Doxorubicin
ADRIAMYCIN
Pronunciation: dox-oe-ROO-bi-sin
What it isAnthracycline topoisomerase II inhibitor; a backbone for breast cancer, lymphoma, and sarcoma.
Why this oneRemains 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.
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityCumulative cardiomyopathy and severe myelosuppression
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Adjuvant breast cancer (axillary node-positive, after resection; with cyclophosphamide) | Adult women | 60 mg/m2 IV bolus on day 1 q21d | 60 mg/m2 q21d × 4 cycles | 60 mg/m2 q21d |
| Other cancers, single agent (ALL, AML, Hodgkin/NHL, metastatic breast, Wilms', neuroblastoma, soft-tissue/bone sarcoma, ovarian, bladder, thyroid, gastric, bronchogenic) | Adults | 60–75 mg/m2 IV q21d | 60–75 mg/m2 IV q21d | 75 mg/m2 q21d; cumulative >550 mg/m2 ↑ cardiomyopathy risk |
| Other cancers, combination chemotherapy | Adults | 40–75 mg/m2 IV q21–28d | 40–75 mg/m2 IV q21–28d | 75 mg/m2 per cycle; cumulative >550 mg/m2 ↑ cardiomyopathy risk |
Renal Undefined
Hepatic Bilirubin 1.2–3 mg/dL: reduce dose 50%; 3.1–5 mg/dL: reduce 75%; >5 mg/dL or Child-Pugh C: contraindicated (do not initiate/discontinue).
Consider lower dose or longer intervals in heavily pretreated, elderly, or obese patients. CBC before each dose; delay for unresolved severe myelosuppression. Discontinue if cardiomyopathy develops. No age-based dose adjustment in peds.
Instructions
- Hazardous drug — special handling/disposal.
- Dilute in NS or D5W; protect from light; use within 1 h.
- IV injection over 3–10 min via central line or free-flowing peripheral line (peripheral ≤10 min); continuous infusion via central line only; slow rate if venous streaking or facial flushing.
- Extravasation: stop immediately, aspirate before removing needle, do not flush or apply pressure, ice 15 min 4 times/day × 3 days, elevate limb; consider dexrazoxane (adults).
- Do not admix with other drugs (precipitates with heparin or fluorouracil); avoid alkaline solutions.
Available strengths
- inj 2 mg/mL
Contraindications
- Severe myocardial insufficiency
- Recent myocardial infarction (within 4–6 weeks)
- Severe persistent drug-induced myelosuppression
- Severe hepatic impairment (Child-Pugh C or bilirubin >5 mg/dL)
Cautions
- Cardiomyopathy and arrhythmias
- Secondary malignancies (AML/MDS)
- Extravasation and tissue necrosis
- Severe myelosuppression
- Hepatic impairment (reduced clearance)
- Tumor lysis syndrome
- Potentiation of radiation toxicity / radiation recall
- Embryo-fetal toxicity
Adverse reactions
- Alopecia
- Nausea
- Vomiting
Pregnancy Can cause fetal harm—avoid in 1st trimester; contraception during and 6 months after (females) / 3 months after (males).
Lactation Present in human milk (exceeds plasma levels); do not breastfeed during treatment and for 10 days after the final dose.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2 mg/mL | inj | per unit | not offered |
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Self-check
- Why track lifetime doxorubicin exposure?
Cumulative, largely irreversible cardiotoxicity. - What can doxorubicin extravasation cause?
Tissue necrosis.