II. Indications
- FDA Approved
- Off-Label
- Hepatocellular Carcinoma
- Multiple Myeloma
- Renal Cancer
- Salivary Gland Cancer
- Thymic cancer or thymoma
- Uterine Cancer (Endometrial Cancer, Uterine Sarcoma)
- Waldenstrom's Macroglobulinemia
III. Mechanism
- See Antibiotic Chemotherapy
- This formulation is a non-liposomal preparation of Doxorubicin
- Doxorubicin is a derivative of Daunorubicin, an anthracycline Aminoglycoside antineoplastic
- Daunorubicin is isolated from the bacterium Streptomyces peucetius (Caesius variety)
- Doxorubicin is a hydroxylated form of Daunorubicin
- Doxorubicin inserts between adjacent DNA base pairs
- Blocks DNA Transcription by RNA Polymerase
- Doxorubicin also inhibits Topoisomerase 2
- Inhibits normal Nucleotide strand ligation during DNA Replication
- Doxorubicin also induces free radical formation with several secondary effects
- Lipid peroxidation of cell membrane lipids (cytotoxic effects)
- Toxic effects (esp. cardiovascular adverse effects)
IV. Medications
- Doxorubicin IV Solution: 2 mg/ml in 5, 10, 25 and 100 ml vials
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
- Severe skin and soft tissue necrosis on extravasation
- Cardiotoxicity (esp. children)
- Risk of Congestive Heart Failure (esp. with multiple doses)
- Myelosuppression
- Hyperuricemia
- Infusion reactions (severe)
- Alopecia
- Mucositis
- Necrotizing colitis
- Palmar-Plantar erythrodysesthesia
- Carcinogenic (risk of secondary malignancy)
- Urine Discoloration (transient red coloration)
VII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
- Complete Blood Count
- Liver Function Tests
- Renal Function Tests
- Serum Uric Acid
- Echocardiogram with ejection fraction
VIII. Resources
- Doxorubicin Injection Solution (DailyMed)
- Doxorubicin (StatPearls)
IX. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia