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Doxorubicin

(dox-uh-roo-buh-sin)

Trade/other name(s): Adriamycin, Rubex

Why would this drug be used?

Doxorubicin is given to treat non-Hodgkin's lymphoma, multiple myeloma, acute leukemias, Kaposi sarcoma, Ewing sarcoma, Wilm tumor, and cancers of the breast, adrenal cortex, endometrium, lung, ovary, and other sites. It is sometimes used to treat non-cancerous conditions as well.

How does this drug work?

Doxorubicin is part of a group of chemotherapy drugs known as anthracycline antibiotics. It slows or stops the growth of cancer cells.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that you alter your medicine dose, regimen, or timing.
  • If you have previously been treated for cancer with daunorubicin, epirubicin, idarubicin, or mitoxantrone (similar types of chemotherapy), or any other drug that may cause heart damage. Your dose of doxorubicin may need to be adjusted.
  • If you have ever had radiation treatment to your chest. Radiation may cause some damage to the heart, and your doctor may change your doxorubicin dose to reduce the risk of further damage.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug could cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you think you might want to have children in the future. Some chemotherapy drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • If you are breast-feeding. The drug passes into breast milk and may harm the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If doxorubicin is given with paclitaxel, progesterone, cyclosporine, cytarabine, streptozocin, saquinavir, or blood pressure medicines such as verapamil, diltiazem, and other calcium channel blockers, the side effects of doxorubicin may be worse.

If doxorubicin is given with cyclophosphamide, it may increase the risk of bleeding in the bladder and the risk of heart problems.

Doxorubicin may not work as well if it's given with phenobarbital.

Doxorubicin may lower the level of the anti-seizure drug phenytoin in the blood, making it less effective.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements. Also, be sure to ask whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Doxorubicin is given as a shot in a vein, and the dose time runs about 15 minutes. The dose and how often you get the medicine depends on several factors: your size, your blood counts, how well your liver is working, and the type of cancer being treated. Since doxorubicin may case nausea and vomiting, you will be given anti-nausea medicine before and after you take the drug. You will have your blood counts (white blood cells, red blood cells, platelets) checked before each treatment. If your counts are too low, treatment will be delayed. This medicine may be given along with other anti-cancer medicines.

Precautions

Doxorubicin is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

Doxorubicin can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain with urination, a new cough, diarrhea, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Doxorubicin may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

Large total doses of doxorubicin may injure your heart muscle and can cause congestive heart failure either during or after your treatment. To ensure that any damage is found early, your doctor will test your heart function before you receive your first treatment, and then during the treatment. During and after your treatment with doxorubicin, let your doctor know right away if you notice shortness of breath, swollen feet or ankles, or irregular heartbeat. These effects can show up months or even years after you get the drug.

Doxorubicin can cause radiation recall. If you have ever had radiation therapy, the skin or tissue damage from prior radiation therapy can become red and appear damaged again after you get this drug. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

This drug can kill large numbers of cancer cells within the first 24 hours of treatment, spilling the cells' contents into the blood. This can lead to electrolyte imbalances and tumor lysis syndrome, which can result in serious kidney damage and other problems. If your doctor thinks you may be at risk, he or she will give you medicines and/or fluids to help prevent it. If you notice pain in the back or sides of your chest, or blood in your urine, call your doctor right away.

Doxorubicin causes the urine to turn reddish for 1 to 2 days after each dose is given. This is a normal side effect that occurs while your body gets rid of the drug, but it may stain clothes.

This drug can cause allergic reactions. Mild reactions usually consist of fever and chills. More serious reactions are rare. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives (welts), nausea, itching, headache, coughing, shortness of breath, tightness in the chest, or swelling of the face, eyes, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • loss of appetite
  • darkening of nail beds and skin creases of hands
  • hair loss or thinning*
  • nausea*
  • vomiting*

Less common

  • sores in mouth or on lips*
  • sores or ulcerations in the throat, esophagus, or colon
  • radiation recall skin changes*

fetal abnormalities if taken while pregnant or if becoming pregnant while on this drug

Rare

  • temporary changes in electrocardiogram (EKG)
  • irregular heartbeat
  • heart damage and congestive heart failure with shortness of breath, swollen feet and ankles, which can happen months or years after treatment*
  • leukemia or myelodysplastic syndrome, which may happen years after treatment
  • allergic reaction*
  • dark spots or patches of the tongue or mouth
  • tumor lysis syndrome, kidney damage*
  • fever and chills

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes– first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 11/07/2011
Last Revised: 11/07/2011