Doxorubicin

DEA Class; Rx

Common Brand Names; Adriamycin, Caelyx, Rubex, Doxil, Lipodox, Myocet

Hypersensitivity

Active infection

Severe hepatic impairment

Baseline neutrophil count <1500/mm³

Recent MI or severe myocardial insufficiency

Prior treatment max dose of doxorubicin, daunorubicin, idarubicin, or other anthracyclines

Cardiomyopathy, CHF, impaired cardiac function

IM/SC administration

• Neutropenia (52%)
• Anemia (52%)
• Leukopenia (42%)
• Pruritus (37%)
• Nausea (37%)
• Stomatitis (37%)
• Fatigue (33%)
• CHF (30%)
• Thrombocytopenia (24%)
• Vomiting (22%)
• Rash (21%)
• Alopecia (15%)
• Anorexia (12%)
• Constipation (12%)
• Diarrhea (10%)
• Cardiomyopathy (0.5-9%)

Vesicant

Pericarditis and myocarditis reported during or following treatment; assess left ventricular cardiac function (eg, MUGA or echocardiogram) prior to initiation of doxorubicin; discontinue in patients who develop signs or symptoms of cardiomyopathy; consider use of dexrazoxane to reduce incidence and severity of cardiomyopathy due to administration in patients who have received a cumulative doxorubicin hydrochloride dose of 300 mg/m² and who will continue to receive doxorubicin hydrochloride

The risk of developing secondary acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) is increased following treatment with doxorubicin hydrochloride. Cumulative incidences ranged from 0.2% at five years to 1.5% at 10 years in two separate trials involving the adjuvant treatment of women with breast cancer. These leukemias generally occur within 1 to 3 years of treatment

Drug clearance of doxorubicin is decreased in patients with elevated serum bilirubin with increased risk of toxicity; reduce dose in patients with serum bilirubin levels of 1.2 to 5 mg/dL; obtain liver tests including ALT, AST, alkaline phosphatase, and bilirubin prior to and during therapy

Doxorubicin hydrochloride can induce tumor lysis syndrome in patients with rapidly growing tumors; evaluate blood uric acid levels, potassium, calcium, phosphate, and creatinine after initial treatment; hydration, urine alkalinization, and prophylaxis with allopurinol to prevent hyperuricemia may minimize potential complications of tumor lysis syndrome

Therapy can increase radiation-induced toxicity to myocardium, mucosa, skin, and liver; radiation recall, including but not limited to cutaneous and pulmonary toxicity, can occur in patients who receive drug after prior radiation therapy

Secondary oral cancers, primarily squamous cell carcinoma, reported with long-term (ie, >1 yr)

Use caution in the elderly, liver impairment, and concomitant radiotherapy

Not effective in malignant melanoma, kidney CA, bowel CA, brain tumors, CNS metastasis

Therapy can cause myelosuppression; a dose-dependent, reversible neutropenia is predominant manifestation of myelosuppression from therapy; obtain complete blood counts prior to each treatment and carefully monitor patients during treatment for possible clinical complications due to myelosuppression; delay next dose if severe myelosuppression has not improved; consider dose reduction for patients with prolonged myelosuppression based on severity of reaction

Based on findings in animals and its mechanism of action, drug can cause fetal harm when administered to a pregnant woman; avoid use during 1st trimester

Data are not available regarding effects on breastfed children or milk production