Doxorubicin
ADRIAMYCIN
What it isAnthracycline topoisomerase II inhibitor; a backbone for breast cancer, lymphoma, and sarcoma.
Why this oneIt remains one of the most broadly active cytotoxics and anchors curative lymphoma regimens.
What limits it⚑ Cardiotoxicity is cumulative and largely irreversible, so track lifetime exposure. Extravasation causes tissue necrosis.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Ovarian cancer | Adults | IV 50 mg/m2 over 60 min q28d | Continue until progression or unacceptable toxicity | IV 50 mg/m2 q4wk (do not re-escalate after toxicity reduction) |
| AIDS-related Kaposi's sarcoma | Adults | IV 20 mg/m2 over 60 min q21d | Continue until progression or unacceptable toxicity | IV 20 mg/m2 q3wk |
| Multiple myeloma (with bortezomib) | Adults | IV 30 mg/m2 over 60 min on day 4 of each 21-day cycle, after bortezomib | 8 cycles or until progression/unacceptable toxicity | IV 30 mg/m2 per cycle |
Renal Undefined
Hepatic Reduce dose for serum bilirubin >=1.2 mg/dL (PK not adequately evaluated in hepatic impairment; hepatically eliminated)
Do not increase dose after a reduction for toxicity. Defined delay/25%-reduction rules for hand-foot syndrome, stomatitis, and neutropenia/thrombocytopenia (delay until ANC >=1,500 and platelets >=75,000); separate modification table when combined with bortezomib
Instructions
- Do NOT substitute for other (conventional) doxorubicin HCl products
- Dilute in D5W (doses <=90 mg in 250 mL; >90 mg in 500 mL); refrigerate diluted solution 2–8°C, use within 24 h
- Infuse first dose at 1 mg/min; if no infusion reaction, complete over 1 h; never bolus or undiluted; no in-line filters; do not mix with other drugs; do not rapidly flush the line
- Extravasation: stop infusion for burning/stinging; aspirate before removing needle, do not flush or apply pressure, ice 15 min 4x/day for 3 days, elevate extremity
- Cytotoxic — follow special handling/disposal; wash skin/mucosa contact with soap and water
Contraindications
- History of severe hypersensitivity reaction (incl. anaphylaxis) to doxorubicin HCl
Cautions
- Cardiomyopathy: risk proportional to cumulative anthracycline dose (count prior anthracyclines/anthracenediones; prior mediastinal irradiation lowers threshold) — LVEF (MUGA/echo) before, during, after
- Infusion-related reactions (flushing, dyspnea, hypotension, bronchospasm...) — mostly first infusion; have resuscitation drugs/equipment available
- Hand-foot syndrome — may require dose delay/reduction or discontinuation
- Secondary oral neoplasms
- Embryo-fetal toxicity — effective contraception during and 6 months after (females and males)
- Infertility: possible amenorrhea/premature menopause; oligo-/azoospermia
Adverse reactions
- >20%: asthenia, fatigue, fever, anorexia, nausea, vomiting, stomatitis, diarrhea, constipation, hand-foot syndrome, rash, neutropenia, thrombocytopenia, anemia
Pregnancy Can cause fetal harm; avoid during 1st trimester; verify pregnancy status before initiating; embryotoxic/abortifacient in animals at ~0.12x clinical dose
Lactation Discontinue breastfeeding during treatment
⚠ BOXED WARNINGS
- Cardiomyopathy and heart failure
- Secondary malignancies
- Extravasation and tissue necrosis
- Severe myelosuppression
Classes and tags
Clinical profile
Mechanism of action: Doxorubicin ballicule
