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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Chemotherapy supportive agents

Drugs that protect healthy tissue from chemotherapy or its side products: the bladder, the heart, the kidney or the bone marrow.

Updated 2026-11-01

## What they are

A mixed group with one aim: make cancer treatment safer. Calcium folinate rescues normal cells from methotrexate (and boosts fluorouracil), mesna neutralises bladder-toxic metabolites of ifosfamide, dexrazoxane protects the heart from anthracyclines, rasburicase removes uric acid in tumour lysis, and amifostine protects the kidney and salivary glands.

## Mechanism of action

Each one targets a specific mechanism of injury: a reduced folate that bypasses dihydrofolate reductase (calcium folinate); a thiol that binds acrolein in the urine (mesna); an iron chelator that limits anthracycline free radicals (dexrazoxane); an enzyme that oxidises uric acid to soluble allantoin (rasburicase); and a thiol compound that protects the kidney from cisplatin and the salivary glands from radiotherapy (amifostine).

Target: Several (folate pool, toxic metabolites, iron, uric acid)

## Key points

- Calcium folinate rescues from methotrexate but enhances fluorouracil; it is never given intrathecally.
- Mesna prevents haemorrhagic cystitis from ifosfamide (and high-dose cyclophosphamide) by binding acrolein in the bladder.
- Dexrazoxane: cardioprotection with anthracyclines and treatment of anthracycline extravasation.
- Rasburicase is contraindicated in G6PD deficiency (haemolysis, methaemoglobinaemia).

## Drugs in this class

- [**Calcium folinate** An already-reduced folate (leucovorin) that rescues normal cells from methotrexate and strengthens fluorouracil. Never… Reduced-folate pool (bypasses dihydrofolate reductase)](https://durgical.com/en/pharmacology/calcium-folinate/)
- [**Mesna** A thiol drug that binds acrolein in the urine and protects the bladder from haemorrhagic cystitis caused by ifosfamide. Acrolein and other urotoxic ifosfamide metabolites (in urine)](https://durgical.com/en/pharmacology/mesna/)
- [**Rasburicase** A recombinant urate oxidase enzyme that turns uric acid into soluble allantoin in tumour lysis. It must not be given… Uric acid (the drug is the enzyme urate oxidase)](https://durgical.com/en/pharmacology/rasburicase/)
- [**Dexrazoxane** An iron chelator that protects the heart from anthracyclines such as doxorubicin; it is also used for anthracycline… Topoisomerase II (catalytic inhibitor) and intracellular iron](https://durgical.com/en/pharmacology/dexrazoxane/)
- [**Amifostine** A thiol cytoprotectant that protects the kidney from cisplatin and the salivary glands from radiotherapy. It has been… Normal tissue (thiol protection against cisplatin and radiation injury)](https://durgical.com/en/pharmacology/amifostine/)

## Others in the class

- calcium levofolinate
- glucarpidase
- palifermin
- uridine triacetate

## Test yourself

Think of the answer, then tap the question to see it.

## Which supportive drug neutralises acrolein, and which chemotherapy produces it?

Mesna; acrolein is a urinary metabolite of ifosfamide and cyclophosphamide.

## Which enzyme deficiency must be ruled out before rasburicase?

Glucose-6-phosphate dehydrogenase (G6PD) deficiency.

## Which drug protects the heart from doxorubicin, and how is it thought to work?

Dexrazoxane, an iron chelator that limits iron-driven free-radical injury.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - LEUCOVORIN CALCIUM injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=82c445f5-4cb7-4457-af19-3b5b8a121b4f) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - MESNA injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a880160b-fa82-453a-a971-29ab897876a7) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - DEXRAZOXANE- dexrazoxane for injection injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c1d98fbe-5fd9-4518-b1a5-fac92e32928f) (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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