Home Drug Guide Doxorubicin Hydrochloride

Drug Guide

Generic Name

Doxorubicin Hydrochloride

Brand Names Doxil (liposomal), Rubex, Adriamycin Pfs, Doxorubicin Hydrochloride (liposomal)

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Anthracycline antibiotic

FDA Approved Indications

Treatment of various cancers including breast cancer, bladder cancer, lymphoma, and others

Mechanism of Action

Doxorubicin intercalates into DNA strands, inhibiting topoisomerase II activity, leading to DNA breaks and apoptosis of cancer cells.

Dosage and Administration

Adult: Dose varies based on type of cancer and patient factors; typically 60-75 mg/m² IV every 21 days.

Pediatric: Dosing is weight- and age-dependent; requires careful monitoring.

Geriatric: Dose adjustments may be necessary; increased risk of cardiotoxicity.

Renal Impairment: Use with caution; dose adjustments may be needed.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Not applicable; administered intravenously.

Distribution: Widely distributed, including into the heart, liver, kidney, and spleen.

Metabolism: Metabolized in the liver to active metabolites.

Excretion: Excreted mainly via bile and feces; small amount in urine.

Half Life: Approximately 20-48 hours.

Contraindications

Severe myelosuppression
Known hypersensitivity to doxorubicin

Precautions

Cardiac toxicity risk, especially with cumulative doses; monitor cardiac function; secondary malignancies; liver function tests.

Adverse Reactions - Common

Myelosuppression (Frequent)
Nausea and vomiting (Common)
Alopecia (Common)
Stomatitis (Common)

Adverse Reactions - Serious

Cardiotoxicity (heart failure) (Serious, cumulative dose-dependent)
Extravasation leading to tissue necrosis (Serious)
Secondary malignancies (e.g., leukemia) (Rare)

Drug-Drug Interactions

Other cardiotoxic agents (e.g., trastuzumab, cyclophosphamide)
CYP3A4 inhibitors or inducers

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor CBC, cardiac function (ECHO, ECG), liver function.

Diagnoses:

Risk for infection due to myelosuppression
Risk for impaired cardiac output

Implementation: Administer IV as prescribed; monitor for adverse effects; implement antiemetics as needed.

Evaluation: Assess blood counts, cardiac function, and for signs of toxicity.

Patient/Family Teaching

Report signs of infection, unusual bruising, or bleeding.
Use effective contraception during and for several months after treatment.
Avoid pregnancy during treatment.
Notify healthcare provider of any signs of heart failure or allergic reactions.

Special Considerations

Black Box Warnings:

Cardiotoxicity, including cardiomyopathy and heart failure, especially with cumulative doses.
Secondary malignancies, including leukemia.

Genetic Factors: Certain genetic variants may influence metabolism and toxicity.

Lab Test Interference: May cause false-positive tests for myocardial damage.

Overdose Management

Signs/Symptoms: Severe myelosuppression, mucositis, cardiotoxicity.

Treatment: Supportive care; no specific antidote; consider use of dexrazoxane for cardioprotection if indicated.

Storage and Handling

Storage: Store vials refrigerated at 2-8°C.

Stability: Stable under recommended storage conditions; protect from light.