Dexrazoxane

How it works

It is a cyclic derivative of EDTA that chelates intracellular iron and interferes with topoisomerase II beta, reducing the formation of anthracycline-iron complexes and the free-radical damage that injures cardiac muscle.

Prescribing in practice

• Because it may attenuate antitumour efficacy and carries a risk of secondary malignancy and myelosuppression, its use as a cardioprotectant is restricted to defined situations set out in the SPC.
• It is given by intravenous infusion shortly before the anthracycline dose under specialist oncology supervision.
• Dose is calculated in relation to the anthracycline dose, so adjustments are needed when the chemotherapy regimen changes.

Monitoring

Monitor full blood count and cardiac function (including left ventricular ejection fraction) during therapy.

Counselling the patient

• Report breathlessness, ankle swelling or palpitations promptly, as these may indicate heart strain.
• Expect blood tests to check your blood counts before and during treatment.

Evidence & guidelines

Dexrazoxane is licensed and supported by trial evidence for limiting cumulative anthracycline cardiotoxicity, with use governed by MHRA and SPC restrictions.