Indications

• For the treatment of secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis
• Mitoxantrone is an antineoplastic antibiotic that is used in the treatment of acute leukemia, lymphoma, and prostate and breast cancer, but also for late-stage, severe multiple sclerosis.
• Mitoxantrone (NOVANTRONE) is supplied for iv infusion. To induce remission in acute nonlymphocytic leukemia in adults, the drug is given in a daily dose … for 3 days as a component of a regimen that also includes cytosine arabinoside. Mitoxantrone also is used in advanced hormone-resistant prostate cancer. In 2000, mitoxantrone was approved by the FDA for the treatment of late-stage secondary progressive multiple sclerosis.
• To reduce neurologic disability and/or the frequency of clinical relapses in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (i.e., patients whose neurologic status is significantly abnormal between relapses)
• The combination of mitoxantrone and prednisone is approved as a second-line treatment for metastatic hormone-refractory prostate cancer. Until recently this combination was the first line of treatment; however, a combination of docetaxel and prednisone improves survival rates and lengthens the disease-free period.^[rx]
• Mitoxantrone is also used to treat multiple sclerosis (MS), most notably the subset of the disease known as secondary-progressive MS. In the absence of a cure, mitoxantrone is effective in slowing the progression of secondary-progressive MS and extending the time between relapses in both relapsing-remitting MS and progressive-relapsing MS.^[rx]
• Acute Lymphoblastic Leukemia (ALL)
• Acute Myeloid Leukemia
• Acute Promyelocytic Leukemia
• Hodgkin’s Lymphoma
• Metastatic Breast Cancer
• Non-Hodgkin’s Lymphoma (NHL)
• Progressive Relapsing Multiple Sclerosis
• Relapsed Leukemia
• Relapsed Lymphomas
• Relapsing-Remitting Multiple Sclerosis (RRMS)
• Secondary Progressive Multiple Sclerosis (SPMS)
• Hormone refractory, advanced Prostate cancer
• Relapsed Hepatocellular carcinoma

Use in Cancer

Mitoxantrone hydrochloride is approved to be used with other drugs to treat:

• Acute non-lymphocytic leukemia in adults.
• Prostate cancer. It is used as palliative treatment in patients with advanced disease that is hormone-refractory (does not respond to hormone treatment).

Mitoxantrone hydrochloride is also being studied in the treatment of other types of cancer.

Contraindications

• a bacterial infection.
• an infection due to a fungus.
• a bad infection.
• decreased function of bone marrow.
• anemia.
• decreased blood platelets.
• low levels of white blood cells.
• low levels of a type of white blood cell called neutrophils.

Dosage

 Strengths: 2 mg/mL

Acute Nonlymphocytic Leukemia

• INDUCTION THERAPY: 12 mg/m2 IV daily on days 1 to 3 (in combination with cytarabine at 100 mg/m2 given as a continuous 24-hour IV infusion on days 1 to 7)
• SECOND INDUCTION THERAPY (if needed in the event of an incomplete antileukemic response to the first induction): 12 mg/m2 IV daily on days 1 and 2 (in combination with cytarabine given as a continuous 24-hour IV infusion on days 1 to 5)
• CONSOLIDATION THERAPY: 12 mg/m2 given IV daily on days 1 and 2 (in combination with cytarabine given as a continuous 24-hour IV infusion on days 1 to 5). The first course is given approximately 6 weeks after the final induction course and the second is generally administered 4 weeks after the first.
• The IV infusion should be given over 5 to 15 minutes.
• Most complete remissions from ANLL occur during initial induction therapy. In the event of an incomplete antileukemic response, a second induction course may be administered.
• Second inductions should be withheld until severe or life-threatening nonhematologic toxicity associated with the first induction dose is cleared.
• For the initial therapy of acute nonlymphocytic leukemia (ANLL) in adults (includes myelogenous, promyelocytic, monocytic, and erythroid acute leukemias) in combination with other approved drug(s)

Multiple Sclerosis

• 12 mg/m2 given as a short (approximately 5 to 15 minute) IV infusion every 3 months
• The IV infusion should be given over 5 to 15 minutes.
• Evaluation of left ventricular ejection fraction (LVEF) by echocardiogram or multiple gated acquisition (MUGA) scan is recommended prior to all doses.
• LVEF evaluations are recommended if signs of congestive heart failure develop.
• This drug should not be administered to MS patients who have received a cumulative lifetime dose of 140 mg/m2 or more, or those with either an LVEF less than 50% or a clinically significant reduction in LVEF.
• Complete blood counts, including platelets, should be monitored prior to each dose and if signs of infection develop.
• This drug should not be administered to MS patients with neutrophil counts less than 1500 cells/mm3.
• Liver function tests should also be monitored prior to each dose. Use of this drug in MS abnormal liver function tests is not recommended.
• Women who are capable of becoming pregnant (even if they are using birth control) should have a pregnancy test before each dose.

Prostate Cancer

• 12 to 14 mg/m2 given as a short IV infusion every 21 days (in combination with corticosteroids)
• The IV infusion should be given over 5 to 15 minutes.

US BOXED WARNINGS:

• This drug should be administered under the supervision of a physician experienced in the use of cytotoxic chemotherapy agents.
• This drug should be given slowly into a freely flowing IV infusion. It should never be given subcutaneously, IM, or intra-arterially. Severe local tissue damage may occur if there is extravasation during administration.
• NOT FOR INTRATHECAL USE. Severe injury with permanent sequelae can result from intrathecal administration.
• Except for the treatment of acute nonlymphocytic leukemia, this drug generally should not be given to patients with baseline neutrophil counts of less than 1,500 cells/mm3. In order to monitor the occurrence of bone marrow suppression, primarily neutropenia, which may be severe and result in infection, it is recommended that frequent peripheral blood cell counts be performed on all patients receiving this drug.
• Cardiotoxicity: Congestive heart failure (CHF), potentially fatal, may occur either during therapy or months to years after termination of therapy. The risk increases with cumulative dose and may occur whether or not cardiac risk factors are present. Presence or history of cardiovascular disease, radiotherapy to the mediastinal/pericardial area, previous therapy with other anthracyclines or anthracene diones, or use of other cardiotoxic drugs may increase this risk. In cancer patients, the risk of symptomatic CHF was estimated to be 2.6% for patients receiving up to a cumulative dose of 140 mg/m2. To mitigate the cardiotoxicity risk, prescribers should consider the following:
• ALL PATIENTS: All patients should be assessed for cardiac signs and symptoms by history, physical examination, and ECG prior to starting therapy. All patients should have baseline quantitative evaluation of left ventricular ejection fraction (LVEF) using appropriate methodology (e.g., echocardiogram, multi-gated radionuclide angiography (MUGA), MRI).
• MULTIPLE SCLEROSIS PATIENTS: MS patients with a baseline LVEF below the lower limit of normal should not be treated with this drug. MS patients should be assessed for cardiac signs and symptoms by history, physical examination, and ECG prior to each dose. MS patients should undergo quantitative reevaluation of LVEF prior to each dose using the same methodology that was used to assess baseline LVEF. Additional doses of mitoxantrone should not be administered to multiple sclerosis patients who have experienced either a drop in LVEF to below the lower limit of normal or a clinically significant reduction in LVEF during therapy. MS patients should not receive a cumulative mitoxantrone dose greater than 140 mg/m2. MS patients should undergo yearly quantitative LVEF evaluation after stopping therapy to monitor for late-occurring cardiotoxicity.
• SECONDARY LEUKEMIA: Therapy in patients with MS and in patients with cancer increases the risk of developing secondary acute myeloid leukemia.

Patient advice:

• Patients should be informed of the availability of a Medication Guide and instructed to read it prior to initiating treatment and prior to each infusion.
• Patients should be advised that this drug can cause myelosuppression and be informed of signs of myelosuppression.
• Patients should be advised that this drug can cause congestive heart failure that may lead to death, even in people who have never had heart problems before.
• Patients with MS should be advised that they should receive cardiac monitoring prior to each dose and yearly after stopping therapy.
• Patients should be advised that this drug may impart a blue-green color to the urine and/or sclera for 24 hours after administration.

Side Effects

The Most Common

• nausea
• vomiting
• diarrhea
• constipation
• heartburn
• loss of appetite
• sores on the mouth and tongue
• runny or stuffed nose
• thinning or loss of hair
• changes in the area around or under fingernails and toenails
• missed or irregular menstrual periods
• extreme tiredness
• weakness
• headache
• back pain
• unusual bleeding or bruising
• small red or purple dots on the skin
• hives
• itching
• rash
• difficulty swallowing
• shortness of breath
• fainting
• dizziness
• pale skin
• yellowing of the skin or eyes
• seizures
• redness, pain, swelling, burning, or blue discoloration at the site where the injection was given

More common

• Black, tarry stools
• bladder pain
• bloody or cloudy urine
• cough or shortness of breath
• difficult, burning, or painful urination
• dizziness
• fainting
• fast, slow, or irregular heartbeat
• frequent urge to urinate
• lower back or side pain
• pale skin
• stomach pain
• swelling or inflammation of the mouth
• troubled breathing with exertion
• ulcers, sores, or white spots in the mouth
• unusual bleeding or bruising
• unusual tiredness or weakness
• Absent, missed, or irregular menstrual periods
• back pain
• body aches or pains
• congestion
• constipation
• diarrhea
• dryness or soreness of the throat
• hair loss
• headache
• longer or heavier menstrual periods
• nausea or vomiting
• oral bleeding
• pain or tenderness around the eyes and cheekbones
• runny nose
• sneezing
• stopping of menstrual bleeding
• stuffy nose
• tender, swollen glands in the neck
• thinning of the hair

Rare

• Blood in the urine or stools
• decrease in urination
• fever or chills
• pinpoint red spots on the skin
• seizures
• sore, red eyes
• swelling of the feet and lower legs
• yellow eyes or skin
• Blue skin at the place of injection
• pain or redness at the place of injection
• skin rash

Drug Interactions

DRUG	INTERACTION
Abatacept	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Abatacept.
Abciximab	The risk or severity of bleeding can be increased when Abciximab is combined with Mitoxantrone.
Abemaciclib	Abemaciclib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Acenocoumarol	The risk or severity of bleeding can be increased when Acenocoumarol is combined with Mitoxantrone.
Acetaminophen	The metabolism of Acetaminophen can be increased when combined with Mitoxantrone.
Acetyldigitoxin	Acetyldigitoxin may decrease the cardiotoxic activities of Mitoxantrone.
Acetylsalicylic acid	The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Mitoxantrone.
Adalimumab	The risk or severity of adverse effects can be increased when Adalimumab is combined with Mitoxantrone.
Adenovirus type 7 vac	The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Mitoxantrone.
Afatinib	Afatinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Aldesleukin	The risk or severity of adverse effects can be increased when Aldesleukin is combined with Mitoxantrone.
Alectinib	Alectinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Alefacept	The risk or severity of adverse effects can be increased when Alefacept is combined with Mitoxantrone.
Alemtuzumab	The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Mitoxantrone.
Allogeneic processed	The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Mitoxantrone.
Allopurinol	The risk or severity of adverse effects can be increased when Allopurinol is combined with Mitoxantrone.
Alteplase	The risk or severity of bleeding can be increased when Alteplase is combined with Mitoxantrone.
Altretamine	The risk or severity of adverse effects can be increased when Altretamine is combined with Mitoxantrone.
Ambroxol	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Ambroxol.
Aminophylline	The metabolism of Aminophylline can be increased when combined with Mitoxantrone.
Amsacrine	The risk or severity of adverse effects can be increased when Amsacrine is combined with Mitoxantrone.
Anagrelide	The risk or severity of bleeding can be increased when Anagrelide is combined with Mitoxantrone.
Anakinra	The risk or severity of adverse effects can be increased when Anakinra is combined with Mitoxantrone.
Anastrozole	The risk or severity of cardiotoxicity can be increased when Mitoxantrone is combined with Anastrozole.
Ancrod	The risk or severity of bleeding can be increased when Ancrod is combined with Mitoxantrone.
Anifrolumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Anifrolumab.
Anistreplase	The risk or severity of bleeding can be increased when Anistreplase is combined with Mitoxantrone.
Anthrax immune	The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Mitoxantrone.
Anthrax vaccine	The risk or severity of infection can be increased when Anthrax vaccine is combined with Mitoxantrone.
Antilymphocyte i	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Antilymphocyte immunoglobulin (horse).
Antithrombin Alfa	The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Mitoxantrone.
Antithrombin III human	The risk or severity of bleeding can be increased when Antithrombin III human is combined with Mitoxantrone.
Antithymocyte immun	The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Mitoxantrone.
Apalutamide	The serum concentration of Mitoxantrone can be decreased when it is combined with Apalutamide.
Apixaban	The risk or severity of bleeding can be increased when Apixaban is combined with Mitoxantrone.
Apremilast	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Apremilast.
Ardeparin	The risk or severity of bleeding can be increased when Ardeparin is combined with Mitoxantrone.
Argatroban	The risk or severity of bleeding can be increased when Argatroban is combined with Mitoxantrone.
Arsenic trioxide	The risk or severity of adverse effects can be increased when Arsenic trioxide is combined with Mitoxantrone.
Articaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Articaine.
AstraZeneca COVID-19 Vaccine	The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Mitoxantrone.
Avacopan	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Avacopan.
Avanafil	Avanafil may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Avatrombopag	Avatrombopag may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Azacitidine	The risk or severity of adverse effects can be increased when Azacitidine is combined with Mitoxantrone.
Azathioprine	The risk or severity of adverse effects can be increased when Azathioprine is combined with Mitoxantrone.
Bacillus calmette-guerin	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Mitoxantrone.
Bacillus calmette-	The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Mitoxantrone.
Bacillus calmette-gu	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Mitoxantrone.
Baricitinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Baricitinib.
Basiliximab	The risk or severity of adverse effects can be increased when Basiliximab is combined with Mitoxantrone.
BCG vaccine	The risk or severity of infection can be increased when BCG vaccine is combined with Mitoxantrone.
Beclomethasone dipropionate	The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Mitoxantrone.
Belatacept	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Belatacept.
Belimumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Belimumab.
Belinostat	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Belinostat.
Belumosudil	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Belumosudil.
Bemiparin	The risk or severity of bleeding can be increased when Bemiparin is combined with Mitoxantrone.
Bendamustine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Bendamustine.
Bendroflumethiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Mitoxantrone.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Benzocaine.
Benzthiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Mitoxantrone.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Benzyl alcohol.
Betamethasone	The risk or severity of adverse effects can be increased when Betamethasone is combined with Mitoxantrone.
Betrixaban	The risk or severity of bleeding can be increased when Betrixaban is combined with Mitoxantrone.
Bevacizumab	The risk or severity of cardiotoxicity can be increased when Bevacizumab is combined with Mitoxantrone.
Bexarotene	The risk or severity of adverse effects can be increased when Bexarotene is combined with Mitoxantrone.
Bimekizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Bimekizumab.
Bivalirudin	The risk or severity of bleeding can be increased when Bivalirudin is combined with Mitoxantrone.
Bleomycin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Mitoxantrone.
Blinatumomab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Blinatumomab.
Bordetella pertussis	The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Bortezomib	The risk or severity of adverse effects can be increased when Bortezomib is combined with Mitoxantrone.
Bosutinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Bosutinib.
Brentuximab vedotin	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Brentuximab vedotin.
Brigatinib	Brigatinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Brodalumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Brodalumab.
Budesonide	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Budesonide.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Bupivacaine.
Buprenorphine	Buprenorphine may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Busulfan	The risk or severity of adverse effects can be increased when Busulfan is combined with Mitoxantrone.
Butacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Butamben.
Cabazitaxel	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Cabazitaxel.
Caffeine	Caffeine may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Canakinumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Canakinumab.
Cangrelor	The risk or severity of bleeding can be increased when Cangrelor is combined with Mitoxantrone.
Cannabidiol	Cannabidiol may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Capecitabine	The risk or severity of adverse effects can be increased when Capecitabine is combined with Mitoxantrone.
Caplacizumab	The risk or severity of bleeding can be increased when Caplacizumab is combined with Mitoxantrone.
Capmatinib	The serum concentration of Mitoxantrone can be increased when it is combined with Capmatinib.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Capsaicin.
Carbamazepine	The risk or severity of adverse effects can be increased when Carbamazepine is combined with Mitoxantrone.
Carboplatin	The risk or severity of adverse effects can be increased when Carboplatin is combined with Mitoxantrone.
Carfilzomib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Carfilzomib.
Carmustine	The risk or severity of adverse effects can be increased when Carmustine is combined with Mitoxantrone.
Carvedilol	The metabolism of Carvedilol can be increased when combined with Mitoxantrone.
Cenobamate	The metabolism of Cenobamate can be increased when combined with Mitoxantrone.
Certolizumab pegol	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Certolizumab pegol.
Chlorambucil	The risk or severity of adverse effects can be increased when Chlorambucil is combined with Mitoxantrone.

Chloramphenicol	The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Mitoxantrone.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Chloroprocaine.
Chlorothiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Mitoxantrone.
Chlorzoxazone	The metabolism of Chlorzoxazone can be increased when combined with Mitoxantrone.
Cholesterol	Cholesterol may increase the excretion rate of Mitoxantrone which could result in a lower serum level and potentially a reduction in efficacy.
Ciclesonide	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ciclesonide.
Cilostazol	The risk or severity of bleeding can be increased when Cilostazol is combined with Mitoxantrone.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Cinchocaine.
Cisplatin	The risk or severity of adverse effects can be increased when Cisplatin is combined with Mitoxantrone.
Cladribine	The risk or severity of adverse effects can be increased when Cladribine is combined with Mitoxantrone.
Clobetasol propionate	The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Mitoxantrone.
Clofarabine	The risk or severity of adverse effects can be increased when Clofarabine is combined with Mitoxantrone.
Clofazimine	Clofazimine may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Clopidogrel	The risk or severity of bleeding can be increased when Clopidogrel is combined with Mitoxantrone.
Clostridium tetani t	The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Clozapine	The risk or severity of neutropenia can be increased when Mitoxantrone is combined with Clozapine.
Cobicistat	Cobicistat may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Cocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Cocaine.
Corticotropin	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Corticotropin.
Cortisone acetate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Cortisone acetate.
Corynebacterium	The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Cyanocobalamin	The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Mitoxantrone.
Cyclopenthiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Mitoxantrone.
Cyclophosphamide	The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Mitoxantrone.
Cyclosporine	The serum concentration of Mitoxantrone can be increased when it is combined with Cyclosporine.
Cyclothiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Mitoxantrone.
Cytarabine	The risk or severity of adverse effects can be increased when Cytarabine is combined with Mitoxantrone.
Dabigatran	The risk or severity of bleeding can be increased when Dabigatran is combined with Mitoxantrone.
Dabigatran etexilate	The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Mitoxantrone.
Dabrafenib	Dabrafenib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dacarbazine	The risk or severity of adverse effects can be increased when Dacarbazine is combined with Mitoxantrone.
Daclatasvir	Daclatasvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dacomitinib	Dacomitinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dactinomycin	The risk or severity of adverse effects can be increased when Dactinomycin is combined with Mitoxantrone.
Dalteparin	The risk or severity of bleeding can be increased when Dalteparin is combined with Mitoxantrone.
Danaparoid	The risk or severity of bleeding can be increased when Danaparoid is combined with Mitoxantrone.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mitoxantrone.
Darolutamide	Darolutamide may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dasabuvir	Dasabuvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dasatinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Dasatinib.
Daunorubicin	The risk or severity of adverse effects can be increased when Daunorubicin is combined with Mitoxantrone.
Decitabine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Decitabine.
Defibrotide	The risk or severity of bleeding can be increased when Defibrotide is combined with Mitoxantrone.
Deflazacort	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Deflazacort.
Denosumab	The risk or severity of adverse effects can be increased when Denosumab is combined with Mitoxantrone.
Desirudin	The risk or severity of bleeding can be increased when Desirudin is combined with Mitoxantrone.
Deslanoside	Deslanoside may decrease the cardiotoxic activities of Mitoxantrone.
Desoximetasone	The risk or severity of adverse effects can be increased when Desoximetasone is combined with Mitoxantrone.
Deucravacitinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Deucravacitinib.
Dexamethasone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Dexamethasone.
Dexamethasone acetate	Dexamethasone acetate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Dexrazoxane	The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Mitoxantrone.
Dextran	The risk or severity of bleeding can be increased when Dextran is combined with Mitoxantrone.
Dicoumarol	The risk or severity of bleeding can be increased when Dicoumarol is combined with Mitoxantrone.
Diethylstilbestrol	Diethylstilbestrol may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Difluocortolone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Difluocortolone.
Digitoxin	Digitoxin may decrease the cardiotoxic activities of Mitoxantrone.
Digoxin	Digoxin may decrease the cardiotoxic activities of Mitoxantrone.
Dimethyl fumarate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Dimethyl fumarate.
Dinutuximab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Dinutuximab.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Diphenhydramine.
Dipyridamole	The risk or severity of bleeding can be increased when Dipyridamole is combined with Mitoxantrone.
Diroximel fumarate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Diroximel fumarate.
Docetaxel	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Docetaxel.
Doxorubicin	The risk or severity of adverse effects can be increased when Doxorubicin is combined with Mitoxantrone.
Drotrecogin alfa	The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Mitoxantrone.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Dyclonine.
Ebola Zaire vaccine	The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Mitoxantrone.
Eculizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Eculizumab.
Edetic acid	The risk or severity of bleeding can be increased when Edetic acid is combined with Mitoxantrone.
Edoxaban	The risk or severity of bleeding can be increased when Edoxaban is combined with Mitoxantrone.
Efalizumab	The risk or severity of adverse effects can be increased when Efalizumab is combined with Mitoxantrone.
Efgartigimod alfa	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Efgartigimod alfa.
Elacestrant	The serum concentration of Mitoxantrone can be increased when it is combined with Elacestrant.
Elbasvir	Elbasvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Eltrombopag	Eltrombopag may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Emapalumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Emapalumab.
Enasidenib	Enasidenib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Enflurane	The metabolism of Enflurane can be increased when combined with Mitoxantrone.
Enoxaparin	The risk or severity of bleeding can be increased when Enoxaparin is combined with Mitoxantrone.
Epirubicin	The risk or severity of adverse effects can be increased when Epirubicin is combined with Mitoxantrone.
Epoprostenol	The risk or severity of bleeding can be increased when Epoprostenol is combined with Mitoxantrone.
Eptifibatide	The risk or severity of bleeding can be increased when Eptifibatide is combined with Mitoxantrone.
Eribulin	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Eribulin.
Erlotinib	Erlotinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Mitoxantrone.
Estradiol	Estradiol may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estradiol acetate	Estradiol acetate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estradiol benzoate	Estradiol benzoate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estradiol cypionate	Estradiol cypionate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estradiol dienanthate	Estradiol dienanthate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estradiol valerate	Estradiol valerate may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Estramustine	The risk or severity of adverse effects can be increased when Estramustine is combined with Mitoxantrone.
Etanercept	The risk or severity of adverse effects can be increased when Etanercept is combined with Mitoxantrone.
Ethanol	The metabolism of Ethanol can be increased when combined with Mitoxantrone.
Ethosuximide	The metabolism of Ethosuximide can be increased when combined with Mitoxantrone.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Etidocaine.
Etoposide	The risk or severity of adverse effects can be increased when Etoposide is combined with Mitoxantrone.
Everolimus	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Everolimus.

Famtozinameran	The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Mitoxantrone.
Febuxostat	The excretion of Mitoxantrone can be decreased when combined with Febuxostat.
Fedratinib	Fedratinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Felbamate	The metabolism of Felbamate can be increased when combined with Mitoxantrone.
Filgotinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Filgotinib.
Fingolimod	Mitoxantrone may increase the immunosuppressive activities of Fingolimod.
Floxuridine	The risk or severity of adverse effects can be increased when Floxuridine is combined with Mitoxantrone.
Flucytosine	The risk or severity of adverse effects can be increased when Flucytosine is combined with Mitoxantrone.
Fludarabine	The risk or severity of adverse effects can be increased when Fludarabine is combined with Mitoxantrone.
Fludrocortisone	The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Mitoxantrone.
Fluindione	The risk or severity of bleeding can be increased when Fluindione is combined with Mitoxantrone.
Flunisolide	The risk or severity of adverse effects can be increased when Flunisolide is combined with Mitoxantrone.
Fluocinolone acetonide	The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Mitoxantrone.
Fluocinonide	The risk or severity of adverse effects can be increased when Fluocinonide is combined with Mitoxantrone.
Fluocortolone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Fluocortolone.
Fluorometholone	The risk or severity of adverse effects can be increased when Fluorometholone is combined with Mitoxantrone.
Fluorouracil	The risk or severity of adverse effects can be increased when Fluorouracil is combined with Mitoxantrone.
Flupentixol	The risk or severity of myelosuppression can be increased when Flupentixol is combined with Mitoxantrone.
Fluprednisolone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Fluprednisolone.
Fluticasone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Fluticasone.
Fluticasone furoate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Fluticasone furoate.
Fluticasone propionate	The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Mitoxantrone.
Fondaparinux	The risk or severity of bleeding can be increased when Fondaparinux is combined with Mitoxantrone.
Fostamatinib	Fostamatinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Fostemsavir	Fostemsavir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Fusidic acid	Fusidic acid may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Gallium nitrate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Gallium nitrate.
Gefitinib	Gefitinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Gemcitabine	The risk or severity of adverse effects can be increased when Gemcitabine is combined with Mitoxantrone.
Gemtuzumab ozogamicin	The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Mitoxantrone.
Gilteritinib	Gilteritinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Glasdegib	Glasdegib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Glatiramer	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Glatiramer.
Glecaprevir	Glecaprevir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Golimumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Golimumab.
Grazoprevir	Grazoprevir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Guselkumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Guselkumab.
Haemophilus influenzae	The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Mitoxantrone.
Halothane	The metabolism of Halothane can be increased when combined with Mitoxantrone.
Heparin	The risk or severity of bleeding can be increased when Heparin is combined with Mitoxantrone.
Hepatitis A Vaccine	The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Mitoxantrone.
Hepatitis B Vaccine	The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Mitoxantrone.
Human adenovirus	The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Mitoxantrone.
Hydrochlorothiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Mitoxantrone.
Hydrocortisone acetate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Hydrocortisone acetate.
Hydrocortisone butyrate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Hydrocortisone butyrate.
Hydrocortisone succinate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Hydrocortisone succinate.
Hydroflumethiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Mitoxantrone.
Hydroxychloroquine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Hydroxychloroquine.
Hydroxyurea	The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Mitoxantrone.
Ibritumomab tiuxetan	The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Mitoxantrone.
Ibrutinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ibrutinib.
Icosapent ethyl	The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Mitoxantrone.
Idarubicin	The risk or severity of adverse effects can be increased when Idarubicin is combined with Mitoxantrone.
Idelalisib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Idelalisib.
Ifosfamide	The risk or severity of adverse effects can be increased when Ifosfamide is combined with Mitoxantrone.
Iloprost	The risk or severity of bleeding can be increased when Iloprost is combined with Mitoxantrone.
Imatinib	The risk or severity of adverse effects can be increased when Imatinib is combined with Mitoxantrone.
Indomethacin	The risk or severity of adverse effects can be increased when Indomethacin is combined with Mitoxantrone.
Inebilizumab	The risk or severity of infection can be increased when Mitoxantrone is combined with Inebilizumab.
Infliximab	The risk or severity of adverse effects can be increased when Infliximab is combined with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen can be decreased when used in combination with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus	The therapeutic efficacy of Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen can be decreased when used in combination with Mitoxantrone.
Influenza A vi	The therapeutic efficacy of Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus A	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza A virus A/Vi	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza B virus	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza B virus	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Influenza B virus B/B	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Mitoxantrone.
Interferon alfa-2a	The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Mitoxantrone.
Interferon alfa-2b	The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Mitoxantrone.
Interferon alfa-n1	The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Mitoxantrone.
Interferon alfa-n3	The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Mitoxantrone.
Interferon alfacon-1	The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Mitoxantrone.
Interferon beta-1b	The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Mitoxantrone.
Interferon gamma-1b	The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Mitoxantrone.
Irinotecan	The risk or severity of adverse effects can be increased when Irinotecan is combined with Mitoxantrone.
Isavuconazole	Isavuconazole may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Isoflurane	The metabolism of Isoflurane can be increased when combined with Mitoxantrone.
Istradefylline	Istradefylline may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Itraconazole	Itraconazole may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Ixabepilone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ixabepilone.
Ixekizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ixekizumab.
Janssen COVID-19 Vaccine	The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Mitoxantrone.
Japanese encephalitis	The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Mitoxantrone.
Lansoprazole	Lansoprazole may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Lasmiditan	The serum concentration of Mitoxantrone can be increased when it is combined with Lasmiditan.
Ledipasvir	Ledipasvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Leflunomide	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Leflunomide.
Lenalidomide	The risk or severity of adverse effects can be increased when Lenalidomide is combined with Mitoxantrone.
Leniolisib	The excretion of Mitoxantrone can be decreased when combined with Leniolisib.
Lepirudin	The risk or severity of bleeding can be increased when Lepirudin is combined with Mitoxantrone.
Letermovir	Letermovir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Levobupivacaine.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Lidocaine.

Linezolid	The risk or severity of adverse effects can be increased when Linezolid is combined with Mitoxantrone.
Lipegfilgrastim	Mitoxantrone may increase the myelosuppressive activities of Lipegfilgrastim.
Lomustine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Lomustine.
Lopinavir	The serum concentration of Mitoxantrone can be increased when it is combined with Lopinavir.
Magnesium	The serum concentration of Magnesium can be decreased when it is combined with Mitoxantrone.
Maribavir	Maribavir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Measles virus vaccine	The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Mitoxantrone.
Mechlorethamine	The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Mitoxantrone.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Meloxicam.
Melphalan	The risk or severity of adverse effects can be increased when Melphalan is combined with Mitoxantrone.
Meningococcal	The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Mitoxantrone.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Mepivacaine.
Mepolizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Mepolizumab.
Meprednisone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Meprednisone.
Mercaptopurine	The risk or severity of adverse effects can be increased when Mercaptopurine is combined with Mitoxantrone.
Methimazole	The risk or severity of adverse effects can be increased when Methimazole is combined with Mitoxantrone.
Methotrexate	The risk or severity of adverse effects can be increased when Methotrexate is combined with Mitoxantrone.
Methoxy polyethylen	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Mitoxantrone.
Methoxyflurane	The metabolism of Methoxyflurane can be increased when combined with Mitoxantrone.
Methylprednisolone	The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Mitoxantrone.
Mitomycin	The risk or severity of adverse effects can be increased when Mitomycin is combined with Mitoxantrone.
Moderna COVID-19 Vaccine	The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Mitoxantrone.
Modified vaccinia ankara	The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Mitoxantrone.
Mometasone furoate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Mometasone furoate.
Monomethyl fumarate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Monomethyl fumarate.
Mosunetuzumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Mosunetuzumab.
Mumps virus strain	The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Mitoxantrone.
Muromonab	The risk or severity of adverse effects can be increased when Muromonab is combined with Mitoxantrone.
Mycophenolate mofetil	The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Mitoxantrone.
Mycophenolic acid	The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Mitoxantrone.
Nadroparin	The risk or severity of bleeding can be increased when Nadroparin is combined with Mitoxantrone.
Natalizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Natalizumab.
Nelarabine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Nelarabine.
Nelfinavir	Nelfinavir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Nilotinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Nilotinib.
Nilvadipine	The metabolism of Nilvadipine can be increased when combined with Mitoxantrone.
Nimesulide	The risk or severity of bleeding can be increased when Nimesulide is combined with Mitoxantrone.
Novobiocin	Novobiocin may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Nuvaxovid	The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Mitoxantrone.
Obinutuzumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Obinutuzumab.
Ocrelizumab	Ocrelizumab may increase the immunosuppressive activities of Mitoxantrone.
Ofatumumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ofatumumab.
Olaparib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Olaparib.
Osimertinib	Osimertinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Oteseconazole	The serum concentration of Mitoxantrone can be increased when it is combined with Oteseconazole.
Ouabain	Ouabain may decrease the cardiotoxic activities of Mitoxantrone.
Oxaliplatin	The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Mitoxantrone.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Oxetacaine.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Oxybuprocaine.
Ozanimod	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ozanimod.
Paclitaxel	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Paclitaxel.
Pacritinib	The serum concentration of Mitoxantrone can be increased when it is combined with Pacritinib.
Palbociclib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Palbociclib.
Palifermin	The therapeutic efficacy of Palifermin can be decreased when used in combination with Mitoxantrone.
Panobinostat	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Panobinostat.
Pantoprazole	Pantoprazole may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Paritaprevir	Paritaprevir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Parnaparin	The risk or severity of bleeding can be increased when Parnaparin is combined with Mitoxantrone.
Pazopanib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pazopanib.
Pegaspargase	The risk or severity of adverse effects can be increased when Pegaspargase is combined with Mitoxantrone.
Pegcetacoplan	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pegcetacoplan.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Mitoxantrone.
Peginterferon alfa-2a	The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Mitoxantrone.
Peginterferon alfa-2b	The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Mitoxantrone.
Peginterferon beta-1a	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Peginterferon beta-1a.
Pemetrexed	The risk or severity of adverse effects can be increased when Pemetrexed is combined with Mitoxantrone.
Penicillamine	The risk or severity of adverse effects can be increased when Penicillamine is combined with Mitoxantrone.
Pentosan polysulfate	The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Mitoxantrone.
Pentostatin	The risk or severity of adverse effects can be increased when Pentostatin is combined with Mitoxantrone.
Pentoxifylline	The risk or severity of bleeding can be increased when Pentoxifylline is combined with Mitoxantrone.
Pertussis vaccine	The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Mitoxantrone.
Pertuzumab	The risk or severity of cardiotoxicity can be increased when Mitoxantrone is combined with Pertuzumab.
Phenindione	The risk or severity of bleeding can be increased when Phenindione is combined with Mitoxantrone.
Phenobarbital	The metabolism of Phenobarbital can be increased when combined with Mitoxantrone.
Phenol	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Phenol.
Phenprocoumon	The risk or severity of bleeding can be increased when Phenprocoumon is combined with Mitoxantrone.
Phenylalanine	The risk or severity of adverse effects can be increased when Phenylalanine is combined with Mitoxantrone.
Phenytoin	The metabolism of Phenytoin can be increased when combined with Mitoxantrone.
Pibrentasvir	Pibrentasvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Pimecrolimus	The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Mitoxantrone.
Pirfenidone	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pirfenidone.
Pirtobrutinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pirtobrutinib.
Polythiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Mitoxantrone.
Pomalidomide	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pomalidomide.
Ponatinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ponatinib.
Ponesimod	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ponesimod.
Pralatrexate	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Pralatrexate.
Pralsetinib	Pralsetinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Pramocaine.
Prasugrel	The risk or severity of bleeding can be increased when Prasugrel is combined with Mitoxantrone.
Pravastatin	Pravastatin may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Prednisolone	The risk or severity of adverse effects can be increased when Prednisolone is combined with Mitoxantrone.
Prednisone	The risk or severity of adverse effects can be increased when Prednisone is combined with Mitoxantrone.
Pretomanid	The serum concentration of Mitoxantrone can be increased when it is combined with Pretomanid.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Prilocaine.
Primidone	The metabolism of Primidone can be increased when combined with Mitoxantrone.
Procaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Procaine.
Procarbazine	The risk or severity of adverse effects can be increased when Procarbazine is combined with Mitoxantrone.
Progesterone	Progesterone may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Proparacaine.

Propoxycaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Propoxycaine.
Propylthiouracil	The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Mitoxantrone.
Protein C	The risk or severity of bleeding can be increased when Protein C is combined with Mitoxantrone.
Protein S human	The risk or severity of bleeding can be increased when Protein S human is combined with Mitoxantrone.
Rabeprazole	Rabeprazole may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Rabies immune globulin	The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Mitoxantrone.
Rabies v antigen, A	The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Mitoxantrone.
Rabies vi antigen, B	The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Mitoxantrone.
Raltitrexed	The risk or severity of adverse effects can be increased when Raltitrexed is combined with Mitoxantrone.
Ravulizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ravulizumab.
Regorafenib	Regorafenib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Reteplase	The risk or severity of bleeding can be increased when Reteplase is combined with Mitoxantrone.
Reviparin	The risk or severity of bleeding can be increased when Reviparin is combined with Mitoxantrone.
Rilonacept	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Rilonacept.
Rilpivirine	Rilpivirine may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Ripretinib	Ripretinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Risankizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Risankizumab.
Ritonavir	Ritonavir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Rituximab	The risk or severity of adverse effects can be increased when Rituximab is combined with Mitoxantrone.
Rivaroxaban	The risk or severity of bleeding can be increased when Rivaroxaban is combined with Mitoxantrone.
Roflumilast	Roflumilast may increase the immunosuppressive activities of Mitoxantrone.
Rolapitant	Rolapitant may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Ropeginterferon alfa-2b	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ropeginterferon alfa-2b.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Ropivacaine.
Rosiglitazone	The metabolism of Rosiglitazone can be increased when combined with Mitoxantrone.
Rotavirus vaccine	The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Mitoxantrone.
Roxadustat	The serum concentration of Mitoxantrone can be increased when it is combined with Roxadustat.
Rubella virus vaccine	The risk or severity of infection can be increased when Rubella virus vaccine is combined with Mitoxantrone.
Rucaparib	Rucaparib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Ruxolitinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Ruxolitinib.
Safinamide	Safinamide may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Saquinavir	Saquinavir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Sarilumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Sarilumab.
Satralizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Satralizumab.
Secukinumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Secukinumab.
Selumetinib	The metabolism of Selumetinib can be increased when combined with Mitoxantrone.
Sevoflurane	The metabolism of Sevoflurane can be increased when combined with Mitoxantrone.
Siltuximab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Siltuximab.
Simeprevir	Simeprevir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Siponimod	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Siponimod.
Sipuleucel-T	The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Mitoxantrone.
Sirolimus	The risk or severity of adverse effects can be increased when Sirolimus is combined with Mitoxantrone.
Smallpox (Vaccinia)	The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Mitoxantrone.
Sodium citrate	The risk or severity of bleeding can be increased when Sodium citrate is combined with Mitoxantrone.
Sorafenib	The risk or severity of adverse effects can be increased when Sorafenib is combined with Mitoxantrone.
Sotagliflozin	Sotagliflozin may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Sotorasib	The serum concentration of Mitoxantrone can be increased when it is combined with Sotorasib.
Sparsentan	Sparsentan may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Spesolimab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Spesolimab.
Stiripentol	The excretion of Mitoxantrone can be decreased when combined with Stiripentol.
Streptokinase	The risk or severity of bleeding can be increased when Streptokinase is combined with Mitoxantrone.
Streptozocin	The risk or severity of adverse effects can be increased when Streptozocin is combined with Mitoxantrone.
Sulfamethoxazole	The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Mitoxantrone.
Sulfasalazine	The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Mitoxantrone.
Sulfinpyrazone	The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Mitoxantrone.
Sulodexide	The risk or severity of bleeding can be increased when Sulodexide is combined with Mitoxantrone.
Sunitinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Sunitinib.
Sutimlimab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Sutimlimab.
Tacrolimus	Tacrolimus may increase the immunosuppressive activities of Mitoxantrone.
Tafamidis	The serum concentration of Mitoxantrone can be increased when it is combined with Tafamidis.
Tamoxifen	The metabolism of Tamoxifen can be increased when combined with Mitoxantrone.
Taurocholic acid	Taurocholic acid may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Tedizolid phosphate	The risk or severity of myelosuppression can be increased when Mitoxantrone is combined with Tedizolid phosphate.
Telmisartan	Telmisartan may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Temozolomide	The risk or severity of adverse effects can be increased when Temozolomide is combined with Mitoxantrone.
Temsirolimus	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Temsirolimus.
Tenecteplase	The risk or severity of bleeding can be increased when Tenecteplase is combined with Mitoxantrone.
Teniposide	The risk or severity of adverse effects can be increased when Teniposide is combined with Mitoxantrone.
Tepotinib	Tepotinib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Teprotumumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Teprotumumab.
Teriflunomide	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Teriflunomide.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Mitoxantrone is combined with Tetracaine.
Thalidomide	The risk or severity of adverse effects can be increased when Thalidomide is combined with Mitoxantrone.
Theophylline	The metabolism of Theophylline can be increased when combined with Mitoxantrone.
Thiotepa	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Thiotepa.
Ticagrelor	The risk or severity of bleeding can be increased when Ticagrelor is combined with Mitoxantrone.
Tick-borne encephalitis	The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Mitoxantrone.
Ticlopidine	The risk or severity of bleeding can be increased when Ticlopidine is combined with Mitoxantrone.
Tinzaparin	The risk or severity of bleeding can be increased when Tinzaparin is combined with Mitoxantrone.
Tioguanine	The risk or severity of adverse effects can be increased when Tioguanine is combined with Mitoxantrone.
Tirofiban	The risk or severity of bleeding can be increased when Tirofiban is combined with Mitoxantrone.
Tivozanib	Tivozanib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Tixocortol	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Tixocortol.
Tocilizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Tocilizumab.
Tofacitinib	Mitoxantrone may increase the immunosuppressive activities of Tofacitinib.
Topotecan	The risk or severity of adverse effects can be increased when Topotecan is combined with Mitoxantrone.
Tositumomab	The risk or severity of adverse effects can be increased when Tositumomab is combined with Mitoxantrone.
Trabectedin	The metabolism of Trabectedin can be increased when combined with Mitoxantrone.
Trastuzumab	The risk or severity of neutropenia can be increased when Trastuzumab is combined with Mitoxantrone.
Trastuzumab emtansine	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Trastuzumab emtansine.
Tretinoin	The risk or severity of cardiotoxicity can be increased when Tretinoin is combined with Mitoxantrone.
Triamcinolone	The risk or severity of adverse effects can be increased when Triamcinolone is combined with Mitoxantrone.
Trichlormethiazide	The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Mitoxantrone.
Trifluridine	The risk or severity of adverse effects can be increased when Trifluridine is combined with Mitoxantrone.
Triflusal	The risk or severity of bleeding can be increased when Triflusal is combined with Mitoxantrone.
Trilostane	The risk or severity of adverse effects can be increased when Trilostane is combined with Mitoxantrone.
Trimethadione	The metabolism of Trimethadione can be increased when combined with Mitoxantrone.
Typhoid vaccine	The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Mitoxantrone.
Typhoid Vaccine Live	The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Mitoxantrone.
Typhoid Vi polysacch	The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Mitoxantrone.

Ublituximab	The risk or severity of infection can be increased when Ublituximab is combined with Mitoxantrone.
Upadacitinib	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Upadacitinib.
Urokinase	The risk or severity of bleeding can be increased when Urokinase is combined with Mitoxantrone.
Vandetanib	Vandetanib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Varicella zoster vaccine	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Mitoxantrone.
Varicella zoster vaccine	The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Mitoxantrone.
Vedolizumab	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Vedolizumab.
Velpatasvir	Velpatasvir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Vemurafenib	Vemurafenib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Venetoclax	Venetoclax may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Venlafaxine	Venlafaxine may increase the excretion rate of Mitoxantrone which could result in a lower serum level and potentially a reduction in efficacy.
Vibrio cholerae CVD	The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Mitoxantrone.
Vilanterol	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Vilanterol.
Vinblastine	The risk or severity of adverse effects can be increased when Vinblastine is combined with Mitoxantrone.
Vincristine	The risk or severity of adverse effects can be increased when Vincristine is combined with Mitoxantrone.
Vindesine	The risk or severity of adverse effects can be increased when Vindesine is combined with Mitoxantrone.
Vinorelbine	The risk or severity of adverse effects can be increased when Vinorelbine is combined with Mitoxantrone.
Vismodegib	Vismodegib may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Voclosporin	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Voclosporin.
Vorapaxar	The risk or severity of bleeding can be increased when Vorapaxar is combined with Mitoxantrone.
Vorinostat	The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Vorinostat.
Voxilaprevir	Voxilaprevir may decrease the excretion rate of Mitoxantrone which could result in a higher serum level.
Warfarin	The risk or severity of bleeding can be increased when Warfarin is combined with Mitoxantrone.
Ximelagatran	The risk or severity of bleeding can be increased when Ximelagatran is combined with Mitoxantrone.
Yellow fever vaccine	The risk or severity of infection can be increased when Yellow fever vaccine is combined with Mitoxantrone.
Zidovudine	The risk or severity of adverse effects can be increased when Zidovudine is combined with Mitoxantrone.

Pregnancy and Lactation

AU TGA pregnancy category: D
US FDA pregnancy category: D

Pregnancy

This drug can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Women with who are capable of becoming pregnant, even if they are using birth control, should have a pregnancy test, before receiving each dose of this drug. Women of childbearing potential should be advised to avoid becoming pregnant. During therapy and for at least 6 months after termination of therapy, effective contraception should be practiced by patients of reproductive age, of either sex

Lactation

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, such as mitoxantrone. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence, but the duration of abstinence is not clear. In one patient, mitoxantrone was still detectable in milk 28 days after a dose of 6 mg per square meter. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breast milk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.

One mother received 3 daily doses of 6 mg/sq. m. of mitoxantrone intravenously along with 5 daily doses of etoposide 80 mg/sq. m. and cytarabine 170 mg/sq. m. intravenously. She resumed breastfeeding her infant 3 weeks after the third dose of mitoxantrone at a time when mitoxantrone was still detectable in milk. The infant had no apparent abnormalities at 16 months of age.

One mother received 3 daily doses of 6 mg/sq. m. of mitoxantrone intravenously along with 5 daily doses of etoposide 80 mg/sq. m. and cytarabine 170 mg/sq. m. intravenously. She resumed breastfeeding her infant 3 weeks after the third dose of mitoxantrone at a time when mitoxantrone was still detectable in milk. The infant had no apparent abnormalities at 16 months of age.

Why is this medication prescribed?

Mitoxantrone injection is used to adults with various forms of multiple sclerosis (MS; a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control) including the following:

• relapsing-remitting forms (course of disease where symptoms flare up from time to time), or
• progressive relapsing (course of disease with occasional relapses), or
• secondary progressive forms (course of disease where relapses occur more often).

Mitoxantrone injection is also used together with steroid medications to relieve pain in people with advanced prostate cancer who did not respond to other medications. Mitoxantrone injection is also used with other medications to treat certain types of leukemia. Mitoxantrone injection is in a class of medications called anthracene diones. Mitoxantrone treats MS by stopping certain cells of the immune system from reaching the brain and spinal cord and causing damage. Mitoxantrone treats cancer by stopping the growth and spread of cancer cells.

How should this medicine be used?

Mitoxantrone injection comes as a liquid to be given intravenously (into a vein) by a doctor or nurse in a hospital or clinic. When mitoxantrone injection is used to treat MS, it is usually given once every 3 months for about 2 to 3 years (for a total of 8 to 12 doses). When mitoxantrone injection is used to treat prostate cancer, it is usually given once every 21 days. When mitoxantrone injection is used to treat leukemia, you will continue to receive this medication based on your condition and how you respond to the treatment.

If you are using mitoxantrone injection for MS, you should know that it controls MS but does not cure it. Continue to receive treatments even if you feel well. Talk to your doctor if you no longer want to receive treatment with mitoxantrone injection.

If you are using mitoxantrone injection for MS, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

Other uses for this medicine

Mitoxantrone injection is also sometimes used to treat non-Hodgkin’s lymphoma (NHL; cancer that begins in a type of white blood cell that normally fights infection). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using mitoxantrone injection,

• tell your doctor and pharmacist if you are allergic to mitoxantrone injection, any other medications, sulfites, or any of the other ingredients in mitoxantrone injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had any blood-clotting problems, anemia (decreased amount of red blood cells in the blood), or liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are using mitoxantrone injection. Talk to your doctor about effective birth control methods that you can use during your treatment. If you become pregnant while using mitoxantrone injection, call your doctor immediately. Mitoxantrone injection may harm the fetus. If you are using mitoxantrone injection to treat MS, even if you are using birth control, your doctor should give you a pregnancy test before each treatment. You must have a negative pregnancy test before the start of each treatment.
• tell your doctor if you are breastfeeding. Do not breastfeed while you are using mitoxantrone injection.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using mitoxantrone injection.
• you should know that mitoxantrone injection is dark blue in color and may cause the white parts of your eyes to have a slight blue color for a few days after you receive each dose. It may also change the color of your urine to a blue-green color for about 24 hours after you receive a dose.

References