Mitomycin (Specialist drug)

How it works

Following intracellular activation it alkylates and cross-links DNA, inhibiting DNA synthesis and generating cytotoxic free radicals.

Prescribing in practice

• It causes delayed, cumulative bone-marrow suppression and is a potent vesicant that causes severe tissue necrosis if extravasated, so it must be given by experienced staff with extravasation precautions.
• Cumulative use is associated with haemolytic uraemic syndrome and pulmonary toxicity, which should be watched for.
• Intravesical and intravenous routes have different protocols and the drug requires careful cytotoxic handling.

Monitoring

Monitor full blood count before each course, with renal function and respiratory assessment over cumulative therapy and vigilance for haemolytic uraemic syndrome.

Counselling the patient

• Report fever, bruising, bleeding, breathlessness or reduced urine output to your team.
• After bladder instillation, follow the team's advice on bladder emptying and hygiene to protect skin.
• Inform staff immediately of pain, stinging or swelling at the drip site during infusion.

Evidence & guidelines

Long-established cytotoxic used per the SPC and specialist oncology protocols across systemic and intravesical indications.