Adriamycin

Brand Names: Adriamycin

Common Name: doxorubicin

What is this drug used for?

Doxorubicin belongs to the group of cancer-fighting medications known as antineoplastics, and specifically to the family of antineoplastics called anthracyclines. Doxorubicin is used to treat many types of cancer, including cancers of the blood (e.g., leukemia), bone, breast, ovaries, testicles, thyroid, head and neck, bladder, stomach and soft tissues, Hodgkin's disease, lung cancer, non-Hodgkin's lymphoma, Wilm's tumour, and neuroblastomas. Doxorubicin prevents the growth of cancer cells by interfering with the genetic material DNA, which is necessary for reproduction of cells.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Is there any reason not to take this drug?

Doxorubicin should not be used by anyone who:

• is allergic to doxorubicin, other related cancer-fighting medications (e.g., epirubicin, daunorubicin, mitoxantrone, mitomycin), any ingredients of the medication, or any component of the container
• has a history of severe heart disease
• has already been treated with the maximum allowable lifetime dose of any anthracycline or anthracenedione medications (daunorubicin, doxorubicin, epirubicin, idarubicin or mitoxantrone)
• has low blood cell counts caused by previous treatment with other cancer medications or radiation therapy
• has severe heart insufficiency
• has severe heart rhythm problems
• has severe liver function impairment

In addition, doxorubicin should not be given directly into the bladder if tumours have penetrated the bladder wall, bladder infections are present, or there is inflammation of the bladder.

What about possible side effects?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication.If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• diarrhea
• fatigue
• loss of appetite
• nausea and vomiting
• reddish urine (not blood) - this is normal, and lasts 1 to 2 days after each dose
• temporary total loss of hair (returns after treatments end)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• pain, redness, swelling at the place of injection
• signs of anemia such as feeling weak, dizzy, or short of breath.
• signs of infection such as fever over 38°C,chills or sweating, sore throat, coughing, redness or swelling around a cut, wound or catheter site, painful or difficult urination, unusual vaginal itching or discharge
• skin rash or itching
• sores in the mouth and on the lips

Seek immediate medical attention if any of the following occur:

• fast or irregular heartbeat
• shortness of breath
• signs of a severe allergic reaction such as difficulty breathing or hives
• signs of bleeding such as black, tarry stools, blood in urine or vomit, or any other unusual bleeding or bruising
• swelling of feet and lower legs

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

There may be an interaction between doxorubicin and any of the following:

• actinomycin-D
• amiodarone
• digoxin
• cyclophosphamide
• cyclosporine
• mercaptopurine
• other cancer drugs, especially anthracyclines
• paclitaxel
• phenobarbital
• phenytoin
• streptozocin
• vaccines
• zidovudine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Heart problems: This medication increases the risk of heart problems such as abnormal heart rhythm, congestive heart failure, and a weakened heart (cardiomyopathy). Some of these problems occur early in treatment, while others occur later in treatment. People with existing heart disease, those who have had radiotherapy, people who have been treated with this medication in the past, and people who are taking certain medications that act on the heart, are more at risk of theses problems. Your doctor will monitor you closely for these problems.

Infection: As well as killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). Avoid contact with people with contagious infections and tell your doctor if you begin to notice signs of an infection, such as fever or chills.

Liver function: People with impaired liver function may require lower doses of this medication. This medication should not be used by people who have severe liver impairment.

Secondary leukemia: There is some evidence to suggest that people who receive treatment with doxorubicin are at slightly increased risk of developing leukemia. This risk is increased when doxorubicin is given along with other anticancer medications or with radiotherapy. Talk to your doctor if you have concerns.

Pregnancy: Although there is no conclusive information regarding the effects of doxorubicin during pregnancy, it should not be used by pregnant women unless the benefits outweigh the risks. Women and men receiving doxorubicin should use effective contraceptive methods. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Doxorubicin passes into breast milk. Women should not breast-feed while receiving doxorubicin treatment due to risk of harm to the infant.

Children: Children who receive doxorubicin are at an increased risk of developing leukemia. Children may also be more susceptible to the heart effects of this medication.

Special Instructions:

The recommended dose of doxorubicin varies widely according to the specific condition being treated, the response to therapy, the other medications being used, and body size. Doxorubicin is usually injected into a vein through a specially prepared site on your skin. It is less often administered into the bladder or into an artery. The most common dosing schedule is one dose every 21 days. Some dosing schedules call for smaller doses of the medication to be administered for 3 consecutive days every 4 weeks.

It is important that this medication be used exactly as prescribed by your doctor.

Very careful handling of this medication is required. Doxorubicin is always given under the supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

Store this medication in the refrigerator and protect it from light.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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