Doxorubicin

Cytostatic · Cytotoxic antibiotic

Indications

For the treatment of disseminated neoplastic conditions such as acute leukaemia, soft tissue and bone sarcomas, breast carcinoma, ovarian carcinoma, lymphomas of both Hodgkin and non-Hodgkin type, small cell lung cancer and gastric carcinoma and bladder carcinoma.

Dosage

Acute lymphoblastic & myeloblastic leukaemia/Wilms' tumour/neuroblastoma/ soft tissue & bone sarcomas/breast, ovarian, bronchogenic, bladder, thyroid, & gastric carcinoma/Hodgkin's disease/ malignant lymphoma: Monotherapy: 60-75 mg/m² IV every 21 day. Combination Therapy: 40-60 mg/m² IV every 21-28 days.

Administration

IV: Administer IV push over 1-2 min or IVP Bolus. Infusion via central venous line recommended. Reconstitute lyophilized powder with NS to a final concentration of 2 mg/mL as follows. Further dilution in D5W or NS is stable for 48 hours at room temperature (25°C) when protected from light. Unstable in solutions with a pH < 3 or > 7. Standard IV Dilution: IVP: Dose/syringe (concentration: 2 mg/mL). IVP Bolus: Dose 50-100 mL D5W or NS. Compatibility: Stable in D5W, LR, NS.

Adverse Effects

Alopecia, stomatitis, myelosuppression or GI disorders (nausea, vomiting, diarrhoea), tachycardia, ECG changes, arrhythmias, cardiomyopathy, CHF, GI upset, anorexia, facial flushing, skin reactions, conjunctivitis, lacrimation, red urine, asthenia, fatigue, fever, dizziness, Kaposi's sarcoma; also, oral moniliasis, retinitis, vasodilatation, dyspnoea, mucosal inflammation, wt loss.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Patients with marked myelosuppression, stomatitis. Severe hepatic impairment. General infection, severe arrhythmia, cardiac impairment, history of MI, previous treatment with maximum dose of anthracycline. Precautions: Cardiac failure. Hematological monitoring required. Pegylated liposomal formulations of doxorubicin have different dose regimens from aqueous formulations; check carefully. Hepatic or severe renal impairment. Monitor for secondary oral cancer. Immunocompromised. Reduction or delay of doses may be required to manage adverse events. Previous anthracycline therapy. History of haemorrhagic cystitis. Elderly.

Interactions

Heparin, inducers, inhibitors and substrates of CYP, clozapine, cyclosporin, other cytotoxics, trastuzumab, other cardiotoxic or hepatotoxic agents, vaccines.

Advice to Patient

This medication is administered intravenously. Inform prescriber immediately if there is burning/swelling/redness/irritation/pain at infusion site or if there is difficulty in breathing, chest pain, palpitations, swelling of extremities. Contact prescriber if there is fever, chills, unusual bruising or bleeding, fatigue, unrelieved nausea, vomiting, diarrhoea, changes in urinary pattern, unhealed sores in mouth, purulent vaginal discharge. Take small, frequent meals to maintain good nutritional status. Avoid highly crowded places to prevent infection. Do not get vaccinated without consulting prescriber.

Pharmacokinetics

Metabolism: Primarily hepatic to doxorubicinol (active), then to inactive aglycones, conjugated sulfates and glucuronides. Half-life elimination: Distribution: Approx. 5 minutes. Terminal: 20 to 48 hours. Male: 54 hours; Female: 35 hours. Excretion: Feces ( approx. 40%); urine (5% to 12%).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.