mitomycin C (Mutamycin, Mitomycinum, Ametycin)

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Introduction

Tradename: Mutamycin.

Indications

Contraindications

pregnancy category = x

safety in lactation = -

Dosage

10-20 mg/m2 IV every 6-8 weeks
bladder irrigation: 20-40 mg in 40 mL of normal saline or sterile water every 1-2 weeks

Powder for injection: 5 mg, 20 mg.

Stability: Reconstituted is stable:

in sterile water for 7 days & 14 days if refrigerated
3 hours in D5W at room temperature
12 hours in normal saline at room temperature
24 hours in lactated ringers (LR) at room temperature
mitomycin 5-15 mg + heparin 1000-10,000 units in normal saline stable for 48 hours at room temperature

Pharmacokinetics

well distributed
no CSF penetration
inactivated by hepatic microsomal enzymes
further degraded by kidney & spleen
elimination 1/2life 1 hour
not removed by dialysis

elimination via liver

1/2life = 1 hour

elimination by hemodialysis = -

Adverse effects

common (> 10%)
- nausea/vomiting (mild to moderate, 10%)
  - begins 1-2 hours after treatment
  - lasts 3-4 days
- myelosuppression
  - WBC (moderate)
  - platelets (severe)
  - onset 21 days
  - nadir 36 days
  - recovery 42-56 days
- extravasation with tissue necrosis
less common (1-10%)
- stomatitis, discolored fingernails (violet), paresthesias of extremities, alopecia
- pulmonary fibrosis (7%)*
  - independent of dosing
  - manifest as dry cough with progressive dyspnea
  - generally responsive to steroid therapy
- renal toxicity*
  - elevation of serum creatinine (2%)
  - hemolytic uremic syndrome (generally, doses > 30 mg)
uncommon (< 1%)
- thrombophlebitis, weakness, paresthesias, fever, pruritus, microangiopathic hemolytic anemia, malaise, rash,
- cardiomyopathy, heart failure (generally, doses > 30 mg)^[4]
other
- diarrhea, hepatotoxicity, headache, confusion

* pneumonitis/nephrotoxicity with cumulative doses of 60 mg/m2

Drug interactions

vinca alkaloids

drug interaction(s) of antibiotics with warfarin

Test interactions

increases serum K+

Mechanism of action

antitumor antibiotic
inhibits DNA synthesis
at high concentrations, inhibits RNA synthesis

More general terms

antibiotic antineoplastic agent

References

↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
↑ ^3.0 ^3.1 Deprecated Reference
↑ ^4.0 ^4.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015

Database

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