Mitoxantrone is an
immunosuppressant, a type of medicine that reduces the activity of the
immune system. It has been used to treat
leukemia and some advanced prostate cancer. Multiple sclerosis (MS) appears to be a disease in
which the immune system attacks the covering of the nerve fibers (myelin sheath)
within the brain and spinal cord, so immunosuppressants may slow the progression
of the disease. Immunosuppressants other than mitoxantrone, though, have not
been shown to significantly reduce the progression of MS or the frequency of
Mitoxantrone may be injected once every 3 months for up to 3 years.
A higher total dose increases the risk of serious heart damage.
Mitoxantrone is used to treat several forms of worsening MS, including
secondary progressive MS,
progressive relapsing MS, and advanced
Mitoxantrone is one of only two
medicines that have been shown to benefit people who have secondary progressive
MS that is relapsing. The interferon beta medicine Betaseron is the other.
Interferon beta will likely remain the first choice for treating secondary
progressive MS, because it does not carry the risk of heart damage associated
with mitoxantrone. Mitoxantrone may be
tried if you develop severe side effects from interferon beta, cannot take the
medicine for some other reason, or continue to have active disease.
Mitoxantrone reduces the frequency of relapses and helps slow the
development of disability in people who have secondary progressive MS that is
relapsing or advanced relapsing-remitting MS. Some studies have shown that
when mitoxantrone is combined with other drugs such as intravenous
methylprednisolone (IVMP) or interferon beta, the rate of new MS lesions in the brain
has been reduced.1
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Because mitoxantrone can lower your number of platelets (cells that help blood clot), you may have problems with bleeding. Make sure you know the signs of abnormal bleeding.
or other emergency services right away if you have:
Call your doctor right away if you have:
Common side effects of this medicine include:
See Drug Reference for a full list of side effects. (Drug Reference
is not available in all systems.)
Use of mitoxantrone may cause serious, even fatal, heart damage in
some people, including heart failure. It also can cause
leukemia. Frequent tests, including a
heart scan, are recommended before each injection of this medicine. To reduce
the risk of heart damage associated with the medicine, you should receive
only a limited number of doses. The U.S. Food and Drug Administration (FDA) recommends up to 12 total doses, or no more than 140 mg/m³ total cumulative dose.
Typically, the medicine is injected once every 3 months for 2 to 3
Due to these safety concerns and the limitations on its use, mitoxantrone
is for the most part being used only in specialized MS clinics or centers
staffed by neurologists and other health professionals who specialize in
treating people with MS.
As with interferon beta, people who are taking mitoxantrone need to
have regular blood tests to monitor white and red blood cell counts and liver
function. These are in addition to the regular testing needed to monitor heart
function. Mitoxantrone is not recommended for people who already have heart
disease, liver problems, or certain blood disorders, because it may make these
Mitoxantrone can keep your immune system from fighting infection. When you are taking this medicine (and even when you have finished taking it), try not to be around people who are sick. And make sure you talk to your doctor before you get any vaccinations.
Medicine is one of the many tools your doctor has to treat a health problem. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Women who use this medicine during pregnancy have a higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Stuart WH, Vermersch P (2004). Concomitant therapy for
multiple sclerosis. Neurology, 63(Suppl 5):
May 14, 2012
Adam Husney, MD - Family Medicine
& Anne C. Poinier, MD - Internal Medicine & Barrie J. Hurwitz, MD - Neurology
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