What is the chemo drug called the Red Devil?
- The chemotherapy (“chemo”) drug “The Red Devil” is doxorubicin (Adriamycin). It is an intravenous cancer medicine with a clear, bright red color, which is how it got its nickname.
- Doxorubicin may also cause your urine or other body fluids to turn a reddish color for 1 to 2 days after a dose is given, which is normal and temporary.
- Doxorubicin can cause harsh side effects such as heart toxicity (heart failure), severe nausea and vomiting, and total hair loss (alopecia).
- The brand name product Adriamycin has now been discontinued in the U.S., but the generic doxorubicin is still on the market.
Doxorubicin, in the drug class known as anthracyclines, has been used for decades in the treatment of various solid cancers such as breast cancer and ovarian cancer, or blood cancers like leukemia or lymphoma. It works by inhibiting an enzyme known as topoisomerase 2 and blocking RNA and DNA synthesis, which leads to cell death.
Because of its heart toxicity (cardiotoxicity), doxorubicin has a maximum cumulative dose that can be given to each patient. The higher the total dose you receive over time, the greater your chance for heart side effects. Your doctor will monitor your heart before, during and after doxorubicin treatment. Patients typically receive injections every 21 to 28 days on a specific cycle, but your dose schedule may be different.
You may NOT be able to use doxorubicin if you have severe heart disease or severe liver disease. Contact your doctor right away if you feel extremely weak or tired, have a fast heartbeat, any level of shortness of breath, or swelling in your ankles or feet. A medicine known as dexrazoxane may be used to help protect your heart when receiving Adriamycin.
The liposomal form of doxorubicin (brand name: Doxil) has been developed as an alternative. It cannot be substituted on a mg-for-mg basis with regular doxorubicin. Liposomal doxorubicin is placed inside small fat particles (liposomes) which allows a longer blood circulation time.
Brand and generic forms of doxorubicin and doxorubicin liposomal are available in the U.S.
What are the most common side effects with the Red Devil?
The 3 most common side effects with doxorubicin are hair loss (alopecia), nausea and vomiting. Hair loss was seen in up to 92% of patients, and nausea and vomiting occurred in over 70% of patients. Your doctor will help control your nausea and vomiting with anti-nausea medicine before you receive doxorubicin.
Common side effects of doxorubicin may include:
- nausea and vomiting, which can be severe
- total hair loss (alopecia) - may fully or partially grow back after treatment
- swollen mouth and mouth sores
- loss of appetite (anorexia)
- shortness of breath
- fatigue, extreme tiredness
- low platelets (thrombocytopenia)
- low white blood cell numbers in the blood (leukopenia), which may increase your risk for infections
Learn more: Doxorubicin Warnings and Side Effects (in more detail)
This is not all the information you need to know about doxorubicin or doxorubicin liposomal for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss any questions you have with your doctor or other health care provider.
- Doxorubicin prescribing information. Revised 3/2020. New York, NY. Pfizer Inc. Accessed Dec. 7, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/050467s078,050629s030lbl.pdf
- Doxorubicin monograph. Drugs.com. Accessed Dec. 7, 2021 at https://www.drugs.com/mtm/doxorubicin.html
- Blanchard S. Can the Red Devil be Tamed? July 12, 2020. Accessed Dec. 7, 2021 at https://moffitt.org/endeavor/archive/can-the-red-devil-be-tamed/
Related medical questions
- What is the strongest chemotherapy drug for breast cancer?
- How is Lartruvo administered?
- What is the lifetime or cumulative dose for Adriamycin?
- How does AC (Adriamycin and Cytoxan [cyclophosphamide]) work for Breast Cancer?
- What are the long-term side effects of Adriamycin?
- Does Adriamycin cause heart failure?