Doxorubicin (Adriamycin, Doxil, Rubex)

Brand name: Adriamycin ®, Rubex ®, Doxil®    

Generic name:Doxorubicin  

Other names: Hydroxydaunomycin, Hydroxydoxorubicin and Liposomal  

Therapeutic Class:  anthracycline antiobiotic 

Manufacturer / Distributor:  Generic 

Availability:  Doxorubicin is available by prescription only  

Dosage form: Doxorubicin is given through a vein (intravenous injection) 

Indications : Doxorubicin is a used to treat a variety of cancers, including: 

• cervical cancer 
• endometrial cancer 
• head and neck cancer  
• Prostate cancer  
• liver cancer  
• ovarian cancer  
• gestational trophoblastic tumors (a rare cancer in women rises in the uterus or womb)
• carcinoid tumors 
• non small cell lung cancer 
• multiple myeloma (a form of blood cancer) 
• Pancreatic cancer(Cancer of the pancreas) 
• esophageal cancer (Cancer of the esophagus) 
• retinoblastoma (a common intraocular cancer of childhood)
• hepatoblastoma (a certain type of liver cancer that occurs in children)  
• cancer of the thymus (a small organ in your upper chest, under your breastbone)  
• cancer of the adrenal cortex (the outside layer of the adrenal gland)  
• chronic lymphocytic leukemia (a type of cancer of the blood and lymph system) 
• Ewing’s sarcoma (a type of cancer occurs in the bone or close to the bone, most often in adolescents) 
• Autoimmune deficiency syndrome (AIDS)–associated Kaposi's sarcoma (a type of cancer of the skin and mucous membranes that is more common in patients with AIDS).  

Doxorubicin can be prescribed in the treatment of other medical conditions not mentioned in this article; talk to your doctor or pharmacist for more information. 

Dosage: Doxorubicin is administered only in hospital by specialists in oncology, hematology, or by competent nurses. The drug requires special monitoring during treatment. Doxorubicin is given by injection into a vein over 3-10 minutes; in exceptional cases, the medication can be taken by continuous infusion over a period of 48-96 hrs. 

Overdose: Overdose enhances the toxic effects of doxorubicin. Very high doses of Doxorubicin can cause heart problems and severe aplastic anemia (bone marrow does not produce enough new cells) in the space of 10 to 14 days. In fact, heart failure can occur even 6 months after an overdose. If you experience serious adverse reactions during and after the treatment, see your health care provider immediately. Treatment of Doxorubicin overdose usually includes supportive measures and possibly blood transfusions. Hospital stay is sometimes necessary.  

Contraindications : Doxorubicine is contraindicated or should be used with precaution in the following conditions: 

·         Pregancy  

·         breast feeding 

·         kidney failure 

·         measles or flu shots vaccinations  

·         heart disease associated with myocardial failure  

·         allergy to Doxorubicin or any of its components  

·         patients who have low blood counts 

·         Patients who have already received the maximum dose allowed during the lifetime of anthracycline drugs (Daunorubicin, epirubicin, idarubicin, and others) or mitoxantrone. 

Mechanism of action (MOA): Doxorubicin prevents the growth of cancer cells by inhibiting their synthesis of DNA and RNA, a genetic process necessary for reproduction and growth of cells. 

Interactions: Doxorubicin should not be associated with certain drugs; they can modify its curative effects and/or increase the risk of developing side effects. Consult your doctor before taking any of these medicines: 

• Ganciclovir , an antiviral drug 
• Amphotericin B, a polyene antifungal drug
• Azathioprine , an immune system inhibitor 
• Digoxin, a medication used in the treatment of several heart conditions
• Plicamycin , a chemotherapy used to stops the growth of cancer cells
• Amiodarone , a medication used to treat irregular heart beat
• Barbiturates, depressant drug that causes relaxation and sleepiness
• Cimetidine , a drug used to inhibit the production of acid in the stomach
• Colchicines , a medication used to treat pain of gouty arthritis
• Cyclophosphamide (Cytoxan), a medication of the alkylating agent family used to treat a variety of cancers 
• Cyclophosphamide (Cytoxan, Cytoxan, Neosar, Procytox, Revimmune), a drug used to treat several types of cancers

Side effects: Despite the beneficial effects of Doxorubicin in the treatment of many cancers, it can damage non-cancerous cells and cause side effects; the most common Doxorubicin side effects include: 

• nausea 
• vomitting 
• fatigue 
• diarrhea  
• difficulty swallowing 
• hair loss
• darkened and dry skin 
• decreased appetite  
• weight loss  
• darkening of fingernails or toenails 
• Swelling, pain, redness, or peeling of skin on the palms and soles of the feet.  

Doxorubicin e can cause serious side effects which require immediate medical attention; contact your doctor immediately if you experience any of these symptoms: 

• bloody urine 
• persistent cough 
• red urine or sweat 
• shortness of breath or difficulty breathing 
• persistent diarrhea or constipation  
• unusual bruising or bleeding 
• swelling and/or pain at the injection site
• sore throat and fever.  

References:  

1 - ch.oddb.org 

2 - santeontario.com (Doxorubicine) Chlorhydrate pour injection USP 

3 - nlm.nih.gov, Doxorubicin