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Mitosol

Last reviewed on RxList: 8/20/2020
Drug Description

What is Mitosol and how is it used?

Mitosol (mitomycin) is an antibiotic intended for topical application to the surgical site of glaucoma filtration surgery.

What are side effects of Mitosol?

Common side effects of Mitosol include:

  • local reactions such as eye inflammation
  • hypotony
  • hypotony maculopathy
  • blebitis
  • endophthalmitis
  • vascular reactions
  • corneal reactions, and
  • cataract

DESCRIPTION

Mitomycin is an antibiotic isolated from the broth of Streptomyces verticillus Yingtanensis which has been shown to have antimetabolic activity.

Mitomycin is a blue-violet crystalline powder with the molecular formula of C15H18N4O5 and a molecular weight of 334.33. Its chemical name is 7-amino-9α-methoxymitosane and it has the following structural formula:

Mitosol® 
  (mitomycin) Structural Formula Illustration

Mitosol® is a sterile lyophiliized mixture of mitomycin and mannitol, which, when reconstituted with Sterile Water for Injection, provides a solution for application in glaucoma filtration surgery. Mitosol® is supplied in vials containing 0.2 mg of mitomycin. Each vial also contains mannitol 0.4 mg, at a 1:2 ratio of mitomycin to mannitol. Each mL of reconstituted solution contains 0.2 mg mitomycin and has a pH between 5.0 and 8.0.

Indications & Dosage

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INDICATIONS

Mitosol® is an antimetabolite indicated for use as an adjunct to ab externo glaucoma surgery.

DOSAGE AND ADMINISTRATION

Mitosol® is intended for topical application to the surgical site of glaucoma filtration surgery. It is not intended for intraocular administration. If intraocular administration occurs, cell death leading to corneal infarction, retinal infarction, and ciliary body atrophy may result.

Method Of Reconstitution

Each vial of Mitosol® contains 0.2 mg of mitomycin and mannitol in a 1:2 concentration ratio. To reconstitute, add 1 mL of Sterile Water for Injection, then shake to dissolve. If product does not dissolve immediately, allow to stand at room temperature until the product dissolves into solution.

Method Of Use

Sponges provided within the Mitosol® Kit should be fully saturated with the entire reconstituted contents in the manner prescribed in the Instructions for Use. A treatment area approximating 10mm x 6mm +/- 2mm should be treated with the Mitosol®. Apply fully saturated sponges equally to the treatment area, in a single layer, with the use of a surgical forceps. Keep the sponges on the treatment area for two (2) minutes, then remove and return to the Mitosol® Tray for defined disposal in the Chemotherapy Waste Bag provided.

Stability

Lyophilized Mitosol® stored at controlled room temperature (i.e., 20°C – 25°C or 68°F – 77° F) is stable for the shelf life indicated on the package. Avoid excessive heat. Protect from light.

Reconstituted with Sterile Water for Injection at a concentration of 0.2 mg/mL, mitomycin is stable for one (1) hour at room temperature.

HOW SUPPLIED

Dosage Forms And Strengths

Mitosol® is a sterile lyophilized mixture of mitomycin and mannitol, which, when reconstituted with Sterile Water for Injection, provides a solution for application in glaucoma filtration surgery. Mitosol® is supplied in vials containing 0.2 mg of mitomycin. Each vial also contains mannitol 0.4 mg, at a 1:2 ratio of mitomycin to mannitol. Each mL of reconstituted solution contains 0.2 mg mitomycin and has a pH between 5.0 and 8.0.

Mitosol® (mitomycin for solution) is available in a kit containing:

OneVial containing 0.2 mg mitomycin
One1 mL syringe (Sterile Water For Injection) with Safety Connector
OnePlunger Rod
OneVial Adapter with Spike
One1 mL TB Syringe, Luer Lock
OneSponge Container
Six3 mm Absorbent Sponges
Six6 mm Absorbent Sponges
SixHalf Moon Sponges
OneInstrument Wedge Sponge
OneProtective Foam Pouch
OneChemotherapy Waste Bag
OneLabel, MMC (mitomycin)

Three kits are supplied in each carton (NDC 49771-002-03).

Storage And Handling

Storage

Store kits at 20°C to 25°C (68°F to 77° F).

Handling Procedures

Procedures for Proper Handling and Disposal of anti-cancer drugs should be followed. Appropriate containment and disposal devices are included within the Mitosol® (mitomycin for solution) Kit for Ophthalmic Use.

Manufactured for: Mobius Therapeutics, LLC 1000 Executive Parkway Suite 224. Revised: Aug 2020

SLIDESHOW

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Warnings & Precautions

WARNINGS

Included as part of the "PRECAUTIONS" Section

PRECAUTIONS

Cell Death

Mitomycin is cytotoxic. Use of mitomycin in concentrations higher than 0.2 mg/mL or use for longer than 2 minutes may lead to unintended corneal and/or scleral damage including thinning or perforation. Direct contact with the corneal endothelium will result in cell death.

Hypotony

The use of mitomycin has been associated with an increased incidence of post-operative hypotony.

Cataract Formation

Use in phakic patients has been correlated to a higher incidence of lenticular change and cataract formation.

Nonclincal Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Adequate long-term studies in animals to evaluate carcinogenic potential have not been conducted with Mitosol®. Intravenous administration of mitomycin has been found to be carcinogenic in rats and mice. At doses approximating the recommended clinical injectable dose in humans, mitomycin produces a greater than 100 percent increase in tumor incidence in male Sprague-Dawley rats, and a greater than 50 percent increase in tumor incidence in female Swiss mice. The effect of Mitosol® on fertility is unknown.

Use In Specific Populations

Pregnancy

Teratogenic Effects

Pregnancy Category X [see CONTRAINDICATIONS].

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants from Mitosol®, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. It is recommended that women receiving Mitosol® not breast feed because of the potential for serious adverse reactions in nursing infants.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric

Use No overall differences in safety and effectiveness have been observed between elderly and younger patients.

Overdosage & Contraindications

OVERDOSE

No Information Provided

CONTRAINDICATIONS

Hypersensitivity

Mitosol® is contraindicated in patients that have demonstrated a hypersensitivity to mitomycin in the past.

Pregnant Women

Mitosol® may cause fetal harm when administered to a pregnant woman. Mitomycin administered parenterally has been shown to be teratogenic in mice and rats when given at doses equivalent to the usual human intravenous dose. Mitosol® is contraindicated in women who are or may become pregnant during therapy. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

Clinical Pharmacology

CLINICAL PHARMACOLOGY

Mechanism Of Action

Mitosol® inhibits the synthesis of deoxyribonucleic acid (DNA). The guanine and cytosine content correlates with the degree of mitomycin-induced cross-linking. Cellular RNA and protein synthesis may also be suppressed.

Pharmacokinetics

Absorption

The systemic exposure of mitomycin following ocular administration of Mitosol® in humans is unknown. Based on a comparison of the proposed dose of up to 0.2 mg to intravenous (IV) doses of mitomycin used clinically for treatment of oncologic indications (up to 20 mg/m2), systemic concentrations in humans upon ocular administration are expected to be multiple orders of magnitude lower than those achieved by IV administration.

Metabolism

In humans, mitomycin is cleared from ophthalmic tissue after intraoperative topical application and irrigation, as metabolism occurs in other affected tissues. Systemic clearance is affected primarily by metabolism in the liver. The rate of clearance is inversely proportional to the maximal serum concentration because of saturation of the degradative pathways.

Excretion

Approximately 10% of an injectable dose of mitomycin is excreted unchanged in the urine. Since metabolic pathways are saturated at relatively low doses, the percent of a dose excreted in urine increases.

Clinical Studies

In placebo-controlled studies reported in the medical literature, mitomycin reduced intraocular pressure (IOP) by 3 mmHg in patients with open-angle glaucoma when used as an adjunct to ab externo glaucoma surgery by Month 12.

In studies with a historical control reported in the medical literature, mitomycin reduced intraocular pressure (IOP) by 5 mmHg in patients with open-angle glaucoma when used as an adjunct to ab externo glaucoma surgery by Month 12.

Medication Guide

PATIENT INFORMATION

  • Instruct patients to discuss with their physician if they are pregnant or if they might become pregnant [see CONTRAINDICATIONS].
  • Instruct patients to discuss with their physician if they have demonstrated a hypersensitivity to mitomycin in the past [see CONTRAINDICATIONS].
  • Nursing mothers should be advised that it is not known if Mitosol® is excreted in human milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue use of the drug, taking into account the importance of the drug to the mother. It is recommended that women receiving Mitosol® not breast feed because of the potential for serious adverse reactions in nursing infants [see Use In Specific Populations].
  • Patients should be advised of the toxicity of Mitosol® and potential complications.
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