Pharmacology · Antitumour antibiotics
Mitomycin !
A Streptomyces drug that, once activated in the cell, cross-links DNA. Used for anal, gastric and pancreatic cancers and inside the bladder.
Updated 2026-11-01
Also called: mitomycin C
Mechanism of action
Mitomycin is a prodrug. After enzymatic or chemical reduction inside the cell it becomes a bifunctional or trifunctional alkylating agent that cross-links DNA at guanine (O6 and N7) and adenine (N6). DNA synthesis stops, and attempts at repair produce strand breaks.
- Reduction inside the cell activates mitomycin
- It alkylates guanine and adenine
- DNA cross-links stop DNA synthesis
Pharmacokinetics
- Absorption
- Intravenous, or instilled into the bladder for superficial bladder tumours.
- Metabolism
- Inactivated mainly in the liver.
- Half-life
- Short: it is cleared from the blood in well under two hours.
Indications
- Disseminated adenocarcinoma of the stomach, in combination. Gastric cancer →
- Disseminated adenocarcinoma of the pancreas, in combination. Pancreatic cancer →
- Superficial transitional-cell bladder tumours, by bladder instillation. Bladder cancer →
- Anal cancer, in combination with fluorouracil.
Adverse effects
Common
- Bone-marrow suppression (mainly platelets and white cells), followed for weeks after treatment
- Mouth sores and hair loss
- Nausea and vomiting
Contraindications
- Previous hypersensitivity or idiosyncratic reaction to mitomycin
- Thrombocytopenia, coagulation disorders or increased bleeding tendency
- Raised serum creatinine (kidney impairment)
Key interactions
- Vinca alkaloids (vincristine, vinblastine, vinorelbine)
- Acute breathlessness and severe bronchospasm have occurred most often with this combination.
What is monitored
- Platelets, white cells and haemoglobin during treatment and for weeks afterwards
- Creatinine, haemoglobin and blood smear for signs of haemolytic uraemic syndrome
- Cough and breathlessness
Administration and safety
- Vesicant: given intravenously with care to avoid extravasation, which causes necrosis.
- The route on the order (intravenous or bladder instillation) is checked before giving it.
- Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.
Nursing care
- Independent double check of drug, patient, route and cycle before giving it (high-alert medicine).
- Watch the infusion site closely and ask about pain or burning.
- Bleeding precautions while platelets are low; counts are followed for weeks after the dose.
- Teaching: report dark urine, less urine, unusual tiredness, bruising, cough or breathlessness.
Pregnancy and breastfeeding
Safe use in pregnancy has not been established; it is teratogenic in animals.
Test yourself
Think of the answer, then tap the question to see it.
How does mitomycin damage DNA?
After reductive activation inside the cell it becomes an alkylating agent that cross-links DNA at guanine and adenine.
Which serious syndrome combining haemolysis, low platelets and kidney failure is linked to mitomycin?
Haemolytic uraemic syndrome.
Which combination with mitomycin has been linked to acute bronchospasm?
Mitomycin with vinca alkaloids.
Related drugs
Related conditions
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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 - MITOMYCIN injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); DailyMed - VINCRISTINE SULFATE injection, solution (DailyMed (U.S. National Library of Medicine), 2026); 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).
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