Adriamycin ®

This list includes common and less common and important side effects for those taking adriamycin.  Side effects that are very rare - occurring in less than 10 percent of patients - are not listed here.  But you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C), chills (possible signs of infection)
• Blistering at the IV site
• Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not emergency situations.  Contact your health care provider within 24 hours of noticing any of the following:

• Mouth sores (painful redness, swelling or ulcers)
• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Fast or irregular heart beats
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Extreme fatigue (unable to carry on self-care activities)
• Swelling of the feet or ankles

Precautions:

• Before starting adriamycin treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). 
• Do not receive any kind of vaccination without your doctor's approval while taking adriamycin .
• For both men and women:  Use contraceptives, and do not conceive a child (get pregnant) while taking adriamycin .  Barrier methods of contraception, such as condoms, are recommended.  Discuss with your doctor when you may safely become pregnant after therapy.
• Do not breast feed while taking this medication.
• People with congestive heart failure, those who have already had high doses of this drug or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive this drug.

Self care tips: 

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise. 
• Get plenty of rest.
• Maintain good nutrition.
• In general, drinking alcoholic beverages should be minimized or avoided.  You should discuss this with your doctor.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

A baseline heart evaluation is recommended before starting treatment.  A full blood count will be done regularly, and a heart function test will be done as your doctor prescribes.  Various tests to monitor the function of other organs (such as your kidneys and liver) will also be ordered by your physician.

How Adriamycin works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normalchecks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells.  Chemotherapy will kill all cells that are rapidly dividing.  The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Adriamycin is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific. There are several types of antitumor antibiotics:

• Anthracyclines:  Doxorubicin, Daunomycin, Mitoxantrone, and Idarubicin
• Chromomycins:  Dactinomycin and Plicamycin
• Miscellaneous:  Mitomycin and Bleomycin