[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/) › Dexrazoxane [Pharmacology](https://durgical.com/en/pharmacology/) · [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/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 - Class: [Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/chemotherapy-supportive-agents/) - Enzyme: Topoisomerase II (catalytic inhibitor) and intracellular iron - ATC code: V03AF02 Also called: ICRF-187 ✂**Topoisomerase II (catalytic inhibitor) and intracellular iron**Dexrazoxane ⓘ The crystal shows dexrazoxane (ICRF-187) bound to the ATPase region of yeast topoisomerase II; its heart protection is attributed mainly to iron chelation. **Target in 3D:** Topoisomerase II (catalytic inhibitor) and intracellular iron. PDB structure 1QZR (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1QZR) · Drag to rotate · pinch to zoom ## 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 →](https://durgical.com/en/conditions/breast-cancer/) - Treatment of anthracycline extravasation in adults. ## Adverse effects ### Common - Adds to the myelosuppression of chemotherapy - Pain on injection ### Serious (rare, important) - Severe myelosuppression when combined with chemotherapy - Secondary acute myeloid leukaemia and myelodysplasia (reported mainly in children) - Does not fully remove the risk of anthracycline heart damage ## 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. ## Memory aid DEXRAZoxane «DEfends the heart by RAZing iron»: no iron, no radicals, less anthracycline heart damage. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/dexrazoxane/) ## Related drugs - [Doxorubicin](https://durgical.com/en/pharmacology/doxorubicin/) - [Daunorubicin](https://durgical.com/en/pharmacology/daunorubicin/) - [Epirubicin](https://durgical.com/en/pharmacology/epirubicin/) ## Related conditions - [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) [← Back to the class: Chemotherapy supportive agents](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c1d98fbe-5fd9-4518-b1a5-fac92e32928f) (DailyMed (U.S. National Library of Medicine), 2025); [DailyMed - DOXORUBICIN HYDROCHLORIDE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae80bd3a-b99a-4e01-a444-b9d05687f00e) (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](https://atcddd.fhi.no/atc_ddd_index/?code=V03AF02) (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. --- Source: https://durgical.com/en/pharmacology/dexrazoxane/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/dexrazoxane/