doxorubicin hydrochloride at a glance
Medicine class
Cytotoxic anthracycline chemotherapy.
How it is given
Administered into a vein by trained cancer-care professionals.
Formulation safety
Conventional and pegylated-liposomal doxorubicin have different properties and must never be interchanged.
Temporary urine colour
Urine may appear red or pink shortly after treatment because the medicine is red.
What is doxorubicin hydrochloride used for?
Licensed uses depend on the formulation selected.
Conventional doxorubicin is licensed for a broad range of cancers, including acute leukaemias, lymphomas, soft-tissue and bone sarcomas, paediatric cancers, breast and lung cancers, and other solid tumours.
Pegylated-liposomal doxorubicin is licensed for metastatic breast cancer where cardiac risk is increased.
It is also licensed for advanced ovarian cancer following failure of first-line platinum-based chemotherapy.
Other licensed uses of the pegylated-liposomal formulation include progressive multiple myeloma with bortezomib after previous therapy, and specified cases of AIDS-related Kaposi’s sarcoma.
How does doxorubicin hydrochloride work?
Doxorubicin inserts itself between DNA base pairs, disrupting the production and copying of DNA, RNA and proteins. It also generates reactive molecules that contribute to cell damage; rapidly dividing cancer cells are particularly affected.
doxorubicin hydrochloride preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 2 mg/mL
How to take doxorubicin hydrochloride
Doxorubicin is prepared and administered intravenously by specialist staff. Pegylated-liposomal doxorubicin is given as a diluted infusion and must not be administered undiluted, as a rapid injection, into muscle or under the skin. Food does not determine administration, but follow any instructions from the treatment unit.
Confirm that the prescribed product is conventional or pegylated-liposomal doxorubicin.
Tell the nurse immediately if the infusion site stings, burns, becomes painful, red or swollen.
Anti-sickness treatment may be provided by the cancer team.
doxorubicin hydrochloride side effects
Common or expected effects
- Reduced blood-cell counts, increasing the likelihood of infection, anaemia, bruising or bleeding
- Nausea, vomiting, diarrhoea, reduced appetite and tiredness
- Sore mouth or mouth ulcers
- Hair loss
- Fever or chills
- Red or pink urine shortly after conventional doxorubicin
- Painful redness, swelling or peeling of the hands and feet, particularly with pegylated-liposomal doxorubicin
Get urgent medical advice
- Fever, shivering or other infection symptoms, which can indicate neutropenic infection
- Unusual bruising, persistent bleeding or marked breathlessness
- Chest pain, palpitations, swelling or new breathlessness, which may indicate heart toxicity
- Sudden breathing difficulty, facial swelling, widespread rash, dizziness or collapse during an infusion
- Pain, burning, redness or swelling at the infusion site because leakage can damage surrounding tissue
- Worsening breathlessness, dry cough and fever with pegylated-liposomal doxorubicin, which require prompt assessment for lung inflammation
- Severe blistering or peeling skin
doxorubicin hydrochloride in pregnancy
Doxorubicin can harm an unborn baby and is generally avoided during pregnancy unless specialist assessment concludes that it is clearly necessary. Effective contraception is required during treatment and for a product-specific period afterwards; tell the oncology team immediately about pregnancy or plans to conceive. Discuss fertility preservation before treatment where relevant.
doxorubicin hydrochloride while breastfeeding
Breastfeeding is not recommended during doxorubicin treatment because of the potential for serious harm to the infant. The required period before breastfeeding can resume is formulation-specific and should be confirmed with the oncology team.
doxorubicin hydrochloride interactions
The oncology team should review prescribed, over-the-counter and herbal products before treatment.
Live vaccines
Immunosuppression can make live vaccines cause serious infection; vaccination plans should be agreed with the oncology team.
Trastuzumab and other cardiotoxic treatments
Cardiac toxicity may be increased, requiring careful treatment selection and heart monitoring.
Ciclosporin
It can increase doxorubicin exposure and prolong bone-marrow toxicity; seizures and coma have also been reported with the combination.
Common questions about doxorubicin hydrochloride
Answers are fully visible for fast scanning and source review.
Why are heart tests needed with doxorubicin hydrochloride?
Doxorubicin can weaken heart muscle during treatment or months to years later. Baseline and follow-up assessments help identify changes before serious heart failure develops.
Is pegylated-liposomal doxorubicin hydrochloride the same as conventional doxorubicin hydrochloride?
No. Their distribution, administration requirements, licensed uses and safety profiles differ, so they must not be interchanged.
Can doxorubicin hydrochloride make urine red?
Yes. Its red colour can temporarily make urine look red or pink shortly after conventional treatment; persistent discoloration or suspected blood should still be reported.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.