Care During Chemotherapy and Beyond
Generic name: Doxorubicin
Other brand name: Rubex ®
Chemocare.com uses generic names in all descriptions of drugs. Adriamycin is a trade
name for Doxorubicin. Rubex is another trade name for Doxorubicin. In some cases,
health care professionals may use the trade names Adriamycin or Rubex when referring
to the generic drug name Doxorubicin.
Drug type: Adriamycin is an anti-cancer ("antineoplastic" or "cytotoxic")
chemotherapy drug. This medication is classified as an "anthracycline antiobiotic."
(For more detail, see "How this drug works" section below).
What Adriamycin is used for:
- Cancers treated with adriamycin include: bladder, breast, head and neck, leukemia
(some types), liver, lung, lymphomas, mesothelioma, multiple myeloma, neuroblastoma,
ovary, pancreas, prostate, sarcomas, stomach, testis (germ cell), thyroid, uterus.
- Note: If adriamycin has been approved for one use, physicians sometimes elect
to use adriamycin for other problems if they believe it might be helpful.
How Adriamycin is given:
- Adriamycin is given through a vein by intravenous injection (IV). The syringe
needle is placed directly into the vein or central line and the drug is given over
several minutes. Adriamycin can also be given by continuous infusion.
Rarely, adriamycin is given by injection into an artery. There is no pill
form of adriamycin.
- Adriamycin is a vesicant. A vesicant is a chemical that causes extensive tissue
damage and blistering if it escapes from the vein. The nurse or doctor who
gives adriamycin must be carefully trained. If you notice redness or swelling
at the IV site while you are receiving adriamycin, alert your health care professional
- The amount of adriamycin you will receive depends on many factors, including your
height and weight, your general health or other health problems, and the type of
cancer you have. Your doctor will determine your exact dosage and schedule.
Side effects of Adriamycin:
Important things to remember about the side effects of adriamycin:
- You will not get all of the side effects mentioned below.
- Side effects are often predictable in terms of their onset, duration, and severity.
- Side effects are almost always reversible and will go away after therapy is complete.
- Side effects are quite manageable. There are many options to minimize or prevent
The following side effects are common (occurring in greater than 30%) for
patients taking adriamycin:
Early: (within one week after treatment begins)
- Pain along the site where the medication was given
- Nausea or vomiting
Later: (within two weeks after treatment begins)
- Low blood counts. Your white and red blood cells and platelets may temporarily
decrease. This can put you at increased risk for infection, anemia and/or
Nadir: Meaning low point, nadir is the point in time between chemotherapy
cycles in which you experience low blood counts.
Onset: 7 days
Nadir: 10-14 days
Recovery: 21-28 days
- Mouth sores
- Hair loss on the scalp or elsewhere on the body (called alopecia). Most patients
do lose some or all of their hair during their treatment. But your hair will
grow back after treatment is completed.
The following side effects are less common (occurring in 10-29%) for patients
Early: (within one week after treatment begins)
- Eyes watering
- Urine may appear red, red-brown, orange or pink from the color of the medication
for one to two days after you receive a dose.
Later: (within two weeks after treatment begins)
- Darkening of the nail beds.
- Darkening of the skin where previous radiation treatment has been given.
- Problems with fertility - ability to bear children. (occurs in about 10% of both
men and women - this should be discussed with your doctor prior to therapy).
A serious but uncommon side effect of adriamycin can be interference with
the pumping action of the heart. You can receive only up to a certain amount
of adriamycin during your lifetime. This "lifetime maximum dose" may be lower
if you have heart disease risk factors such as radiation to the chest, advancing
age, and use of other heart-toxic drugs. Your doctor will check your heart
function before you may take any adriamycin and will monitor your heart closely
during your treatment. Dose-related heart problems can occur as late as 7
or 8 years after treatments have ended.
There is a slight risk of developing a blood cancer such as leukemia
years after taking adriamycin. Talk to your doctor about this
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
- 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
- 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
- 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
- Miscellaneous: Mitomycin
Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org