Doxorubicin (intravenous)

Sold under the brand name Adriamycin among others, doxorubicin is a chemotherapy drug used to treat many different types of cancer.

Overview

Doxorubicin injection is used in combination with other drugs to treat cancer of the blood, bladder, lymph system, breast, kidneys and more. The dosage given is based on a patient's health condition, body size, and response to therapy. This drug belongs to a class of medications referred to as antineoplastics, medications whose main purpose is to curb the growth of cancer cells which are eventually annihilated by the body. Some side effects may begin to develop in some patients from the drug--some with more serious health ramifications than others. Some effects may not occur in patients until months or years after using the medication. Before a patient starts treatment, they should talk with their doctor first about the benefits and risks of using this particular medicine. All the same, this medication should be given only by or under the direct supervision of the healthcare provider. Also doxorubicin is available in two dosage forms - powder and a solution form.

Conditions Treated?

Type Of Medicine?

  • Chemotherapy drug

Side Effects

It's vital for patients to tell the nurse or doctor if they have any side effects from doxorubicin so they can help patients manage those symptoms. Nurses are fond of giving their patients a contact number to ring in case they have any questions or problems, or if they're in doubt or suspicious about their medication or emerging side effects. All the same, patients should contact their doctor or nurse immediately if any of their side effects get severe, show signs of infections, or have a temperature above 38°C. Also, some side effects may be different for certain individuals, particularly those having this medication with other cancer treatments.

Below are some of the most reported symptoms widespread among many patients who use doxorubicin treatment.

1. Increased risk of getting an infection. Signs of an infection may occasion in a cough, headaches, a sore throat, aching muscles, pain passing urine, or feeling cold and shivery.

2. A sick feeling or being sick. This can start a few hours following treatment and last for a few days. Anti-sickness tablets and injections are given to alleviate the patient's sick mood. Sometimes a patient may need to try different anti-sickness drugs to find out which one specifically is right for them.

Tips:

  • Drink plenty of fluids to stop getting dehydrated
  • Avoid fatty foods, fried foods, or foods with a strong smell
  • Avoid preparing or eating food when having a sick-like feeling
  • Fizzy drinks may do wonders for those feeling sick

3. Episodes of fatigue. Sometimes a patient may feel very tired during and after treatment. For some patients, it might take 6 months or even a year for their energy levels to get fully restored after the treatment ends. Patients with a low red blood cell count also experience fatigue a lot. Developing a gentle exercise routine and sticking to a healthy balanced diet daily are a few effective ways a person can try to get around this problem.

4. Hair loss. Patients could lose all their hair anywhere around their bodies--eyebrows, eyelashes, leg, underarm and so on. The hair loss usually starts gradually within 2 to 3 weeks after starting treatment. Most patients regrow hair once their chemotherapy treatment finishes. It may take several months for patients to grow their full hair back, and it may likely appear a bit softer, curlier, and with a different color than before.

Tips:

  • Ask about getting a wig before starting treatment
  • Choose a wig for a whole new look, particularly one which matches the texture and color of hair
  • Think about having a haircut or shaving all the hair off
  • Wear a hairnet at night to stop loose or falling hair from messing up the bed's pillow

5. Sore mouth and throat. A patient's mouth and throat may get sore, which frequently makes it painful to swallow food and drinks. A patient should have mouthwashes regularly for the sore part to subside and also keep the mouth healthy. Taking painkillers an hour before meals is a great way to reduce soreness and make eating easier.

6. Red or pink urine. This shouldn't worry anyone since the effects won't harm anybody at all. The color change occurs due to the color of the chemotherapy drug given, which may likely fade away after one or two days.

7. Loss of appetite. A patient might experience a loss of appetite for various reasons when undergoing cancer treatment--fatigue, taste changes, or sickness are common culprits.

Tips:

  • Binge eating small meals and snacks throughout the day can be easier to manage
  • Sip high-calorie drinks in between treatments, highly advisable for patients who fear to lose much weight
  • Drink plenty of liquid and be sure not to fill the stomach with a lot of fluids before eating
  • Eat high-calorie foods to keep the body's weight and shape in order

8. Diarrhea. Patients experiencing episodes of diarrhea can get a prescription from their doctor. Drinking about 2.5 liters of fluid a day may also help relieve the problem and keep the patient's body hydrated.

9. High fever and chills. Patients at risk of getting a high temperature may start feeling cold and shivery at the same time. A doctor should be alarmed right away when a patient develops such signs. A patient may even ask their nurse or doctor whether they should take a paracetamol to help lower their body's temperature.

10. Sore, red and peeling soles and palms. A patient's feet soles and hand palms might become red and sore--their body's skin might also peel. The medical term palmar-plantar syndrome is frequently used to refer to this condition by healthcare experts and may cause numbness, tingling, pain, and dryness in patients. A drug prescription and cream can help stop and reverse the affected area of the skin back to normal.

11. Liver changes. A patient may experience short episodes of liver changes that are usually very mild and unlikely to cause any bothersome side effects. In fact, the symptoms fade away on their own when treatment finishes. Nevertheless, it's important for patients to have regular blood tests to examine any changes in levels of chemicals channeled by the liver.

12. Breathlessness and looking pale. Many chemotherapy drugs such as doxorubicin usually make the level of red blood cells drop, thus causing anemia. Due to the low level of oxygen reaching the cells, a person ends up feeling breathless and looking pale. Therefore, it's important to have regular blood tests to check the level of red blood cells.

If the level is very low, a blood transfusion is usually provided to patients to help them become less breathless and less pale. A patient may feel depressed and tired when their blood count is low and feel better once it's back to normal. It's also normal for a patient to experience a rise and drop of red blood cell levels during treatment.

13. Bruising, bleeding gums, or nosebleeds. Normally these side effects occur where a patient's number of platelet levels drops and so their blood is unable to clot properly. From this, a person may begin to nosebleed, have bleeding gums, or even get lots of tiny red spots or bruises on the legs and arms. Patients should get a platelet transfusion if their levels are very low--the new platelets usually work right away after treatment.

Occasional side effects

1. Raised uric acid levels in the blood. Increased levels of uric acid in the blood can result in crystals building up in body tissues and may cause inflamed joints. A person should have regular blood tests to check their levels. Also drinking plenty of fluids usually helps flush out excess uric acid. Some medicines may also be prescribed by the doctor to control uric acid levels.

2. Nail changes. A patient's nails may become dark and white lines may begin to form on them.

3. Damage to the heart muscle. Although this is usually temporary, for a small group of people it may be permanent. The healthcare provider should check his or her patient's heart rate first before and after treatment to ensure the patient is in good condition.

4. Inflammation around the drip site. A patient should tell his or her nurse or doctor straight away any time they experience signs of redness, some swelling, or leaking of the drip site.

5. Allergic reaction. Some people may have an allergic reaction from this medicine, particularly during the first or second treatment. Symptoms patients experience include a skin rash, feeling hot, itching, and shivering.

Other symptoms include dizziness, redness of the face, a headache, anxiety, and shortness of breath. The nurse or doctor should keep a close eye on the patient and treatment should be provided straight away when such an occasion happens.

6. Skin changes. Patients may notice changes in their skin--itching, dryness, rashes, and reddening. Patients should not go swimming if they have a rash because the chlorine in the water can make the area worse.

A smoothing cream (unperfumed) may help exfoliate the dry or itchy area of the skin. It's important to check with the pharmacist, nurse, or doctor first before using any lotions or creams on the skin.

7. Patients should also wear a high-factor sunblock every time they're going out in the sun. Nevertheless, a patient's skin may become darker when having treatment although this goes back to normal when their medication finishes.

8. Sore eyes. Some patients may experience watery eyes (epiphora) from the drug, which occurs because of a swelling of the nearby tissues or a blockage in the drainage system of the eye. Also, in some cases, a patient's eye could just have too many tears.

Some drug prescriptions like eye drops, ointments, or artificial tears are available to help stop and reduce swelling. It's also important for patients to stay away from some irritants such as pollen, dust, or animal hairs. Patients may wear protective goggles to protect their eyes.

Other occasional side effects a patient may experience include abdominal (stomach) pain and heart failure. Therefore, it's vital for patients to check with their doctor if they experience shortness of breath and swelling in their ankles.

Rare side effects

1. Inflammation of a vein in the leg. Some patients may have a sore, red, swollen area on their leg.

2. Period stopping. Women might stop having periods (amenorrhoea) but for a short while.

3. Blood clots. Some patients may have blood clots. It's important for such patients to get treatment to thin their blood, wipe out any clots, and stop any more from occurring. A patient can also ask for a drug prescription from their doctor if they fear they've a higher risk of developing blood clots.

4. Second cancer. There is a small risk that some patients may get a second cancer some years after this treatment. Patients should talk with their doctor when such an occasion occurs in order to begin treatment.

It's important for patients to seek medical attention any time they experience any of the above side effects. It's also possible for other side effects to occur in patients, even after they stop using this drug. If patients notice any other effects, check with the healthcare professional or call the doctor for medical advice about side effects. Patients may also report side effects to the FDA at 1-800-FDA-1088.

Dosage

For Adults:

Dosage Forms And Strengths

Injectable solution

  • 2mg/mL

Powder for injection

  • 10mg

Cancers

Cancer of breast, ovary, stomach, prostate, thyroid, liver, small cell cancer of lung, squamous cell cancer of neck and head, multiple myeloma, Hodgkin's disease, lymphomas, AML, and ALL dosage include:

  • 60-75 mg/m² IV q for 21Days OR

Renal Impairment

  • Dose change or adjustment not necessary

Hepatic Impairment

  • Serum bilirubin 1.2-3 mg/dL [20.5-51.3 micromoles/L]: Give 50% dose

Administration

Limit lifetime cumulative dose to <550 mg/m² to reduce risk of cardiotox

The healthcare provider should keep track of the patient's CBC, cardiac function, and LFTs levels.

For Pediatric Patients:

Dosage Forms And Strengths

Injectable solution

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    • 2mg/mL

Powder for injection

  • 10mg

Cancers

Cancer of stomach, thyroid, neuroblastoma, liver, squamous cell cancer of neck and head, Hodgkin's disease, multiple myeloma, lymphomas, AML, and ALL doses include:

  • 20-30 mg/m²/dose for a week OR

Note: This medication should be given on a fixed schedule, which means patients who miss or forget to take their medicine should call their pharmacist or doctor for further instructions. Caregivers to those who get an overdose of the drug or have severe symptoms such as trouble breathing or passing out should call 911. Or at least call a poison control center right away.

Interactions

Although some medications should not be used together at all, sometimes two different medicines may be used together even if an interaction may likely occur. On such occasions, the doctor may want to change the dose or take other precautions to stop the interactions. Before receiving this drug, it's important for patients to tell their healthcare provider if they're taking any of the below medications. The following interactions are chosen based on their potential significance and aren't necessarily all-inclusive.

Using this drug with any of the below medicines isn't recommended, and the doctor may decide not to treat his or her patient with this medicine or change some of the other drugs the patient takes.

  • Atazanavir

Using this medication with any of the following drugs is also not recommended, but the healthcare professional may choose to use them in some cases. If both drugs are prescribed together, the healthcare provider may change the dose or the frequency in which his or her patients use one or both of the medications.

  • Abiraterone

And finally, using this medication with any of the following drugs may cause a high risk of certain side effects, but at the same time using both drugs could be the best treatment for patients. If both medications are prescribed together, the healthcare provider may change the dose or the frequency in which patients should use either one or both of the medications.

  • Sorafenib

Other interactions

Some drugs shouldn't be used at or around the time of eating food or eating some specific types of food because interactions may occur. Using tobacco or alcohol with certain medications may also cause patients to have interactions. The doctor may change the dose or frequency his or her patients use this drug, or may give them special instructions about the use of alcohol, tobacco, or food.

  • Grapefruit juice

Other medical issues

The presence of other health problems may affect the use of this drug. Patients should check with their healthcare provider if they experience any of the following medical problems:

  • Heart attack (within 4-6 weeks) after treatment

Warnings

  • Try hard to avoid people with infections. A patient should check with their healthcare professional if they think they experience symptoms such as a cough or hoarseness, fever or chills, lower back or side pain, or difficult or painful urination.
  • A patient should check with their healthcare professional immediately if they notice any unusual bruising or bleeding, black tarry stools, blood in the stools or urine, or severe red spots on the skin.
  • Patients should be careful when using regular dental floss, toothbrush, or toothpick. Check with the doctor to see whether he or she can recommend other ways to clean gums and teeth before having any dental work done.
  • A patient shouldn't touch their eyes or the inside part of their nose unless their hands are very clean.
  • A patient should be careful not to cut themselves when using sharp objects such as a safety razor, or a toenail or fingernail cutter.
  • A patient should stay away from sports activities and other situations where bruising or injury could occur.

Storage

Patients should follow product instructions and their pharmacist's advice about storage details. Also, all medicines should be kept away from children and pets. A person should also not flush this medication down the toilet or pour them into a drain unless instructed to do so. This medication should be disposed of properly when expired or no longer needed. Patients should consult the local waste disposal company or their pharmacist for details on how they should throw away this specific product.

Summary

Doxorubicin is classified as an antitumor antibiotic, which is either used alone or in combination with other drugs to treat different types of cancer such as those of the blood, bladder, lymph system, breast, and kidneys. This medicine works by slowing or stopping the growth of cancer cells and is given by injection into a vein by a healthcare provider. The dosage given very much depends on a patient's health condition, body size, and how their body copes with the therapy. Before using doxorubicin, patients should tell their doctor or pharmacist about their medical history and whether they're allergic to the drug. Potential side effects of this drug include nausea and a heightened risk of contracting an infection.

If this medication touches a person's skin, he or she should immediately and completely wash the skin with water and soap. If it gets inside a person's eye, he or she should open the eyelids and flush with water for 15 minutes. After trying all this and nothing seems to work, a patient should seek immediate medical attention to help reduce the side effects and stop the affected area from worsening further. Caregivers should also take precautions by wearing gloves to prevent contact with the patient's body fluids for at least 5 days following treatment. Otherwise, it's important for patients to use this medication as directed or prescribed by the doctor at all times in order to experience satisfactory results after treatment.