Care During Chemotherapy and Beyond
Brand Names: Adriamycin
®, Rubex ®
Doxorubicin is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug.
Doxorubicin is classified as an “anthracycline antiobiotic.” (For more detail,
see “How Doxorubicin Works” section below).
What Doxorubicin Is Used For:
- Cancers treated with Doxorubicin 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 a drug has been approved for one use, physicians sometimes elect to use
this same drug for other problems if they believe it might be helpful.
How Doxorubicin Is Given:
- Doxorubicin 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. Doxorubicin can also be given by continuous infusion.
Rarely, Doxorubicin is given by injection into an artery. There is no pill
form of Doxorubicin.
- Doxorubicin 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 Doxorubicin must be carefully trained. If you notice redness or
swelling at the IV site while you are receiving Doxorubicin, alert your health care
- The amount of Doxorubicin 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 Doxorubicin:
Important things to remember about the side effects of Doxorubicin:
- 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
Early Side Effects: (within one week after treatment begins)
Later Side Effects: (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 bleeding.
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
- 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 taking
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 Doxorubicin can be interference with the pumping
action of the heart. You can receive only up to a certain amount of Doxorubicin
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 Doxorubicin 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
Delayed Effects of Doxorubicin:
There is a slight risk of developing a blood cancer such as leukemia years after
taking Doxorubicin. Talk to your doctor about this risk.
This list includes common and less common and important side effects for those taking Doxorubicin. 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 Doxorubicin treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). Do not take aspirin or products containing aspirin unless your doctor permits this.
- Do not receive any kind of vaccination without your doctor’s approval while taking Doxorubicin.
- For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Doxorubicin. 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 Doxorubicin.
- People with congestive heart failure, those who have already had high doses of Doxorubicin or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive Doxorubicin.
Doxorubicin 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 While Taking Doxorubicin:
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 Doxorubicin 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.
Doxorubicin 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
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