Mitoxantrone should be applied with caution to patients suffering from pancytopenia or severe infections at the florid stage. This applies also in the case of severe hepatic and/or renal insufficiency. Moreover, special attention should be paid to patients with a history of severe heart disease as well as to patients who have been previously treated with anthracyclines and/or irradiated on their mediastinum.
In patients with one or more of the risk factors mentioned under Contraindications or in case of a combination of mitoxantrone with cardiotoxic cytostatic agents or other cardiotoxic medicaments, the treatment has to be carefully monitored (dose adjusting if necessary) and regular controls of cardiac function by suitable methods have to be carried out.
Safe contraception in patients of reproductive age is advised during mitoxantrone treatment and for 3 months after chemotherapy.
The haematological parameters must be monitored before each application of mitoxantrone as well as, at least, once during each treatment cycle. After a total cumulative dose of >160 mg mitoxantrone/m2 body surface area (in risk patients 140 mg/m2), it is recommended that regular control of heart function by suitable methods should be carried out.
The laboratory parameters described under Side Effects, in particular the liver values, should be monitored regularly before and during treatment.
Mitoxantrone must not be mixed with other drugs in an infusion solution or in a syringe.
Heparin must not be added to mitoxantrone solution as precipitation may occur.
Note: Mitoxantrone causes a blue-green coloration of the urine for 1-2 days after administration (panty-liner).