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Planned co-administration or sequential administration of other substances or treatments that could increase the likelihood or severity of toxic effects (by means of pharmacodynamics or pharmacokinetic interactions) requires careful individual assessment of the expected benefit and the risks. Patients receiving such combinations must be monitored closely for signs of toxicity to permit timely intervention.
Antineoplastic drugs: Combination therapy may result in increased myelotoxic and cardiotoxic effects.
Cytostatic drugs and/or radiation therapy: Combination therapy has been associated with t-AML and myelodysplastic syndrome (see Precautions and Adverse Reactions).
Vaccines: The immunosuppressive effects of mitoxantrone can be expected to reduce the response to vaccination. Use of live vaccines may lead to vaccine-induced infection.
Cyclosporine: Cyclosporine may reduce mitoxantrone clearance rate in patients with AML.
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