Drug reference

Doxorubicin

Antineoplastic

Also known as doxorubicin hydrochloride

AntineoplasticATC null

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

11 major

incl. contraindicated

PREGNANCY

. Pregnancy testing should be performed before

FDA category + note

Top interactionssee all 11 →

AdalimumabSevereDatabaseDDInter
AmiodaroneSevereDatabaseDDInter
AmisulprideSevereDatabaseDDInter
AnagrelideSevereDatabaseDDInter

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

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