Mitoxantrone

Mitoxantrone is a type of chemotherapy. You pronounce mitoxantrone as my-toe-zane-trone.

You might have it as a treatment for: 

• breast cancer that has spread
• non-Hodgkin lymphoma
• leukaemia
• prostate cancer

How does mitoxantrone work?

Mitoxantrone works by stopping cancer cells growing and reproducing. 

How do you have mitoxantrone?

You have mitoxantrone as a drip into your bloodstream (intravenous). It is a dark blue liquid.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have mitoxantrone?

You usually have mitoxantrone chemotherapy as a course of several cycles of treatment .

How often you have it depends on the type of cancer you have and what your treatment plan is. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of mitoxantrone?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and tiredness 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• a low level of platelets in the blood causing an increased risk of bruising and bleeding
• loss of appetite
• lacking energy, feeling weak and tired (fatigue)
• an increased risk of heart problems including congestive heart failure and heart attack
• shortness of breath or difficulty breathing
• constipation or diarrhoea
• a sore, inflamed mouth
• high temperature (fever)

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• a serious allergic reaction signs can include difficulty breathing, swelling of the hands, feet, throat, mouth, face or lips, sudden itchy rash (hives) or feeling faint. Contact your advice line straight away if you have any of these symptoms.
• other cancers including leukaemia and myelodysplastic syndrome. Talk to your doctor if this of concern to you.
• your bone marrow not being able to make any blood cells
• weight loss or weight gain
• a sudden change to the chemicals in your blood (tumour lysis syndrome) that can cause kidney problems symptoms such as restlessness, weakness, being sick, joint pain and muscle cramps. This is most common in people being treated for leukaemia or lymphoma.
• feelings of anxiety and confusion
• headaches
• nerve damage causing tingling and prickling (pins and needles)
• colour changes to the whites of the eyes
• changes to your heartbeat
• low blood pressure (hypotension)
• tummy (abdominal) pain
• inflammation of the pancreas
• bleeding in the gut
• inflammation of the mouth, nose, throat, stomach, gut and bowels
• damage to the liver
• nail changes and skin changes such as a rash and reddening
• kidney problems
• changes to the colour of your urine
• pain, swelling and redness around the injection site
• changes to how food and drink tastes

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months for men and 4 months for women after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding

Don’t breastfeed during this treatment and for at least 1 month after treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.