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doxorubicin
generic
Black Box Warnings .
Cardiotoxicity
myocardial damage incl. acute left ventricular failure may occur during tx or months to years after D/C tx; incr. risk w/ higher cumulative dose, w/ incidence rates from 1-2% at a cumulative dose of 300 mg/m^2, 3-5% at 400 mg/m^2, 5-8% at 450 mg/m^2, and 6-20% at 500 mg/m^2, when tx is cycled q3wk; include prior anthracycline or anthracenedione dose in total cumulative dosage; incr. risk if active/dormant cardiovascular dz, prior or concomitant XRT to mediastinal/pericardial area, prior anthracycline or anthracenedione tx, or concomitant cardiotoxic drug tx; cardiac toxicity may occur at lower cumulative doses w/ or w/o cardiac risk factors; incr. risk delayed cardiotoxicity in pediatric pts; assess LVEF before and regularly during and after tx
Secondary AML or Myelodysplastic Syndrome
occur at a higher incidence in pts treated w/ anthracyclines, incl. doxorubicin; cumulative incidences ranged from 0.2% at 5 years to 1.5% at 10 years
Extravasation
can result in severe local tissue injury and necrosis requiring wide excision of affected area and skin grafting; immediately D/C tx and apply ice to affected area if extravasation suspected; do not give IM or SC
Myelosuppression
severe cases resulting in serious infection, septic shock, requirement for transfusion, hospitalization, and death may occur
Adult Dosing .
Dosage forms: INJ
Special Note
- [formulation clarification]
- Info: not interchangeable w/ liposomal doxorubicin products; do not substitute on a mg to mg basis
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments
axillary node positive breast CA, adjuvant tx
- [60 mg/m^2/dose IV x1 on day 1 of 21-day cycle]
- Info: give x4 cycles; use w/ cyclophosphamide
leukemia
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for ALL or AML; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for ALL or AML; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
lymphoma
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for Hodgkin lymphoma or non-Hodgkin lymphoma; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for Hodgkin lymphoma or non-Hodgkin lymphoma; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
solid tumors, metastatic
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for metastatic breast cancer, Wilms tumor, neuroblastoma, soft tissue sarcoma, bone sarcoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, or bronchogenic carcinoma; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for metastatic breast cancer, Wilms tumor, neuroblastoma, soft tissue sarcoma, bone sarcoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, or bronchogenic carcinoma; consider lower dose or longer interval b/w cycles in heavily pretreated pts, elderly pts, or obese pts
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- bilirubin 1.2-3: decr. usual dose by 50%; bilirubin 3.1-5: decr. usual dose by 75%; bilirubin >5 or Child-Pugh Class C: avoid use
Peds Dosing .
- Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments
leukemia
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for ALL or AML; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for ALL or AML; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
lymphoma
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for Hodgkin lymphoma or non-Hodgkin lymphoma; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for Hodgkin lymphoma or non-Hodgkin lymphoma; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
solid tumors, metastatic
- [monotherapy]
- Dose: 60-75 mg/m^2/dose IV x1 on day 1 of 21-day cycle; Max: cumulative dose 550 mg/m^2; Info: for metastatic breast cancer, Wilms tumor, neuroblastoma, soft tissue sarcoma, bone sarcoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, or bronchogenic carcinoma; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
- [combination tx]
- Dose: 40-75 mg/m^2/dose IV x1 on day 1 of 21- or 28-day cycle; Max: cumulative dose 550 mg/m^2; Info: for metastatic breast cancer, Wilms tumor, neuroblastoma, soft tissue sarcoma, bone sarcoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, or bronchogenic carcinoma; consider lower dose or longer interval b/w cycles in heavily pretreated or obese pts
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- bilirubin 1.2-3: decr. usual dose by 50%; bilirubin 3.1-5: decr. usual dose by 75%; bilirubin >5 or Child-Pugh Class C: avoid use