What is the dosing schedule for Totect (dexrazoxane) in anthracycline extravasation on Days 1 through 3?

• A. Day 1: 500 mg/m2; Day 2: 1000 mg/m2; Day 3: 1000 mg/m2
• B. Day 1: 1500 mg/m2; Day 2: 1000 mg/m2; Day 3: 500 mg/m2
• C. Day 1: 1000 mg/m2; Day 2: 1000 mg/m2; Day 3: 500 mg/m2
• D. Day 1: 1000 mg/m2; Day 2: 500 mg/m2; Day 3: 1000 mg/m2

Answer: (C)

Dexrazoxane protects tissue from anthracycline extravasation by chelating iron and reducing free radical injury. For this use, Totect is given over three consecutive days, starting as soon as possible after the extravasation. The standard schedule is 1000 mg/m2 IV on day one, 1000 mg/m2 IV on day two, and 500 mg/m2 IV on day three. The two full high-dose days provide rapid, sustained protection during the most vulnerable period, while the third day with a lower dose maintains protection with less total exposure. This pattern matches established extravasation protocols, whereas schedules starting with a lower dose or with a higher first dose do not align with the typical protective strategy.