Mitomycin Medac (Mitomycin)

Mitomycin Medac is used as intravesical chemotherapy for urothelial malignancies.

• Non‑muscle invasive bladder cancer (Ta/T1): reduces tumour recurrence after transurethral resection.
• Carcinoma in situ of the bladder (CIS): eradicates flat malignant lesions and prevents progression.
• Upper urinary tract urothelial carcinoma after endoscopic resection: provides local control when instilled retrograde.

• Mitomycin exerts its antitumour activity by forming covalent cross‑links between DNA strands, which block DNA replication and transcription. The resulting DNA damage triggers apoptosis in rapidly dividing urothelial cells, leading to selective tumour cell death while sparing most normal tissue.

Mitomycin may cause a range of adverse reactions following intravesical administration.

Common Side Effects

• Bladder irritation: burning or discomfort during urination.
• Dysuria: painful urination.
• Increased urinary frequency.
• Hematuria: blood in urine.
• Mild cystitis: inflammation of the bladder lining.
• Nausea or mild gastrointestinal upset.

Serious or Rare Side Effects

• Systemic bone‑marrow suppression leading to anemia, neutropenia or thrombocytopenia.
• Severe infection secondary to immunosuppression.
• Renal toxicity or acute kidney injury.
• Allergic reactions including rash, bronchospasm or anaphylaxis.
• Pulmonary fibrosis or interstitial lung disease.
• Life‑threatening hemorrhage.

Mitomycin should be used with careful clinical oversight to minimise risks.

• Renal function assessment: ensure adequate creatinine clearance before instillation.
• Bladder integrity: avoid use in patients with active urinary tract infection or gross hematuria.
• Concomitant myelosuppressive therapy: monitor blood counts closely.
• Pregnancy and lactation: contraindicated unless benefits outweigh risks; discuss with specialist.
• Storage: Store below 25°C: keep in original container, protect from light and moisture.

Mitomycin can interact with other agents that affect bone‑marrow function or renal clearance.

Major Interactions (Avoid)

• Concurrent myelosuppressive chemotherapy (e.g., cyclophosphamide, doxorubicin): may cause profound cytopenias.
• Nephrotoxic drugs (e.g., cisplatin, aminoglycosides): increase risk of renal injury.
• Pelvic radiotherapy administered within 2 weeks: heightened bladder toxicity.

Moderate Interactions (Monitor Closely)

• Anticoagulants (e.g., warfarin, direct oral anticoagulants): may exacerbate hematuria.
• High‑dose NSAIDs: can impair renal excretion of mitomycin.
• Immunosuppressants (e.g., azathioprine): may augment infection risk.