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Doxorubicin

  • Medical and Pharmacy Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Brand Name: Adriamycin, Caelyx, Rubex

Generic Name: Doxorubicin

Drug Class: Antineoplastics, Anthracycline

What Is Doxorubicin and How Does It Work?

Doxorubicin is a cytotoxic, anthracycline, topoisomerase II inhibitor indicated as a component of multi-agent adjuvant chemotherapy for treatment of women with axillary lymph node involvement following resection of primary breast cancer. Doxorubicin is also indicated for the treatment of cancers of the ovary, prostate, stomach, thyroid; small cell cancer of lung, liver; squamous cell cancer of head and neck; multiple myeloma, Hodgkin's disease, lymphomas, acute lymphocytic leukemia (ALL), and acute myeloid leukemia (AML).

Doxorubicin is available under the following different brand names: Adriamycin, Caelyx, and Rubex.

Dosage of Doxorubicin:

Adult and Pediatric Dosage Forms and Strengths

Injectable solution

Powder for injection

  • 10 mg
  • 20 mg
  • 50 mg

Dosing Consideraations

Cancers

Adult: 60-75 mg/m² intravenously (IV) every 21 days OR

  • 60 mg/m² IV every 14 days OR
  • 40-60 mg/m² IV every 21-28 days OR
  • 20 mg/m²/dose once/week
Pediatric:
  • 35-75 mg/m² intravenously (IV) every 21 days OR
  • 20-30 mg/m²/dose once/week
  • 60-90 mg/m² IV over 96 hours every 3-4 weeks

Renal Impairment

  • Dose adjustment not necessary

Hepatic Impairment

  • Serum bilirubin less than 1.2 mg/dL: Dose adjustment not necessary
  • Serum bilirubin 1.2-3 mg/dL [20.5-51.3 micromoles/L]: Give 50% dose
  • Serum bilirubin: 3.1-5 mg/dL [53-85.5 micromoles/L]: Give 25% dose
  • Severe hepatic impairment: Contraindicated

Administration

  • Limit lifetime cumulative dose to less than 550 mg/m² to reduce risk of cardiotox
  • Monitor: complete blood count (CBC), cardiac function, liver function tests (LFTs)

SLIDESHOW

Breast Cancer Diagnosis and Treatment See Slideshow

What Are Side Effects Associated with Using Doxorubicin?

Common Side effects of Doxorubicin include:

Other side effects of doxorubicin include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Doxorubicin?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Doxorubicin has no known severe interactions with other drugs.

Serious Interactions of doxorubicin include:

  • adenovirus types 4 and 7 live, oral
  • afatinib
  • dabigatran
  • edoxaban
  • idelalisib
  • influenza virus vaccine trivalent, adjuvanted
  • ivacaftor
  • nefazodone
  • nintedanib
  • palifermin
  • pomalidomide
  • sofosbuvir/velpatasvir
  • tofacitinib

Doxorubicin has moderate interactions with at least 104 different drugs.

Mild interactions of doxorubicin include:

  • amobarbital
  • artemether/lumefantrine
  • dactinomycin
  • progesterone, natural
  • rifapentine
  • ruxolitinib

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

QUESTION

A lump in the breast is almost always cancer. See Answer

What Are Warnings and Precautions for Doxorubicin?

Warnings

  • Doxorubicin should be administered under the supervision of an experienced cancer chemotherapy physician
  • Cumulative dose-related cardiotoxicity may occur. Potentially fatal congestive heart failure (CHF) may occur months to years after completion of therapy. The risk of developing CHF increases with increasing total cumulative doses of doxorubicin in excess of 450 mg/m²
  • Delayed cardiotoxicity may occur in patients with prior mediastinal irradiation, in those on concurrent cyclophosphamide therapy, or in those with preexisting heart disease
  • Toxicity may also occur at a lower cumulative dose in patients
  • For intravenous (IV) administration only. Severe local tissue damage will occur in extravasation. Do not administer intramuscularly (IM) or subcutaneously (SC)
  • Development of secondary acute myelogenous leukemia and myelodysplastic syndrome reported
  • Severe myelosuppression may occur
  • Reduce dose in hepatic dysfunction
  • This medication contains doxorubicin
  • Do not take Adriamycin, Caelyx, or Rubex if you are allergic to doxorubicin or any ingredients contained in this drug
  • Keep out of reach of children
  • In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

Effects of Drug Abuse

  • No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Doxorubicin?"

Long-Term Effects

  • Cumulative dose-related cardiotoxicity may occur. Potentially fatal congestive heart failure (CHF) may occur months to years after completion of therapy. The risk of developing CHF increases with increasing total cumulative doses of doxorubicin in excess of 450 mg/m²
  • Secondary oral cancers, primarily squamous cell carcinoma, reported with long-term (i.e., greater than1 year)
  • See "What Are Side Effects Associated with Using Doxorubicin?"

Cautions

Pregnancy and Lactation

  • Use doxorubicin during pregnancy only in LIFE-THREATENING emergencies when no safer drug is available
  • There is positive evidence of human fetal risk
  • Doxorubicin enters breast milk
  • It is not recommended for use while breastfeeding
References
Medscape. Doxorubicin.
https://reference.medscape.com/drug/doxorubicin-342120
RxList. Doxorubixin Side Effects Center.
https://www.rxlist.com/doxorubicin-hydrochloride-side-effects-drug-center.htm
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