Drug reference

Doxorubicin

Antineoplastic

Also known as doxorubicin hydrochloride

AntineoplasticATC null

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

. Pregnancy testing should be performed before

FDA category + note

Top interactionssee all 12 →

Live VaccinesContraindicatedDatabase
AdalimumabSevereDatabaseDDInter
AmiodaroneSevereDatabaseDDInter
AmisulprideSevereDatabaseDDInter

Mechanism

Doxorubicin is an anthracycline antibiotic with four distinct cytotoxic mechanisms: it intercalates between DNA base pairs disrupting replication and transcription; it inhibits topoisomerase II by stabilizing the cleavable complex and preventing DNA religation; it generates free radicals through iron-dependent redox cycling of its quinone moiety; and it binds cell membranes altering fluidity and ion transport. The free radical mechanism is the primary cause of its dose-limiting cumulative cardiotoxicity, restricting lifetime doses to 450-550 mg/m².

Indications

recurrent superficial bladder tumourspapillary tumourssymptomatic stage III and IV follicular lymphoma (as part of CHOP regimen)Malignant lymphomasSoft-tissue sarcomasOsteogenic sarcomasHodgkin lymphoma (component of ABVD regimen)Non-Hodgkin lymphoma (component of CHOP regimen)Acute leukemiaBreast cancerGenitourinary cancerThyroid cancerStomach cancerNeuroblastomaAIDS-related Kaposi sarcoma (liposomal formulation)Ovarian cancer (liposomal formulation)Multiple myeloma (liposomal formulation)Ovary cancerBladder cancerLung cancersSarcomas

Dosing

Adult: l INDICATIONS AND DOSE Bladder irrigation during urological surgery | Irrigation for transurethral resection of the prostate gland and bladder tumours ▶ Adult: (consult product literature) Dissolution of blood clots Clot retention is usually treated by irrigation with sterile sodium chloride solution 0.9% but sterile sodium citrate solution for bladder irrigation 3% p. 832 may also be helpful.…

Pharmacokinetics

Half-life

30 h (terminal t1/2, multiphasic)

Bioavailability

Protein binding

Rapidly enters the heart, kidneys, lungs, liver, and spleen; does not cross the blood-brain barrier.

Metabolism

Converted to an active alcohol intermediate.

Excretion

Cleared by a complex pattern of hepatic metabolism and biliary excretion.

Side effects

Common

micturition disordersreduction in bladder capacitynausea and vomitingMyelosuppression (maximal leukopenia usually during the second week, thrombocytopenia and anemia less pronounced)StomatitisMucositisDiarrheaAlopeciaErythematous streaking near the site of infusion ('flare')Facial flushingConjunctivitisLacrimationRed colored urineVomitingMarrow depressionRed urine

Serious

Severe local toxicity in irradiated tissues (skin, heart, lung, esophagus, GI mucosa)
Cardiomyopathy (most important long-term toxicity, often irreversible, cumulative, dose-related, progressing to congestive heart failure, mortality rate approaches 50%)
Acute form of cardiotoxicity (abnormal electrocardiographic changes, ST- and T-wave alterations, arrhythmias, acute reversible reduction in ejection fraction, plasma troponin T increase)
Acute myocardial damage ('pericarditis-myocarditis syndrome') (severe disturbances in impulse conduction and frank congestive heart failure, often associated with pericardial effusion)
Late-onset cardiac toxicity (congestive heart failure years after treatment)
Elevated risk of arrhythmias, congestive heart failure, and sudden death in adult life (in children treated with anthracyclines)
Cardiotoxicity (acute: ECG changes, arrhythmias, hypotension; delayed: congestive heart failure)
Local tissue damage on extravasation
Mutagenic potential
Carcinogenic potential

Pregnancy & lactation

Pregnancy

. Pregnancy testing should be performed before

Drug interactions

Live Vaccines

Contraindicated

Database

Risk of severe or fatal infection from the live vaccine due to the patient's compromised immune system. Reduced immune response to the vaccine.

Live vaccines are contraindicated during doxorubicin therapy and for a period after treatment until immune function recovers. Inactivated vaccines may be given, but the immune response may be attenuated.

Adalimumab

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Amiodarone

Severe

Database

Increased risk of cardiac dysfunction, including arrhythmias and heart failure.

Close monitoring of cardiac function (ECG, LVEF) is essential if co-administration is necessary. Consider alternative antiarrhythmic agents if possible.

Source: DDInter

Amisulpride

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Anagrelide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Arsenic Trioxide