sys­tem, Mitox­antrone can help con­trol the cells that attack myelin and cause lesions. This may help reduce the symp­toms of MS in some patients.

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2. What should my doc­tor know before I use Mitoxantrone?

You and your doc­tor will need to talk about the risks and ben­e­fits of this med­i­cine. For you and your doc­tor to decide if this med­ica­tion is right for you, your doc­tor will need to know the fol­low­ing: Tell your doc­tor about all the med­i­cines you are tak­ing, includ­ing non-​prescription med­i­cines and nutri­tional sup­ple­ments. Tell your doc­tor if you have now or had in the past:

  • Pre­vi­ous treat­ment with Mitoxantrone
  • Prob­lems asso­ci­ated with heart dis­ease (for exam­ple high blood pres­sure, high cholesterol)
  • Blood-​clotting problems
  • Ane­mia or low red blood cell counts
  • Low white blood cell counts
  • Unusual or unex­pected bleeding
  • Liver dis­ease or problems
  • Pre­vi­ous his­tory of can­cer or benign tumours
  • Can­cer chemother­apy treatment
  • Radi­a­tion to the chest area
  • Infec­tions
  • Any known aller­gies or sensitivities

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3. What can I expect dur­ing my treatment?

  • Mitox­antrone is given intra­venously (infused into the vein)
  • Your doc­tor will deter­mine an infu­sion sched­ule: when, and how often you will receive an infusion.
  • While the treat­ment takes 23 hours, count on spend­ing about half a day in the Neu­ro­log­i­cal Day Cen­ter to see a doc­tor and have your blood tests reviewed etc…
  • As part of your treat­ment, you will be given an anti-​nausea drug and an intra­venous steroid
  • Once a sched­ule has been set, it is impor­tant not to miss a dose. If you can­not keep an appoint­ment, please resched­ule right away.

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4. What can I expect after my treatment?

Gen­er­ally the med­ica­tion is well tol­er­ated. You may expe­ri­ence some nau­sea and loss of appetite in the days fol­low­ing your treat­ment. You will be given med­ica­tion to help con­trol nau­sea, if needed. Some patients find they are very tired (fatigued) for a num­ber of days fol­low­ing their Mitox­antrone dose. Speak to your doc­tor or nurse about ways to man­age fatigue if this is a prob­lem for you.

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5. Will I have to have any tests while tak­ing Mitoxantrone?

You will need to have reg­u­lar test­ing of your heart and blood to help avoid side effects.

Blood sam­ples will be taken before each dose of Mitox­antrone to make sure your blood counts are nor­mal and to mon­i­tor your liver func­tion. Your doc­tor may also request a blood sam­ple if you have signs of infection.

If you are a woman who is capa­ble of becom­ing preg­nant, you should use an effec­tive means of birth con­trol since Mitox­antrone may be harm­ful to the fetus. If you sus­pect you are preg­nant, you must have a preg­nancy test and should know the results before you receive your next Mitox­antrone dose.

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6. How long will I take Mitoxantrone?

There is a life­time limit of Mitox­antrone treat­ment because high doses may dam­age your heart. For most patients, the limit is approx­i­mately 9 doses given over 2 to 3 years. After you reach your limit, you should not receive any addi­tional Mitox­antrone. You and your doc­tor should both keep track of how much Mitox­antrone you get.

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7. Who should not take Mitoxantrone?

  • Women who are preg­nant, try­ing to get preg­nant, or breast­feed­ing should not use Mitox­antrone because it may harm the baby.
  • Peo­ple who have active heart disease.

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8. Impor­tant infor­ma­tion about Mitoxantrone

Your Heart
To mea­sure pos­si­ble changes in your heart, you will have reg­u­lar test­ing of your heart’s abil­ity to pump blood, which is called the left ven­tric­u­lar ejec­tion frac­tion (LVEF). This requires hav­ing two pain­less tests before the first dose of Mitox­antrone is given: a MUGA scan and an electrocardiogram.

What is a MUGA scan? In the MUGA scan a small amount of radioac­tive dye will be injected into your blood­stream. The dye attaches to red cells in the blood and then a spe­cial cam­era traces the cells as they pass through your heart and cir­cu­la­tion system.

What is an elec­tro­car­dio­gram (ECG or EKG)? An ECG is a record­ing of the elec­tri­cal activ­ity of the heart. For this test small disks will be placed on your chest, using sticky patches or suc­tion cups. Wires lead­ing from these disks con­nect to a machine that records elec­tri­cal impulses of the heart.

You will be tested before the first dose of Mitox­antrone is given. The total amount of Mitox­antrone you receive will be care­fully tracked. Your doc­tor will also test your heart if you show signs of heart prob­lems. Your doc­tor may stop Mitox­antrone if your tests show that your heart’s abil­ity to pump blood has decreased.

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9. Side effects

The most com­mon side effects of Mitox­antrone in clin­i­cal stud­ies in peo­ple with MS, have been:

  • nau­sea
  • hair thin­ning
  • loss of men­strual periods
  • blad­der infections
  • mouth sores

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10. How can the side effects of Mitox­antrone be managed?

Most side effects of Mitox­antrone are not severe and can gen­er­ally be treated.

The nau­sea asso­ci­ated with Mitox­antrone is usu­ally mild and lasts for less than 24 hours. Your doc­tor may give you a drug before you receive Mitox­antrone to help con­trol your nau­sea. Here are some help­ful hints to con­trol or relieve nau­sea right after your dose of Mitoxantrone:

  • Avoid eat­ing for at least a few hours before treatment
  • Eat small meals through­out the day
  • Don’t eat sweet, fried, or fatty foods
  • Drink cool, clear, unsweet­ened fruit juices, like apple or grape juice
  • Avoid odors that bother you, like cook­ing smells, smoke, or perfume
  • Rest in a chair after eat­ing, but don’t lie flat for at least 2 hours after a meal
  • Breathe deeply and slowly if you feel nauseated
  • Take antacids
  • Place a cool wash­cloth on your forehead

Thin­ning hair
Most peo­ple have only slight hair thin­ning when treated with Mitox­antrone. If your hair thins while tak­ing Mitox­antrone, try the following:

  • Mild sham­poos
  • Soft hair­brushes
  • Low heat when dry­ing your hair
  • Not col­or­ing or perming your hair

Men­strual dis­or­der
Some women tak­ing Mitox­antrone may expe­ri­ence changes in their men­strual peri­ods. These changes may include a heav­ier or lighter men­strual flow. For some women men­stru­a­tion stops. Talk to your doc­tor if you notice any changes in your men­strual cycle while you are tak­ing Mitoxantrone.

Mitox­antrone may have an impact on fer­til­ity. Speak with your doc­tor if you have con­cerns about fer­til­ity and use of Mitoxantrone.

Because it can lower your white blood cell count, Mitox­antrone can increase your risk of get­ting an infec­tion. This risk is great­est within 1014 days of treat­ment. Blad­der infec­tions have been the most com­mon types of infec­tion in peo­ple with MS treated with Mitox­antrone. You should call your doc­tor or nurse right away if you have dif­fi­culty or pain when uri­nat­ing, an increased need to uri­nate, or if you have any other signs of infec­tion, includ­ing fever, chills, sore throat, or cough.

Blad­der and other infec­tions can be treated with antibi­otics. You can also take the steps below to help reduce your chances of get­ting an infection:

  • Wash hands frequently
  • Avoid peo­ple who have infections
  • Eat a well-​balanced diet and drink plenty of fluids
  • Get plenty of rest and appro­pri­ate exercise

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11. What are other pos­si­ble side effects?

Mitox­antrone is dark blue in color, so it may turn your urine a blue­green color. The white part of your eyes may also have a slight blue color. This effect should only last for a few days.

Mitox­antrone can lower your num­ber of platelets, a type of blood cell nec­es­sary for blood clot­ting. If you notice any unusual bleed­ing or bruis­ing, call your doc­tor immediately.

Other side effects may also occur. Be sure to tell your doc­tor about any side effects, whether or not they are listed in this brochure.

Rare side effects:
Mitox­antrone may cause con­ges­tive heart fail­ure. The may weaken the heart mus­cle. This is related to the dose of med­ica­tion and is unlikely to hap­pen if your heart is prop­erly mon­i­tored with reg­u­lar tests.

Leukemia is a pos­si­ble side effect which is seri­ous, but rare.

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12. Preg­nancy

Women should not become preg­nant or breast­feed while tak­ing Mitox­antrone because it may harm the fetus. If you wish to become preg­nant, or are con­cerned that you may be already, dis­cuss this mat­ter with your doc­tor. While tak­ing Mitox­antrone, women who might become preg­nant should use effec­tive birth con­trol and should be sure, before each dose, that they are not preg­nant by tak­ing a preg­nancy test. If you do become preg­nant, con­tact your doc­tor immediately.

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13. Addi­tional Resources & Information

Infor­ma­tion about InfoNEURO
Neuro-​Patient Resource Cen­tre
Mon­treal Neu­ro­log­i­cal Hosp­tial Room 354
Tel: (514) 3985358
E-​mail: infoneuro@​muhc.​mcgill.​ca
Web site: http://​infoneuro​.mcgill​.ca/

This infor­ma­tion is for edu­ca­tional pur­poses only, and is not intended to replace the advice of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.

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Col­lab­o­ra­tors: D. Low­den Clin­i­cal Nurse Spe­cial­ist, Mul­ti­ple Scle­ro­sis Clinic, B. Taugher, G. Leduc, S. DeMelo, Nurse Clin­i­cian Edu­ca­tors, Neu­rol­ogy Day Cen­tre.
Reviewed: Dr.Y. Lapierre, Dr. A. Bar-​or.
Pro­duced by the Neuro-​Patient Resource Cen­tre, Novem­ber 2004.
McGill McGill Uni­ver­sity Health Cen­tre.

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