Intravesical Chemotherapy Pregnancy: Contraindicated — cytotoxic

Mitomycin C

Brand names: Mitomycin-C Kyowa

Adult dose

Dose: 40 mg intravesically post-TURBT (single dose); or 40 mg weekly for 6 weeks (adjuvant course)

Route: Intravesical instillation

Frequency: Single immediate post-TURBT dose (within 24 hours); or weekly for 6 weeks

Max: 40 mg per instillation

Single immediate post-TURBT instillation recommended for all low- and intermediate-risk NMIBC — reduces 5-year recurrence rate. Patient must void before instillation; retain for 2 hours

Paediatric dose

Dose: Not applicable N/A/kg

Route: Intravesical

Frequency: Not applicable

Max: Not applicable

Not applicable

Dose adjustments

Renal

No dose adjustment (local therapy)

Hepatic

No dose adjustment

Paediatric weight-based calculator

Patient weight (kg)

Not applicable

Clinical pearls

NICE NG2: A single immediate intravesical dose of mitomycin C within 24 hours of TURBT is recommended for all NMIBC except if perforation suspected — reduces recurrence by approximately 40%
Must NOT be given if perforation is suspected — systemic absorption causes bone marrow suppression and pulmonary toxicity
Contact dermatitis: advise patients to wash genitalia and hands carefully after voiding for 6 hours post-instillation
For intermediate-risk NMIBC: 6-week course of mitomycin C or BCG (BCG preferred for high-risk disease)
Thermochemotherapy (heated intravesical mitomycin C) improves efficacy for BCG-unresponsive NMIBC — available in specialist centres

Contraindications

Bladder perforation or suspected perforation
Active UTI
Do not give if TURBT resulted in bladder perforation or heavy bleeding

Side effects

Chemical cystitis (dysuria, frequency — common)
Haematuria
Skin rash and contact dermatitis (wash hands and genital area after voiding for first 6 hours)
Bladder wall fibrosis (rare, with repeated courses)
Systemic absorption rare but possible with perforation

Interactions

None significant with intravesical route at standard doses

Monitoring

Cystoscopy surveillance
Urinalysis and urine culture
Skin reactions
Symptoms of chemical cystitis

Reference: BNFc; BNF 90; NICE NG2 (Bladder Cancer); EAU Bladder Cancer Guidelines 2024; Sylvester et al. meta-analysis (2004). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways