Dexrazoxane
2,6-Piperazinedione
Also known as: Zinecard · Cardioxane · Eucardion · Totect · ADR-529 · ICRF187 · NSC-169780 · ICRF-187
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
This dose is based on body surface area (mg/m²). Convert body weight to body surface area before dosing.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Treatment of anthracycline (doxorubicin, epirubicin, etc.) extravasation | 1000 mg/m2 | IV | within 6 hours and again on day 2. Infuse 500 mg/m2 on day 3 | 3 days | 🌎 NA |
| Treatment of anthracycline extravasation | 10 times the doxorubicin dose | IV | within 3 hours and again at 24 and 48 hours after extravasation | 48 hours | 🌎 NA |
| Prevention of doxorubicin-induced cardiomyopathy | 10:1 ratio (e.g., 300 mg/m2 of dexrazoxane to 30 mg/m2 doxorubicin) | IV | starting 30 minutes of, and prior to the doxorubicin dose | — | 🌎 NA |
| Prevention of doxorubicin-induced cardiomyopathy | 10:1 ratio (e.g., 300 mg/m2 of dexrazoxane to 30 mg/m2 doxorubicin) | IV | starting 30 minutes before doxorubicin is administered | — | 🌎 NA |
- Treatment of anthracycline (doxorubicin, epirubicin, etc.) extravasation: Terminate doxorubicin infusion immediately, and infuse intravenously in a separate infusion. Acute surgical evaluation is performed. Dosage recommendations are for human patients, but may apply to veterinary patients.
- Treatment of anthracycline extravasation: Anecdotally; significantly reduces local tissue injury.
- Prevention of doxorubicin-induced cardiomyopathy: Given as slow IV bolus (as a short, IV bolus).
- Prevention of doxorubicin-induced cardiomyopathy: Given as slow IV bolus. Use can be considered in breeds at risk (Shelties, Collies, Australian Shepherds, etc.), dogs exceeding usual cumulative dose cutoff, and cases with preexisting cardiac disease where no effective chemo options exist.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Dexrazoxane is an intracellular iron chelator and chemoprotectant primarily used in veterinary oncology.
- Cardioprotection: It is used to attenuate the cumulative, dose-dependent cardiotoxic effects of anthracyclines (such as doxorubicin) in patients showing signs of toxicity, those with pre-existing cardiac disease, or those reaching maximum cumulative dosages.
- Extravasation Management: It acts as a critical antidote for severe tissue necrosis caused by accidental perivascular administration (extravasation) of doxorubicin.
Clinical Pearls:
- While highly effective for cardioprotection, it is very expensive, which can be cost-prohibitive for many clients.
- There is theoretical concern and some human evidence that dexrazoxane may partially protect cancer cells, potentially reducing the antineoplastic efficacy of the chemotherapy protocol.
Mechanism of action
Dexrazoxane is a cyclic derivative of EDTA that readily penetrates cell membranes.
- Once intracellular, it is hydrolyzed into an active ring-opened chelating metabolite.
- Active Metabolite → Chelates intracellular iron → Prevents the formation of the highly reactive anthracycline-iron complex.
- This prevents the generation of destructive superoxide free radicals → Protects the myocardium from oxidative stress and irreversible anthracycline-induced cardiomyopathy.
- Mechanistic Note: It also acts as a reversible inhibitor of Topoisomerase II, which is believed to contribute to its protective effects against severe tissue necrosis during extravasation injuries.
Safety & warnings
Contraindications
- Should not be used unless an anthracycline antineoplastic agent is being used
- Unknown based on monograph, but generally avoid in patients not receiving anthracyclines
Adverse effects
- Additive myelosuppression
- Potential reduction in efficacy of anthracycline antitumor agents
- Testicular atrophy (observed in dogs)
- Myelosuppression (documented in humans)
- Decreased clinical efficacy of anthracycline antineoplastic agents
Precautions
Important: Dexrazoxane should not be used unless an anthracycline antineoplastic agent is being administered.
- Species Limitations: Efficacy and safety for use in cats is not known.
- Reproductive Safety: Causes testicular atrophy in dogs when administered at usual doses for 13 weeks. Teratogenic in rats and rabbits at doses lower than human doses (FDA Category C). Nursing mothers should discontinue nursing.
- Handling Warnings: Wear gloves when handling. Use normal procedures for handling and disposal of anti-cancer medications. If unreconstituted powder contacts skin or mucous membranes, wash off thoroughly with soap and water.
Drug interactions
Additive myelosuppression may occur when used concurrently.
May decrease the clinical efficacy of the chemotherapy
Monitoring
- Echocardiogram (if used for cardioprotection)
- ECG (if used for cardioprotection)
- Complete blood count (CBC) for myelosuppression
- Cardiac monitoring (ECG, echocardiogram) if used for cardiotoxicity
- Extravasation site for healing or necrosis
Pharmacokinetics
Half-life
Distribution
Steady-state volume of distribution is 0.67 L/kg. The drug showed low tissue and protein binding.
Metabolism
Hydrolyzed to an active metabolite.
Elimination
Clearance is about 11 mL/min/kg (dose-independent). Primarily excreted in the urine as unchanged drug and metabolites.
Overdose
Because of the method of administration and drug expense, overdoses are unlikely in veterinary medicine. As there is no known antidote, treatment would be supportive. Potentially, the drug could be removed via hemodialysis.
Available products
Formulations
- Lyophilized Powder for Injection Solution
- Intravenous: 500 mg vials (reconstituted to 20 mg/ml solution for infusion)
Human-labeled
- Dexrazoxane Lyophilized Powder for Injection Solution: 250 mg in single-use vials with 25 mL vial of sodium lactate injection
- Dexrazoxane Lyophilized Powder for Injection Solution: 500 mg regular & preservative free in single-use vials with 50 mL vial of sodium lactate injection
- Cardioxane 500 mg vials
- Zinecard 500 mg vials
Regulatory status
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Unreconstituted vials should be stored at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Once reconstituted with supplied diluent, stable for 6 hours at room temperature or refrigerated. Unused solutions after that time should be discarded. After reconstitution, may be diluted with 0.9% sodium chloride or D5W to 1.3-5 mg/mL. Do not mix with any other drug.
Client information
- Purpose: Your pet is receiving this medication to protect their heart from the side effects of certain chemotherapy drugs (like doxorubicin) or to treat severe tissue damage if chemotherapy accidentally leaks outside the vein.
- Cost & Expectations: This is a highly specialized and expensive medication. While it significantly reduces the risk of heart damage or tissue injury, it may not be fully effective in all cases.
- Side Effects: It may lower your pet's white blood cell count, making them more susceptible to infections. We will monitor their bloodwork closely.
- Safety: Because this drug is given alongside chemotherapy, follow your veterinarian's instructions regarding handling your pet's waste safely at home.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.