doxorubicin (Intravenous route)

Pronunciation

dox-oh-ROO-bi-sin

Intravenous route(Solution;Powder for Solution)

Myocardial damage can occur with DOXOrubicin hydrochloride with incidences from 1% to 20% for cumulative doses from 300 to 500 mg/m(2) when DOXOrubicin hydrochloride is administered every 3 weeks. The risk of cardiomyopathy is further increased with concomitant cardiotoxic therapy. Assess left ventricular ejection fraction (LVEF) before and regularly during and after treatment with DOXOrubicin hydrochloride. Secondary acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) occur at a higher incidence in patients treated with anthracyclines, including DOXOrubicin hydrochloride. Extravasation of DOXOrubicin hydrochloride can result in severe local tissue injury and necrosis requiring wide excision and skin grafting. Immediately terminate the drug, and apply ice to the affected area. Severe myelosuppression resulting in serious infection, septic shock, requirement for transfusions, hospitalization, and death may occur .

Commonly used brand name(s)

In the U.S.

  • Adriamycin

Available Dosage Forms:

  • Powder for Solution
  • Solution

Therapeutic Class: Antineoplastic Agent

Chemical Class: Anthracycline

Uses For doxorubicin

Doxorubicin injection is used together with other medicines to treat cancer of the blood, lymph system, bladder, breast, stomach, lungs, ovaries, thyroid, nerves, kidneys, bones, and soft tissues, including muscles and tendons. It may also be used to treat other kinds of cancer, as determined by your doctor.

Doxorubicin belongs to the group of medicines known as antineoplastics. It seems to interfere with the growth of cancer cells, which are then eventually destroyed by the body. Since the growth of normal body cells may also be affected by doxorubicin, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur until months or years after the medicine is used.

Slideshow: Flashback: FDA Drug Approvals 2013

Before you begin treatment with doxorubicin, you and your doctor should talk about the benefits doxorubicin will do as well as the risks of using it.

doxorubicin is to be given only by or under the direct supervision of your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, doxorubicin is used in certain patients with the following medical conditions:

  • Autoimmune deficiency syndrome (AIDS)–associated Kaposi's sarcoma (a type of cancer of the skin and mucous membranes that is more common in patients with AIDS)
  • Cancer of the adrenal cortex (the outside layer of the adrenal gland)
  • Cancer of the cervix
  • Cancer of the endometrium
  • Cancer of the esophagus
  • Cancers of the head and neck
  • Cancer of the liver
  • Cancer of the pancreas
  • Cancer of the prostate
  • Cancer of the thymus (a small organ found under the breast bone)
  • Carcinoid tumors
  • Chronic lymphocytic leukemia (a type of cancer of the blood and lymph system)
  • Ewing's sarcoma (a type of cancer found in the bone)
  • Gestational trophoblastic tumors (tumors in the uterus or womb)
  • Hepatoblastoma (a certain type of liver cancer that occurs in children)
  • Multiple myeloma (a certain type of cancer of the blood)
  • Non–small cell lung cancer (a certain type of lung cancer usually associated with prior smoking, passive smoking, or radon exposure)
  • Retinoblastoma (a type of eye cancer found primarily in children)
  • Tumors in the ovaries

Before Using doxorubicin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For doxorubicin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to doxorubicin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of doxorubicin injection in children. However, heart problems are more likely to occur in children younger than 2 years of age, who are usually more sensitive to the effects of doxorubicin injection.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of doxorubicin injection in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using doxorubicin.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving doxorubicin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using doxorubicin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Atazanavir
  • Boceprevir
  • Cobicistat
  • Lopinavir
  • Nelfinavir
  • Rotavirus Vaccine, Live
  • Saquinavir
  • Telaprevir

Using doxorubicin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone Acetate
  • Adenovirus Vaccine Type 4, Live
  • Adenovirus Vaccine Type 7, Live
  • Amiodarone
  • Amitriptyline
  • Amobarbital
  • Aprepitant
  • Aprobarbital
  • Azithromycin
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Bosentan
  • Bosutinib
  • Bupropion
  • Butabarbital
  • Butalbital
  • Captopril
  • Carbamazepine
  • Carvedilol
  • Ceritinib
  • Chlorpromazine
  • Cinacalcet
  • Ciprofloxacin
  • Cisplatin
  • Clarithromycin
  • Clobazam
  • Clozapine
  • Conivaptan
  • Crizotinib
  • Cyclophosphamide
  • Cyclosporine
  • Dabigatran Etexilate
  • Dabrafenib
  • Darunavir
  • Delavirdine
  • Desipramine
  • Dexamethasone
  • Dexrazoxane
  • Diltiazem
  • Dronedarone
  • Duloxetine
  • Efavirenz
  • Enzalutamide
  • Erythromycin
  • Etravirine
  • Everolimus
  • Felodipine
  • Fluconazole
  • Fluoxetine
  • Fluphenazine
  • Fluvoxamine
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Imatinib
  • Indinavir
  • Influenza Virus Vaccine, Live
  • Itraconazole
  • Ketoconazole
  • Lomitapide
  • Measles Virus Vaccine, Live
  • Mephobarbital
  • Mercaptopurine
  • Methohexital
  • Miconazole
  • Mifepristone
  • Modafinil
  • Morphine
  • Morphine Sulfate Liposome
  • Mumps Virus Vaccine, Live
  • Nafcillin
  • Nefazodone
  • Nevirapine
  • Nilotinib
  • Oxcarbazepine
  • Paclitaxel
  • Paroxetine
  • Pentobarbital
  • Phenobarbital
  • Phenytoin
  • Piperaquine
  • Posaconazole
  • Quercetin
  • Quinidine
  • Ranolazine
  • Regorafenib
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Rubella Virus Vaccine, Live
  • Secobarbital
  • Siltuximab
  • Simeprevir
  • Smallpox Vaccine
  • Stavudine
  • St John's Wort
  • Telithromycin
  • Terbinafine
  • Thiopental
  • Thioridazine
  • Ticagrelor
  • Tipranavir
  • Tocophersolan
  • Topotecan
  • Trastuzumab
  • Typhoid Vaccine
  • Valspodar
  • Varicella Virus Vaccine
  • Verapamil
  • Voriconazole
  • Warfarin
  • Yellow Fever Vaccine
  • Zidovudine

Using doxorubicin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Eltrombopag
  • Sorafenib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using doxorubicin with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use doxorubicin, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of doxorubicin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bone marrow problem (eg, drug-induced myelosuppression), severe or
  • Heart attack, recent (within 4 to 6 weeks) or
  • Heart disease, severe or
  • Liver disease, severe—Should not be used in patients with these conditions.
  • Infection—May decrease your body's ability to fight infection.
  • Liver disease, mild—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of doxorubicin

A nurse or other trained health professional will give you doxorubicin in a hospital or cancer treatment center. doxorubicin is given through a needle placed in one of your veins.

The medicine is usually given once every 21 to 28 days. You may also receive other medicines to help prevent nausea and vomiting.

Doxorubicin is sometimes given together with certain other medicines. If you are receiving a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to take them at the right times.

While you are using doxorubicin, your doctor may want you to drink extra fluids so that you will pass more urine. This will help prevent kidney problems and keep your kidneys working well.

doxorubicin should come with a patient information leaflet. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

Missed Dose

doxorubicin needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.

Precautions While Using doxorubicin

It is very important that your doctor check your progress at regular visits to make sure that doxorubicin is working properly. Blood tests may be needed to check for unwanted effects.

Using doxorubicin while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep you or your partner from getting pregnant during therapy and for 6 months after the last dose of doxorubicin. If you think you have become pregnant while using the medicine, tell your doctor right away.

doxorubicin may cause irreversible heart muscle damage, leading to heart failure. This is more likely to occur if you have other heart problems, have had or currently receiving radiation therapy to your chest, or have received other cancer medicines. Tell your doctor right away if you have chest pain, decreased urine output, irregular heartbeat, trouble breathing, rapid weight gain, or swelling of your hands, ankles, or feet.

doxorubicin may increase risk of new cancers, such as acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS). Talk to your doctor if you have concerns about this risk.

If doxorubicin accidentally seeps out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the place of injection.

While you are being treated with doxorubicin, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Doxorubicin may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine, since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine within the last several months. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Doxorubicin can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

doxorubicin may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

doxorubicin may decrease the amount of sperm made and affect a man's ability to father a child. It may also cause premature menopause in women. Talk with your doctor before you use doxorubicin if you plan to have children.

Doxorubicin causes your urine to turn reddish in color, which may stain clothes. This is not blood. It is to be expected and only lasts for 1 or 2 days after each dose is given.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

doxorubicin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Less common
  • Cough or hoarseness accompanied by fever or chills
  • darkening or redness of the skin (if you recently had radiation treatment)
  • fast or irregular heartbeat
  • fever or chills
  • joint pain
  • lower back or side pain accompanied by fever or chills
  • pain at the injection site
  • painful or difficult urination accompanied by fever or chills
  • red streaks along the injected vein
  • shortness of breath
  • stomach pain
  • swelling of the feet and lower legs
Rare
  • Black, tarry stools
  • blood in the urine
  • pinpoint red spots on the skin
  • unusual bleeding or bruising

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Hair loss, thinning of hair
  • nausea and vomiting
  • sores in the mouth and on the lips
Less common
  • Darkening of the soles, palms, or nails
  • diarrhea

After you stop using doxorubicin, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

  • Fast or irregular heartbeat
  • shortness of breath
  • swelling of the feet and lower legs

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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