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Doxorubicin Disease Interactions

There are 4 disease interactions with doxorubicin.

Major

Antineoplastics (applies to doxorubicin) infections

Major Potential Hazard, High plausibility. Applicable conditions: Infection - Bacterial/Fungal/Protozoal/Viral

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

References

  1. Sanders C, Perez EA, Lawrence HJ "Opportunistic infections in patients with chronic lymphocytic leukemia following treatment with fludarabine." Am J Hematol 39 (1992): 314-5
  2. "Product Information. Methotrexate (methotrexate)." Lederle Laboratories (2002):
  3. "Product Information. Platinol (cisplatin)." Bristol-Myers Squibb (2001):
  4. "Product Information. Vepesid (etoposide)." Bristol-Myers Squibb (2001):
  5. "Product Information. Novantrone (mitoxantrone)." Immunex Corporation (2001):
  6. "Product Information. Mutamycin (mitomycin)." Bristol-Myers Squibb (2001):
  7. "Product Information. Ifex (ifosfamide)." Bristol-Myers Squibb (2001):
  8. "Product Information. Thiotepa (thiotepa)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2001):
  9. Girmenia C, Mauro FR, Rahimi S "Late listeriosis after fludarabine plus prednisone treatment." Br J Haematol 87 (1994): 407-8
  10. Schilling PJ, Vadhan-Raj S "Concurrent cytomegalovirus and pneumocystis pneumonia after fludarabine therapy for chronic lymphocytic leukemia." N Engl J Med 323 (1990): 833-4
  11. Frame JN, Dahut WL, Crowley S "Fludarabine and acute tumor lysis in chronic lymphocytic leukemia." N Engl J Med 327 (1992): 1396-7
  12. Bastion Y, Coiffier B, Tigaud JD, Espinouse D, Bryon PA "Pneumocystis pneumonia in a patient treated with fludarabine for chronic lymphocytic leukemia." Eur J Cancer 27 (1991): 671
  13. "Product Information. Fludara (fludarabine)." Berlex Laboratories (2001):
  14. "Product Information. Idamycin (idarubicin)." Pharmacia and Upjohn (2001):
  15. "Product Information. Matulane (procarbazine)." Roche Laboratories (2001):
  16. "Product Information. DTIC-Dome (dacarbazine)." Bayer (2001):
  17. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn (2001):
  18. "Product Information. Leustatin (cladribine)." Ortho Biotech Inc (2001):
  19. "Product Information. Gemzar (gemcitabine)." Lilly, Eli and Company (2001):
  20. "Product Information. Hycamtin (topotecan)." SmithKline Beecham (2001):
  21. "Product Information. Taxotere (docetaxel)." Rhone Poulenc Rorer (2001):
  22. "Product Information. Taxol (paclitaxel)." Bristol-Myers Squibb (2001):
  23. "Product Information. Nipent (pentostatin)." Hospira Inc (2001):
  24. "Product Information. Tabloid (thioguanine)." Prasco Laboratories (2001):
  25. "Product Information. Xeloda (capecitabine)." Roche Laboratories (2001):
  26. "Product Information. Alkeran (melphalan)." Glaxo Wellcome (2022):
  27. "Product Information. Purinethol (mercaptopurine)." Glaxo Wellcome (2001):
  28. "Product Information. Leukeran Tablets (chlorambucil)." Glaxo Welcome, Research Triangle Pk, NC.
  29. "Product Information. Doxil (doxorubicin liposomal)." Sequus Pharmaceuticals Inc (2001):
  30. "Product Information. Cytosar-U (cytarabine)." Pharmacia and Upjohn (2001):
  31. "Product Information. Uracil Mustard (uracil mustard)." Roberts Pharmaceutical Corporation (2001):
  32. "Product Information. Jevtana (cabazitaxel)." sanofi-aventis (2010):
  33. "Product Information. Halaven (eribulin)." Eisai Inc (2010):
  34. "Product Information. Keytruda (pembrolizumab)." Merck & Company Inc (2014):
  35. "Product Information. Blincyto (blinatumomab)." Amgen USA (2014):
  36. "Product Information. Opdivo (nivolumab)." Bristol-Myers Squibb (2014):
  37. "Product Information. Unituxin (dinutuximab)." United Therapeutics Corporation (2015):
  38. "Product Information. Empliciti (elotuzumab)." Bristol-Myers Squibb (2015):
  39. "Product Information. Pepaxto (melphalan flufenamide)." Oncopeptides Inc. (2021):
View all 39 references
Major

Doxorubicin (applies to doxorubicin) cardiomyopathy

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, History - Myocardial Infarction, Arrhythmias

Myocardial damage, including acute left ventricular failure can occur with doxorubicin. The risk of cardiomyopathy is proportional to the cumulative exposure with incidence rates from 1% to 20% for cumulative doses ranging from 300 mg/m2 to 500 mg/m2 when doxorubicin is administered every 3 weeks. The risk of cardiomyopathy is further increased with concomitant cardiotoxic therapy. Additionally, doxorubicin can also cause arrhythmias, including life-threatening events at any point during treatment. Assess LVEF before and regularly during and after treatment with doxorubicin. Doxorubicin is contraindicated in patients with severe myocardial insufficiency and recent myocardial infarction (past 6 months).

References

  1. Krivit W "Adriamycin cardiotoxicity amelioration by alpha-tocopherol." Am J Pediatr Hematol Oncol 1 (1979): 151-3
  2. Caviale P, McClellan EL "Adriamycin toxicity. Effects in subsequent anesthesia and surgery." J Kans Med Soc 82 (1981): 553,574
  3. Freter CE, Lee TC, Billingham ME, Chak L, Bristow MR "Doxorubicin cardiac toxicity manifesting seven years after treatment. Case report and review." Am J Med 80 (1986): 483-5
  4. Speyer JL, Green MD, Dubin N, Blum RH, Wernz JC, Roses D, Sanger J, Muggia FM "Prospective evaluation of cardiotoxicity during a six-hour doxorubicin infusion regimen in women with adenocarcinoma of the breast." Am J Med 78 (1985): 555-63
  5. McQuillan PJ, Morgan BA, Ramwell J "Adriamycin cardiomyopathy. Fatal outcome of general anaesthesia in a child with adriamycin cardiomyopathy." Anaesthesia 43 (1988): 301-4
  6. Mortensen SA, Olsen HS, Baandrup U "Chronic anthracycline cardiotoxicity: haemodynamic and histopathological manifestations suggesting a restrictive endomyocardial disease." Br Heart J 55 (1986): 274-82
  7. Haq MM, Legha SS, Choksi J, Hortobagyi GN, Benjamin RS, Ewer M, Ali M "Doxorubicin-induced congestive heart failure in adults." Cancer 56 (1985): 1361-5
  8. Lee BH, Goodenday LS, Muswick GJ, Yasnoff WA, Leighton RF, Skeel RT "Alterations in left ventricular diastolic function with doxorubicin therapy." J Am Coll Cardiol 9 (1987): 184-8
  9. Lum BL, Svec JM, Torti FM "Doxorubicin: alteration of dose scheduling as a means of reducing cardiotoxicity." Drug Intell Clin Pharm 19 (1985): 259-64
  10. Sperber AD, Cantor AA, Biran H, Keynan A "Selective right ventricular dysfunction following doxorubicin therapy." Isr J Med Sci 23 (1987): 896-9
  11. Shapira J, Gotfried M, Lishner M, Ravid M "Reduced cardiotoxicity of doxorubicin by a 6-hour infusion regimen. A prospective randomized evaluation." Cancer 65 (1990): 870-3
  12. Porembka DT, Lowder JN, Orlowski JP, Bastulli J, Lockrem J "Etiology and management of doxorubicin cardiotoxicity." Crit Care Med 17 (1989): 569-72
  13. Devoy MA, Tomson CR "Fatal cardiac failure after a single dose of doxorubicin in myeloma- associated cardiac amyloid." Postgrad Med J 68 (1992): 69
  14. Barendswaard EC, Prpic H, Van der Wall EE, Camps JA, Keizer HJ, Pauwels EK "Right ventricle wall motion abnormalities in patients treated with chemotherapy." Clin Nucl Med 16 (1991): 513-6
  15. Lahtinen R, Kuikka J, Nousiainen T, Uusitupa M, Lansimies E "Cardiotoxicity of epirubicin and doxorubicin: a double-blind randomized study." Eur J Haematol 46 (1991): 301-5
  16. Fu LX, Waagstein F, Hjalmarson A "A new insight into adriamycin-induced cardiotoxicity." Int J Cardiol 29 (1990): 15-20
  17. Steinherz L, Steinherz P "Delayed cardiac toxicity from anthracycline therapy." Pediatrician 18 (1991): 49-52
  18. Bristow MR, Thompson PD, Martin RP, Mason JW, Billingham ME, Harrison DC "Early anthracycline cardiotoxicity." Am J Med 65 (1978): 823-32
  19. Rinehart JJ, Lewis RP, Balcerzak SP "Adriamycin cardiotoxicity in man." Ann Intern Med 81 (1974): 475-8
  20. Benjamin RS, Wiernik PH, Bachur NR "Adriamycin chemotherapy--efficacy, safety, and pharmacologic basis of an intermittent single high-dosage schedule." Cancer 33 (1974): 19-27
  21. Lefrak EA, Pitha J, Rosenheim S, Gottlieb JA "A clinicopathologic analysis of adriamycin cardiotoxicity." Cancer 32 (1973): 302-14
  22. Carter SK "Adriamycin-a review." J Natl Cancer Inst 55 (1975): 1265-74
  23. Billingham ME, Bristow MR, Glatstein E, Mason JW, Masek MA, Daniels JR "Adriamycin cardiotoxicity: endomyocardial biopsy evidence of enhancement by irradiation." Am J Surg Pathol 1 (1977): 17-23
View all 23 references
Major

Doxorubicin (applies to doxorubicin) hepatic dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Liver Disease

Doxorubicin is contraindicated in patients with severe hepatic impairment (defined as Child Pugh Class C or serum bilirubin level greater than 5 mg/dL). Doxorubicin is primarily metabolized by the liver and its clearance is reduced in the presence of hepatic dysfunction, increasing the risk for toxicity. Therapy with doxorubicin should be administered cautiously and at a reduced dosage in patients with moderate or mild hepatic function. Close clinical monitoring of hepatic function prior to initiation of doxorubicin therapy is recommended.

References

  1. Aviles A, Herrera J, Ramos E, Ambriz R, Aguirre J, Pizzuto J "Hepatic injury during doxorubicin therapy." Arch Pathol Lab Med 108 (1984): 912-3
  2. Maral RJ, Jouanne M "Toxicology of daunorubicin in animals and man." Cancer Treat Rep 65 Suppl 4 (1981): 9-18
  3. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn (2001):
Major

Doxorubicin (applies to doxorubicin) myelosuppression

Major Potential Hazard, High plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts, Fever, Bleeding

Doxorubicin induces dose-related myelosuppression, primarily affecting leukocytes. Therapy with doxorubicin should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering doxorubicin and the dosage should be reduced. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitory of hematopoietic function is recommended. Doxorubicin is contraindicated in patients with severe persistent drug-induced myelosuppression

References

  1. Johnson PJ, Dobbs N, Kalayci C, Aldous MC, Harper P, Metivier EM, Williams R "Clinical efficacy and toxicity of standard dose adriamycin in hyperbilirubinaemic patients with hepatocellular carcinoma: relation to liver tests and pharmacokinetic parameters." Br J Cancer 65 (1992): 751-5
  2. Maral RJ, Jouanne M "Toxicology of daunorubicin in animals and man." Cancer Treat Rep 65 Suppl 4 (1981): 9-18
  3. Doll DC, Weiss RB "Hemolytic anemia associated with antineoplastic agents." Cancer Treat Rep 69 (1985): 777-82
  4. Tan C, Etcubanas E, Wollner N, Rosen G, Gilladoga A, Showel J, Murphy ML, Krakoff IH "Adriamycin--an antitumor antibiotic in the treatment of neoplastic diseases." Cancer 32 (1973): 9-17
  5. Carter SK "Adriamycin-a review." J Natl Cancer Inst 55 (1975): 1265-74
  6. Bick RL, Fekete LF, Wilson WL "Adriamycin and fibrinolysis." Thromb Res 8 (1976): 467-75
  7. "Product Information. Adriamycin PFS (doxorubicin)." Pharmacia and Upjohn (2001):
  8. "Product Information. Doxil (doxorubicin liposomal)." Sequus Pharmaceuticals Inc (2001):
View all 8 references

Doxorubicin drug interactions

There are 530 drug interactions with doxorubicin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.