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Doxorubicin

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Doxorubicin, Non-Liposomal Doxorubicin, Adriamycin

  • See Also
  1. Liposomal Doxorubicin
  2. Antibiotic Chemotherapy
  3. Chemotherapy
  • Indications
  1. FDA Approved
    1. Acute Lymphocytic Leukemia (ALL)
    2. Acute Myelogenous Leukemia (AML)
    3. Bladder Cancer (Transitional Cell)
    4. Breast Cancer
    5. Bronchogenic Carcinoma
    6. Gastric Cancer
    7. Lymphoma (Hodgkin Lymphoma, Non-Hodgkin Lymphoma)
    8. Neuroblastoma
    9. Ovarian Cancer
    10. Sarcoma (Bone Sarcoma, Soft Tissue Sarcoma)
    11. Thyroid Cancer
    12. Wilm's Tumor
  2. Off-Label
    1. Hepatocellular Carcinoma
    2. Multiple Myeloma
    3. Renal Cancer
    4. Salivary Gland Cancer
    5. Thymic cancer or thymoma
    6. Uterine Cancer (Endometrial Cancer, Uterine Sarcoma)
    7. Waldenstrom's Macroglobulinemia
  • Mechanism
  1. See Antibiotic Chemotherapy
  2. This formulation is a non-liposomal preparation of Doxorubicin
    1. See Liposomal Doxorubicin
  3. Doxorubicin is a derivative of Daunorubicin, an anthracycline Aminoglycoside antineoplastic
    1. Daunorubicin is isolated from the bacterium Streptomyces peucetius (Caesius variety)
    2. Doxorubicin is a hydroxylated form of Daunorubicin
  4. Doxorubicin inserts between adjacent DNA base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  5. Doxorubicin also inhibits Topoisomerase 2
    1. Inhibits normal Nucleotide strand ligation during DNA Replication
  6. Doxorubicin also induces free radical formation with several secondary effects
    1. Lipid peroxidation of cell membrane lipids (cytotoxic effects)
    2. Toxic effects (esp. cardiovascular adverse effects)
  • Medications
  1. Doxorubicin IV Solution: 2 mg/ml in 5, 10, 25 and 100 ml vials
  • Dosing
  1. See other references for disease specific dosing protocols
  • Adverse Effects
  1. Severe skin and soft tissue necrosis on extravasation
    1. Doxorubicin is a strong Vesicant (causes Blistering)
  2. Cardiotoxicity (esp. children)
    1. Risk of Congestive Heart Failure (esp. with multiple doses)
  3. Myelosuppression
  4. Hyperuricemia
  5. Infusion reactions (severe)
  6. Alopecia
  7. Mucositis
  8. Necrotizing colitis
  9. Palmar-Plantar erythrodysesthesia
  10. Carcinogenic (risk of secondary malignancy)
  11. Urine Discoloration (transient red coloration)
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function Tests
    4. Serum Uric Acid
    5. Echocardiogram with ejection fraction
  • Resources
  1. Doxorubicin Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1fd148fb-0fbc-4b6f-b790-23546fb46a71
  2. Doxorubicin (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK459232/
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia