Cardioprotectant / anthracycline extravasation antidote Pregnancy: Should not be used during pregnancy unless clearly necessary - there are no adequate data in pregnant women and animal studies showed embryotoxic and teratogenic effects; it is used with anthracyclines known to have cytotoxic, mutagenic and embryotoxic properties. Both sexually active men and women should use effective contraception during treatment and for at least 6 months after cessation of treatment. Breast-feeding is contraindicated during treatment.

Dexrazoxane

Brand names: Cardioxane, Savene

Dexrazoxane is a cardioprotective agent used to reduce the risk of anthracycline-induced cardiotoxicity and as a treatment for anthracycline extravasation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: A dose equal to 10 times the doxorubicin-equivalent dose or 10 times the epirubicin-equivalent dose - i.e. 500 mg/m2 when the commonly used doxorubicin schedule of 50 mg/m2 is employed, or 600 mg/m2 when the commonly used epirubicin schedule of 60 mg/m2 is employed

Route: Intravenous - short intravenous infusion over 15 minutes. Source product: Cardioxane 500 mg powder for solution for infusion.

Frequency: Approximately 30 minutes prior to each anthracycline administration

Source: UK SPC (eMC) 4.2 for Cardioxane 500 mg powder for solution for infusion (https://www.medicines.org.uk/emc/product/15487/smpc). VERBATIM: 'Cardioxane is administered by a short intravenous infusion (15 minutes), approximately 30 minutes prior to anthracycline administration at a dose equal to 10 times the doxorubicin-equivalent dose and 10 times the epirubicin-equivalent dose.' The 10:1 dexrazoxane-to-anthracycline dose ratio is the governing rule - the 500 mg/m2 and 600 mg/m2 figures are the worked examples given in the SPC for the commonly used doxorubicin 50 mg/m2 and epirubicin 60 mg/m2 schedules. HEPATIC IMPAIRMENT: the dosage ratio should be kept - if the anthracycline dose is reduced, the dexrazoxane dose should be reduced accordingly. MYELOSUPPRESSION WARNING (4.4): myelosuppressive effects may be additive to those of chemotherapy and cell counts at nadir may be lower, so haematological monitoring is necessary; at higher doses of chemotherapy, where the dexrazoxane dose exceeds 1000 mg/m2, myelosuppression may increase significantly. PAEDIATRIC: safety and efficacy in children aged 0 to 18 years have not been established, and use is CONTRAINDICATED in children aged 0 to 18 years planned to receive a cumulative dose of less than 300 mg/m2 of doxorubicin or the equivalent cumulative dose of another anthracycline. Second primary malignancies, including acute myeloid leukaemia and myelodysplastic syndrome, have been reported in paediatric clinical trials in both dexrazoxane and control groups. NOTE: the eMC 4.5 interactions section was not retrieved in this bundle - the yellow fever vaccine contraindication below is taken from 4.3 (which cross-refers to 4.5), and the 'no drug interactions identified' statement is from the US label; source the UK SPC 4.5 separately.

Dose adjustments

Renal

In patients with moderate to severe renal impairment (creatinine clearance under 40 mL/min) the dexrazoxane dose should be reduced by 50%.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Children aged 0 to 18 years who are planned to receive a cumulative dose of less than 300 mg/m2 of doxorubicin or the equivalent cumulative dose of another anthracycline
Hypersensitivity to dexrazoxane
Breast-feeding
Concomitant vaccination with yellow fever vaccine

Side effects

Anaemia and leukopenia (very common); neutropenia, thrombocytopenia, febrile neutropenia, granulocytopenia, febrile bone marrow aplasia (common)
Nausea, vomiting and stomatitis (very common); diarrhoea, constipation, abdominal pain, dyspepsia (common)
Alopecia (very common); nail disorder and erythema (common)
Asthenia (very common); mucosal inflammation, pyrexia, fatigue, malaise, oedema and injection site reactions including pain, swelling, burning sensation, erythema, pruritus and thrombosis (common)
Decreased ejection fraction and tachycardia (common); phlebitis (common)
Acute myeloid leukaemia (uncommon); anaphylactic reaction and hypersensitivity (frequency not known)

Interactions

Yellow fever vaccine - concomitant vaccination is contraindicated (eMC 4.3, cross-referring to 4.5)
No drug interactions have been identified (US label)

Clinical monograph

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.

Reference: UKONS extravasation; ESMO supportive care; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

HFA-ICOS Cardio-Oncology Risk Assessment for Anthracyclines · Cardio-Oncology

Pathways