Pharmacology · Chemotherapy supportive agents
Dexrazoxane !
An iron chelator that protects the heart from anthracyclines such as doxorubicin; it is also used for anthracycline extravasation.
Updated 2026-11-01
Also called: ICRF-187
The crystal shows dexrazoxane (ICRF-187) bound to the ATPase region of yeast topoisomerase II; its heart protection is attributed mainly to iron chelation.
Mechanism of action
Dexrazoxane is a cyclic relative of EDTA that enters cells and is converted into an open-ring chelator. By binding iron it interferes with the iron-driven free-radical reactions thought to underlie anthracycline cardiomyopathy. It also binds topoisomerase II, as the crystal structure shows.
- Dexrazoxane enters the cell and opens its ring
- The open form chelates iron
- Less iron-driven free radicals: less heart damage
Pharmacokinetics
- Absorption
- Intravenous infusion.
- Elimination
- Mainly by the kidneys; clearance falls in kidney impairment, so the dose is reduced.
Indications
- Reducing doxorubicin cardiomyopathy in women with metastatic breast cancer who have already received a substantial cumulative dose and will continue doxorubicin. Breast cancer →
- Treatment of anthracycline extravasation in adults.
Adverse effects
Common
- Adds to the myelosuppression of chemotherapy
- Pain on injection
Contraindications
- Chemotherapy regimens that do not contain an anthracycline
Key interactions
- Doxorubicin at the start of treatment
- Starting both together lowered tumour response, so dexrazoxane is not used at initiation.
- Other myelosuppressive chemotherapy
- Additive marrow suppression.
What is monitored
- Blood count before and during each course
- Ejection fraction before and periodically during anthracycline therapy
- Kidney function (dose adjustment)
Administration and safety
- Given as an intravenous infusion shortly before doxorubicin, never as an intravenous push.
- Not mixed with other drugs; reconstituted solution is used promptly.
- Handled with gloves; skin contact is washed off at once with soap and water.
Nursing care
- Check the cumulative doxorubicin dose: dexrazoxane is not used with the first cycles.
- Time the doxorubicin to start soon after the dexrazoxane infusion ends.
- Blood count before each course; report fever.
Pregnancy and breastfeeding
Can cause fetal harm; effective contraception is used during treatment.
Test yourself
Think of the answer, then tap the question to see it.
How is dexrazoxane thought to protect the heart?
It is converted into an iron chelator that limits iron-driven free-radical injury from anthracyclines.
Why is dexrazoxane not started with the first doxorubicin cycle?
Starting it at initiation lowered tumour response; it is used once a substantial cumulative dose has been reached.
Besides cardioprotection, in which anthracycline emergency can dexrazoxane be used?
Extravasation of an anthracycline such as doxorubicin, in adults.
Related drugs
Related conditions
← Back to the class: Chemotherapy supportive agents
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 - DEXRAZOXANE- dexrazoxane for injection injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2025); DailyMed - DOXORUBICIN HYDROCHLORIDE injection, solution (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.