Doxorubicin Hydrochloride is the hydrochloride salt of doxorubicin, an anthracycline antibiotic with antineoplastic activity. Doxorubicin, isolated from the bacterium Streptomyces peucetius var. caesius, is the hydroxylated congener of daunorubicin. Doxorubicin intercalates between base pairs in the DNA helix, thereby preventing DNA replication and ultimately inhibiting protein synthesis. Additionally, doxorubicin inhibits topoisomerase II which results in an increased and stabilized cleavable enzyme-DNA linked complex during DNA replication and subsequently prevents the ligation of the nucleotide strand after double-strand breakage. Doxorubicin also forms oxygen free radicals resulting in cytotoxicity secondary to lipid peroxidation of cell membrane lipids; the formation of oxygen free radicals also contributes to the toxicity of the anthracycline antibiotics, namely the cardiac and cutaneous vascular effects.
Doxorubicin hydrochloride is an anthracycline. Adriamycin hydrochloride appears as orange-red thin needles. Aqueous solutions are yellow-orange at acid pHs, orange-red at neutral pHs, and violet-blue over pH 9. (NTP, 1992)
Doxorubicin is a deoxy hexoside, an anthracycline, an anthracycline antibiotic, an aminoglycoside, a member of tetracenequinones, a member of p-quinones, a primary alpha-hydroxy ketone and a tertiary alpha-hydroxy ketone. It has a role as an Escherichia coli metabolite. It is a conjugate base of doxorubicin(1+). It derives from a hydride of tetracene.
Doxorubicin is a cytotoxic anthracycline antibiotic isolated from cultures of Streptomyces peucetius var. caesius. Doxorubicin binds to nucleic acids, presumably by specific intercalation of the planar anthracycline nucleus with the DNA double helix.
Mechanism of Action
Doxorubicin has antimitotic and cytotoxic activity through a number of proposed mechanisms of action: Doxorubicin forms complexes with DNA by intercalation between base pairs, and it inhibits topoisomerase II activity by stabilizing the DNA-topoisomerase II complex, preventing the religation portion of the ligation-religation reaction that topoisomerase II catalyzes.
Doxorubicin hydrochloride is an antineoplastic antibiotic with pharmacologic actions similar to those of daunorubicin. Although the drug has anti-infective properties, its cytotoxicity precludes its use as an anti-infective agent. The precise and/or principal mechanism(s) of the antineoplastic action of doxorubicin is not fully understood. It appears that the cytotoxic effect of the drug results from a complex system of multiple modes of action related to free radical formation secondary to metabolic activation of the doxorubicin by electron reduction, intercalation of the drug into DNA, induction of DNA breaks, and chromosomal aberrations, and alterations in cell membranes induced by the drug. Evidence from in vitro studies in cells treated with doxorubicin suggests that apoptosis (programmed cell death) also may be involved in the drug’s mechanism of action. These and other mechanisms (chelation of metal ions to produce drug-metal complexes) also may contribute to the cardiotoxic effects of the drug.
or
Doxorubicin undergoes enzymatic 1- and 2-electron reduction to the corresponding semiquinone and hydroquinone. 7-Deoxyaglycones are formed enzymatically by 1-electron reduction, and the resulting semiquinone free radical reacts with oxygen to produce the hydroxyl radical in a cascade of reactions; this radical may lead to cell death by reacting with DNA, RNA, cell membranes, and proteins. The dihydroquinone that results from 2-electron reduction of doxorubicin also can be formed by the reaction of 2 semiquinones. In the presence of oxygen, dihydroquinone reacts to form hydrogen peroxide, and in its absence, loses its sugar and gives rise to the quinone methide, a monofunctional alkylating agent with low affinity for DNA. The contribution of dihydroquinone and quinone methide to the cytotoxicity of doxorubicin is unclear. Experimental evidence indicates that doxorubicin forms a complex with DNA by intercalation between base pairs, causing inhibition of DNA synthesis and DNA-dependent RNA synthesis by the resulting template disordering and steric obstruction. Doxorubicin also inhibits protein synthesis. Doxorubicin is active throughout the cell cycle including the interphase.
Indications
- Doxorubicin is used to produce regression in disseminated neoplastic conditions like acute lymphoblastic leukemia, acute myeloblastic leukemia, Wilms’ tumor, neuroblastoma, soft tissue and bone sarcomas, breast carcinoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, Hodgkin’s disease, malignant lymphoma and bronchogenic carcinoma in which the small cell histologic type is the most responsive compared to other cell types. Doxorubicin is also indicated for use as a component of adjuvant therapy in women with evidence of axillary lymph node involvement following resection of primary breast cancer.
- Myocet liposomal, in combination with cyclophosphamide, is indicated for the first-line treatment of metastatic breast cancer in adult women.
- Caelyx pegylated liposomal is indicated:as monotherapy for patients with metastatic breast cancer, where there is an increased cardiac risk;for treatment of advanced ovarian cancer in women who have failed a first-line platinum-based chemotherapy regimen;in combination with bortezomib for the treatment of progressive multiple myeloma in patients who have received at least one prior therapy and who have already undergone or are unsuitable for bone marrow transplant;for treatment of AIDS-related Kaposi’s sarcoma (KS) in patients with low CD4 counts (
- Treatment of breast and ovarian cancer.
- Treatment of hepatocellular carcinoma
- Zolsketil pegylated liposomal is a medicine used to treat the following types of cancer in adults:, , • breast cancer that has spread to other parts of the body in patients at risk of heart problems. Zolsketil pegylated liposomal is used on its own for this disease;, , • advanced ovarian cancer in women whose previous treatment including a platinum-based cancer medicine has stopped working;, , • multiple myeloma (a cancer of the white blood cells in the bone marrow), in patients with progressive disease who have received at least one other treatment in the past and have already had, or are unsuitable for, a bone marrow transplantation. Zolsketil pegylated liposomal is used in combination with bortezomib (another cancer medicine);, , • Kaposi’s sarcoma in patients with AIDS who have a very damaged immune system. Kaposi’s sarcoma is a cancer that causes abnormal tissue to grow under the skin, on moist body surfaces or on internal organs., , Zolsketil pegylated liposomal contains the active substance doxorubicin and is a ‘hybrid medicine’. This means that it is similar to a ‘reference medicine’ containing the same active substance called Adriamycin. However, in Zolsketil pegylated liposomal the active substance is enclosed in tiny fatty spheres called liposomes, whereas this is not the case for Adriamycin.,
Use in Cancer
Doxorubicin hydrochloride is approved to be used alone or with other drugs to treat:
- Acute lymphoblastic leukemia (ALL).
- Acute myeloid leukemia (AML).
- Breast cancer. It is used:
- After surgery to remove the primary tumor in women whose cancer has spread to the lymph nodes under the arm. It is used with other drugs.
- In patients with metastatic breast cancer.
- Gastric (stomach) cancer that is metastatic.
- Hodgkin lymphoma.
- Neuroblastoma is metastatic.
- Non-Hodgkin lymphoma.
- Non-small cell lung cancer that is metastatic.
- Ovarian cancer that is metastatic.
- Small cell lung cancer that is metastatic.
- Soft tissue and bone sarcomas that are metastatic.
- Thyroid cancer that is metastatic.
- Transitional cell bladder cancer that is metastatic.
- Wilms tumor that is metastatic.
Doxorubicin hydrochloride is also being studied in the treatment of other types of cancer.
Doxorubicin hydrochloride is also available in a different form called doxorubicin hydrochloride liposome.
FDA Approved | Yes |
---|---|
Dru Use | Doxorubicin hydrochloride is approved to be used alone or with other drugsto treat:
• Acute lymphoblastic leukemia(ALL). • Acute myeloid leukemia(AML). • Breast cancer.It is used: • After surgeryto remove the primary tumorin women whose cancer has spread to the lymph nodesunder the arm. It is used with other drugs. • In patients with metastaticbreast cancer. • Gastric (stomach) cancerthat is metastatic. • Hodgkin lymphoma. • Neuroblastomathat is metastatic. • Non-Hodgkin lymphoma. • Non-small cell lung cancerthat is metastatic. • Ovarian cancerthat is metastatic. • Small cell lung cancerthat is metastatic. • Soft tissueand bone sarcomasthat are metastatic. • Thyroid cancerthat is metastatic. • Transitional cellbladder cancerthat is metastatic. • Wilms tumorthat is metastatic. Doxorubicin hydrochloride is also being studied in the treatment of other types of cancer. Doxorubicin hydrochloride is also available in a different form called doxorubicin hydrochloride liposome. |
Contraindications
Doxorubicin Hydrochloride Injection/for Injection is contraindicated in patients with:
- Severe myocardial insufficiency
- Recent (occurring within the past 4–6 weeks) myocardial infarction
- Severe persistent drug-induced myelosuppression
- Severe hepatic impairment (defined as Child-Pugh Class C or serum bilirubin level greater than 5 mg/dL)
- Severe hypersensitivity reaction to doxorubicin hydrochloride, including anaphylaxis
Dosage
Strengths: 10 mg; 20 mg; 50 mg; 150 mg; 2 mg/mL; 75 mg; 100 mg
Breast Cancer – Adjuvant
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- 60 mg/m2 IV bolus on day 1 of each 21-day treatment cycle, in combination with cyclophosphamide, for a total of 4 cycles
Usual Adult Dose for Breast Cancer
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Neuroblastoma
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Non-Hodgkin’s Lymphoma
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Hodgkin’s Disease
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Ovarian Cancer
NOTE: Several dosage regimens exist for this drug. The information presented here is manufacturer-recommended dosing. Some cancers are more responsive to this drug than others. Always consult institutional protocol.
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Wilms’ Tumor
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Stomach Cancer
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
- Lifetime cumulative doses above 550 mg/m2 are associated with an increased risk of cardiomyopathy.
Acute Lymphoblastic Leukemia
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Bladder Cancer
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 day
- Lifetime cumulative doses above 550 mg/m2 are associated with an increased risk of cardiomyopathy.
Ewing’s Sarcoma
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Acute Myeloblastic Leukemia
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Thyroid Cancer
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Bronchogenic Carcinoma
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
- Lifetime cumulative doses above 550 mg/m2 are associated with an increased risk of cardiomyopathy.
Soft Tissue Sarcoma
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
- Lifetime cumulative doses above 550 mg/m2 are associated with an increased risk of cardiomyopathy.
Neuroblastoma
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Pediatric Dose for Malignant Disease
- As a single agent: 60 to 75 mg/m2 IV over 3 to 10 minutes every 21 days
- In combination with other chemotherapy drugs: 40 to 75 mg/m2 IV every 21 to 28 days
Or
Adult dosing by indication:
Axillary node-positive breast cancer as an adjuvant:
-
60 mg/m^2 IV once on the first day of a 21-day cycle. Use with cyclophosphamide. Patients should receive 4 cycles.
Leukemia monotherapy:
-
60 to 75 mg/m^2 IV once on the first day of a 21-day cycle. The maximum cumulative dose is 550 mg/m^2. (ALL or AML)
Leukemia combination therapy:
-
40 to 75 mg/m^2 IV once on the first day of a 21-day or 29-day cycle. The maximum cumulative dose is 550 mg/m^2. (ALL or AML)
Lymphoma monotherapy:
-
60 to 75 mg/m^2 IV once on the first day of a 21-day cycle. The maximum cumulative dose is 550 mg/m^2. (Hodgkin and non-Hodgkin lymphoma)
Lymphoma combination therapy:
-
40 to 75 mg/m^2 IV once on the first day of a 21-day or 29-day cycle. The maximum cumulative dose is 550 mg/m^2. (Hodgkin and non-Hodgkin lymphoma)
Solid tumors, monotherapy:
-
60 to 75 mg/m^2 IV once on the first day of a 21-day cycle. The maximum cumulative dose is 550 mg/m^2.
Solid tumors, combination therapy:
-
40 to 75 mg/m^2 IV once on the first day of a 21-day or 29-day cycle. The maximum cumulative dose is 550 mg/m^2.
Side Effects
The Most Common
- Cardiac – Cardiogenic shock
- Cutaneous – Skin and nail hyperpigmentation, oncolysis, rash, itching, photosensitivity, urticaria, acral erythema, palmar plantar erythrodysesthesia
- Gastrointestinal – Nausea, mucositis, stomatitis, necrotizing colitis, typhlitis, gastric erosions, gastrointestinal tract bleeding, hematochezia, esophagitis, anorexia, abdominal pain, dehydration, diarrhea, hyperpigmentation of the oral mucosa
- Hypersensitivity – Anaphylaxis
- Laboratory Abnormalities – Increased ALT, increased AST
- Neurological – Peripheral sensory and motor neuropathy, seizures, coma
- Ocular – Conjunctivitis, keratitis, lacrimation
- Vascular – Phlebosclerosis, phlebitis/thrombophlebitis, hot flashes, thromboembolism
- Other – Malaise/asthenia, fever, chills, weight gain
More Common
- nausea
- vomiting
- sores in the mouth and throat
- loss of appetite (and weight loss)
- weight gain
- stomach pain
- diarrhea
- increased thirst
- unusual tiredness or weakness
- dizziness
- hair loss
- separation of fingernail or toenail from the nail bed
- itchy, red, watery, or irritated eyes
- eye pain
- pain, burning, or tingling in the hands or feet
- red discoloration of urine (for 1 to 2 days after dose)
Less Common
- hives
- skin rash
- itching
- difficulty breathing or swallowing
- seizures
Drugs Interaction
DRUG | INTERACTION |
---|---|
Abametapir | The serum concentration of Doxorubicin can be increased when it is combined with Abametapir. |
Abatacept | The metabolism of Doxorubicin can be increased when combined with Abatacept. |
Abciximab | The risk or severity of bleeding can be increased when Abciximab is combined with Doxorubicin. |
Abemaciclib | The metabolism of Abemaciclib can be decreased when combined with Doxorubicin. |
Abrocitinib | The serum concentration of Doxorubicin can be increased when it is combined with Abrocitinib. |
Acalabrutinib | The metabolism of Doxorubicin can be decreased when combined with Acalabrutinib. |
Acebutolol | The metabolism of Acebutolol can be decreased when combined with Doxorubicin. |
Acenocoumarol | The serum concentration of Acenocoumarol can be increased when it is combined with Doxorubicin. |
Acetaminophen | The metabolism of Doxorubicin can be increased when combined with Acetaminophen. |
Acetazolamide | The metabolism of Doxorubicin can be decreased when combined with Acetazolamide. |
Acetyldigitoxin | Acetyldigitoxin may decrease the cardiotoxic activities of Doxorubicin. |
Acetylsalicylic acid | The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Doxorubicin. |
Adalimumab | The metabolism of Doxorubicin can be increased when combined with Adalimumab. |
Adenovirus type 7 vaccine live | The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Doxorubicin. |
Afatinib | The serum concentration of Doxorubicin can be increased when it is combined with Afatinib. |
Albendazole | The metabolism of Doxorubicin can be decreased when combined with Albendazole. |
Aldesleukin | The metabolism of Doxorubicin can be decreased when combined with Aldesleukin. |
Alectinib | The metabolism of Alectinib can be decreased when combined with Doxorubicin. |
Alefacept | The risk or severity of adverse effects can be increased when Alefacept is combined with Doxorubicin. |
Alemtuzumab | The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Doxorubicin. |
Alfuzosin | The metabolism of Alfuzosin can be decreased when combined with Doxorubicin. |
Allogeneic processed thymus tissue | The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Doxorubicin. |
Allopurinol | The risk or severity of adverse effects can be increased when Allopurinol is combined with Doxorubicin. |
Almotriptan | The metabolism of Almotriptan can be decreased when combined with Doxorubicin. |
Alogliptin | The metabolism of Alogliptin can be decreased when combined with Doxorubicin. |
Alpelisib | The metabolism of Doxorubicin can be increased when combined with Alpelisib. |
Alprazolam | The metabolism of Alprazolam can be decreased when combined with Doxorubicin. |
Alteplase | The risk or severity of bleeding can be increased when Alteplase is combined with Doxorubicin. |
Altretamine | The risk or severity of adverse effects can be increased when Altretamine is combined with Doxorubicin. |
Aminoglutethimide | The metabolism of Doxorubicin can be increased when combined with Aminoglutethimide. |
Aminophenazone | The metabolism of Aminophenazone can be decreased when combined with Doxorubicin. |
Aminophylline | The metabolism of Aminophylline can be decreased when combined with Doxorubicin. |
Amiodarone | The serum concentration of Doxorubicin can be increased when it is combined with Amiodarone. |
Amitriptyline | The metabolism of Amitriptyline can be decreased when combined with Doxorubicin. |
Amobarbital | The metabolism of Doxorubicin can be increased when combined with Amobarbital. |
Amoxapine | The metabolism of Amoxapine can be decreased when combined with Doxorubicin. |
Amphetamine | The metabolism of Amphetamine can be decreased when combined with Doxorubicin. |
Amprenavir | The metabolism of Doxorubicin can be decreased when combined with Amprenavir. |
Amsacrine | The risk or severity of adverse effects can be increased when Amsacrine is combined with Doxorubicin. |
Anagrelide | The risk or severity of bleeding can be increased when Anagrelide is combined with Doxorubicin. |
Anakinra | The metabolism of Doxorubicin can be increased when combined with Anakinra. |
Anastrozole | The risk or severity of cardiotoxicity can be increased when Doxorubicin is combined with Anastrozole. |
Ancrod | The risk or severity of bleeding can be increased when Ancrod is combined with Doxorubicin. |
Anifrolumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Anifrolumab. |
Anistreplase | The risk or severity of bleeding can be increased when Anistreplase is combined with Doxorubicin. |
Anthrax immune globulin human | The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Doxorubicin. |
Anthrax vaccine | The risk or severity of infection can be increased when Anthrax vaccine is combined with Doxorubicin. |
Antilymphocyte immunoglobulin (horse) | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Antilymphocyte immunoglobulin (horse). |
Antipyrine | The metabolism of Antipyrine can be decreased when combined with Doxorubicin. |
Antithrombin Alfa | The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Doxorubicin. |
Antithrombin III human | The risk or severity of bleeding can be increased when Antithrombin III human is combined with Doxorubicin. |
Antithymocyte immunoglobulin (rabbit) | The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Doxorubicin. |
Apalutamide | The serum concentration of Doxorubicin can be decreased when it is combined with Apalutamide. |
Apixaban | The risk or severity of bleeding can be increased when Apixaban is combined with Doxorubicin. |
Apremilast | The metabolism of Doxorubicin can be increased when combined with Apremilast. |
Aprepitant | The metabolism of Doxorubicin can be decreased when combined with Aprepitant. |
Ardeparin | The risk or severity of bleeding can be increased when Ardeparin is combined with Doxorubicin. |
Arformoterol | The metabolism of Arformoterol can be decreased when combined with Doxorubicin. |
Argatroban | The risk or severity of bleeding can be increased when Argatroban is combined with Doxorubicin. |
Aripiprazole | The metabolism of Aripiprazole can be decreased when combined with Doxorubicin. |
Aripiprazole lauroxil | The metabolism of Aripiprazole lauroxil can be decreased when combined with Doxorubicin. |
Armodafinil | The metabolism of Doxorubicin can be increased when combined with Armodafinil. |
Arsenic trioxide | The serum concentration of Doxorubicin can be increased when it is combined with Arsenic trioxide. |
Articaine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Articaine. |
Asciminib | The serum concentration of Doxorubicin can be increased when it is combined with Asciminib. |
Astemizole | The metabolism of Doxorubicin can be decreased when combined with Astemizole. |
AstraZeneca COVID-19 Vaccine | The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Doxorubicin. |
Asunaprevir | The serum concentration of Doxorubicin can be increased when it is combined with Asunaprevir. |
Atazanavir | The metabolism of Doxorubicin can be decreased when combined with Atazanavir. |
Atenolol | Atenolol may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Atomoxetine | The metabolism of Atomoxetine can be decreased when combined with Doxorubicin. |
Atorvastatin | The metabolism of Atorvastatin can be decreased when combined with Doxorubicin. |
Atropine | Atropine may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Avacopan | The metabolism of Doxorubicin can be decreased when combined with Avacopan. |
Avanafil | Avanafil may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Avatrombopag | Avatrombopag may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Axitinib | The metabolism of Axitinib can be decreased when combined with Doxorubicin. |
Azacitidine | The risk or severity of adverse effects can be increased when Azacitidine is combined with Doxorubicin. |
Azathioprine | The risk or severity of adverse effects can be increased when Azathioprine is combined with Doxorubicin. |
Azelastine | The metabolism of Azelastine can be decreased when combined with Doxorubicin. |
Azithromycin | The metabolism of Doxorubicin can be decreased when combined with Azithromycin. |
Bacillus calmette-guerin substrain connaught live antigen | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Doxorubicin. |
Bacillus calmette-guerin substrain russian BCG-I live antigen | The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Doxorubicin. |
Bacillus calmette-guerin substrain tice live antigen | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Doxorubicin. |
Baricitinib | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Baricitinib. |
Basiliximab | The risk or severity of adverse effects can be increased when Basiliximab is combined with Doxorubicin. |
BCG vaccine | The risk or severity of infection can be increased when BCG vaccine is combined with Doxorubicin. |
Beclomethasone dipropionate | The metabolism of Doxorubicin can be increased when combined with Beclomethasone dipropionate. |
Belantamab mafodotin | Doxorubicin may decrease the excretion rate of Belantamab mafodotin which could result in a higher serum level. |
Belatacept | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Belatacept. |
Belimumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Belimumab. |
Belinostat | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Belinostat. |
Belumosudil | The serum concentration of Doxorubicin can be increased when it is combined with Belumosudil. |
Belzutifan | The serum concentration of Doxorubicin can be decreased when it is combined with Belzutifan. |
Bemiparin | The risk or severity of bleeding can be increased when Bemiparin is combined with Doxorubicin. |
Bendamustine | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Bendamustine. |
Bendroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Doxorubicin. |
Benzatropine | The metabolism of Benzatropine can be decreased when combined with Doxorubicin. |
Benzocaine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Benzocaine. |
Benzthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Doxorubicin. |
Corticotropin | The metabolism of Doxorubicin can be increased when combined with Corticotropin. |
Cortisone acetate | The metabolism of Doxorubicin can be increased when combined with Cortisone acetate. |
Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) | The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Crizotinib | The metabolism of Doxorubicin can be decreased when combined with Crizotinib. |
Curcumin | The serum concentration of Doxorubicin can be increased when it is combined with Curcumin. |
Cyanocobalamin | The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Doxorubicin. |
Cyclopenthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Doxorubicin. |
Cyclophosphamide | The metabolism of Doxorubicin can be increased when combined with Cyclophosphamide. |
Cyclosporine | The serum concentration of Doxorubicin can be increased when it is combined with Cyclosporine. |
Cyclothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Doxorubicin. |
Cyproterone acetate | The metabolism of Doxorubicin can be decreased when combined with Cyproterone acetate. |
Cytarabine | The risk or severity of adverse effects can be increased when Cytarabine is combined with Doxorubicin. |
Dabigatran | The risk or severity of bleeding can be increased when Dabigatran is combined with Doxorubicin. |
Dabigatran etexilate | The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Doxorubicin. |
Dabrafenib | The serum concentration of Doxorubicin can be decreased when it is combined with Dabrafenib. |
Dacarbazine | The risk or severity of adverse effects can be increased when Dacarbazine is combined with Doxorubicin. |
Daclatasvir | The serum concentration of Doxorubicin can be increased when it is combined with Daclatasvir. |
Dacomitinib | The serum concentration of Doxorubicin can be increased when it is combined with Dacomitinib. |
Dactinomycin | The risk or severity of adverse effects can be increased when Dactinomycin is combined with Doxorubicin. |
Dalfopristin | The metabolism of Doxorubicin can be decreased when combined with Dalfopristin. |
Dalteparin | The risk or severity of bleeding can be increased when Dalteparin is combined with Doxorubicin. |
Danaparoid | The risk or severity of bleeding can be increased when Danaparoid is combined with Doxorubicin. |
Danazol | The metabolism of Doxorubicin can be decreased when combined with Danazol. |
Dapagliflozin | The metabolism of Dapagliflozin can be decreased when combined with Doxorubicin. |
Darbepoetin alfa | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Doxorubicin. |
Darifenacin | The metabolism of Darifenacin can be decreased when combined with Doxorubicin. |
Darolutamide | Darolutamide may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Darunavir | The serum concentration of Doxorubicin can be increased when it is combined with Darunavir. |
Dasabuvir | Dasabuvir may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Dasatinib | The metabolism of Doxorubicin can be decreased when combined with Dasatinib. |
Daunorubicin | The metabolism of Doxorubicin can be decreased when combined with Daunorubicin. |
Debrisoquine | The metabolism of Debrisoquine can be decreased when combined with Doxorubicin. |
Decitabine | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Decitabine. |
Deferasirox | The metabolism of Doxorubicin can be increased when combined with Deferasirox. |
Defibrotide | The risk or severity of bleeding can be increased when Defibrotide is combined with Doxorubicin. |
Deflazacort | The metabolism of Doxorubicin can be increased when combined with Deflazacort. |
Delavirdine | The metabolism of Doxorubicin can be decreased when combined with Delavirdine. |
Denosumab | The risk or severity of adverse effects can be increased when Denosumab is combined with Doxorubicin. |
Deoxycholic acid | Deoxycholic acid may increase the excretion rate of Doxorubicin which could result in a lower serum level and potentially a reduction in efficacy. |
Desipramine | The metabolism of Doxorubicin can be decreased when combined with Desipramine. |
Desirudin | The risk or severity of bleeding can be increased when Desirudin is combined with Doxorubicin. |
Deslanoside | Deslanoside may decrease the cardiotoxic activities of Doxorubicin. |
Desoximetasone | The risk or severity of adverse effects can be increased when Desoximetasone is combined with Doxorubicin. |
Desvenlafaxine | The metabolism of Doxorubicin can be decreased when combined with Desvenlafaxine. |
Deucravacitinib | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Deucravacitinib. |
Deutetrabenazine | The metabolism of Deutetrabenazine can be decreased when combined with Doxorubicin. |
Dexamethasone | The metabolism of Doxorubicin can be increased when combined with Dexamethasone. |
Dexamethasone acetate | The serum concentration of Doxorubicin can be decreased when it is combined with Dexamethasone acetate. |
Dexchlorpheniramine maleate | The metabolism of Dexchlorpheniramine maleate can be decreased when combined with Doxorubicin. |
Dexfenfluramine | The metabolism of Dexfenfluramine can be decreased when combined with Doxorubicin. |
Dexrazoxane | The therapeutic efficacy of Doxorubicin can be decreased when used in combination with Dexrazoxane. |
Dextran | The risk or severity of bleeding can be increased when Dextran is combined with Doxorubicin. |
Dextroamphetamine | The metabolism of Dextroamphetamine can be decreased when combined with Doxorubicin. |
Dextromethorphan | The metabolism of Dextromethorphan can be decreased when combined with Doxorubicin. |
Dextropropoxyphene | The metabolism of Doxorubicin can be decreased when combined with Dextropropoxyphene. |
Diclofenac | Diclofenac may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Dicloxacillin | The metabolism of Doxorubicin can be increased when combined with Dicloxacillin. |
Dicoumarol | The risk or severity of bleeding can be increased when Dicoumarol is combined with Doxorubicin. |
Diethylstilbestrol | The metabolism of Doxorubicin can be decreased when combined with Diethylstilbestrol. |
Difluocortolone | The metabolism of Doxorubicin can be increased when combined with Difluocortolone. |
Digitoxin | The metabolism of Digitoxin can be decreased when combined with Doxorubicin. |
Digoxin | Digoxin may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Dihydrocodeine | The metabolism of Dihydrocodeine can be decreased when combined with Doxorubicin. |
Dihydroergocornine | The metabolism of Doxorubicin can be decreased when combined with Dihydroergocornine. |
Dihydroergocristine | The metabolism of Doxorubicin can be decreased when combined with Dihydroergocristine. |
Dihydroergotamine | The metabolism of Doxorubicin can be decreased when combined with Dihydroergotamine. |
Diltiazem | The metabolism of Doxorubicin can be decreased when combined with Diltiazem. |
Dimethyl fumarate | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Dimethyl fumarate. |
Dimethyl sulfoxide | The metabolism of Doxorubicin can be decreased when combined with Dimethyl sulfoxide. |
Dinutuximab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Dinutuximab. |
Diosmin | The serum concentration of Doxorubicin can be increased when it is combined with Diosmin. |
Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Diphenhydramine. |
Dipyridamole | Dipyridamole may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Diroximel fumarate | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Diroximel fumarate. |
Disulfiram | Disulfiram may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Docetaxel | The serum concentration of Doxorubicin can be increased when it is combined with Docetaxel. |
Dofetilide | The metabolism of Dofetilide can be decreased when combined with Doxorubicin. |
Dolasetron | The metabolism of Dolasetron can be decreased when combined with Doxorubicin. |
Domperidone | The metabolism of Domperidone can be decreased when combined with Doxorubicin. |
Donepezil | The metabolism of Donepezil can be decreased when combined with Doxorubicin. |
Dosulepin | The metabolism of Dosulepin can be decreased when combined with Doxorubicin. |
Doxazosin | The metabolism of Doxorubicin can be decreased when combined with Doxazosin. |
Doxepin | The metabolism of Doxepin can be decreased when combined with Doxorubicin. |
Dronabinol | The serum concentration of Dronabinol can be increased when it is combined with Doxorubicin. |
Dronedarone | The serum concentration of Doxorubicin can be increased when it is combined with Dronedarone. |
Drospirenone | The metabolism of Doxorubicin can be decreased when combined with Drospirenone. |
Drotrecogin alfa | The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Doxorubicin. |
Duloxetine | The metabolism of Duloxetine can be decreased when combined with Doxorubicin. |
Duvelisib | The metabolism of Doxorubicin can be decreased when combined with Duvelisib. |
Dyclonine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Dyclonine. |
Ebastine | The metabolism of Doxorubicin can be decreased when combined with Ebastine. |
Ebola Zaire vaccine (live, attenuated) | The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Doxorubicin. |
Echinacea | The metabolism of Doxorubicin can be increased when combined with Echinacea. |
Eculizumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Eculizumab. |
Edetic acid | The risk or severity of bleeding can be increased when Edetic acid is combined with Doxorubicin. |
Edoxaban | The risk or severity of bleeding can be increased when Edoxaban is combined with Doxorubicin. |
Efalizumab | The risk or severity of adverse effects can be increased when Efalizumab is combined with Doxorubicin. |
Efavirenz | The metabolism of Doxorubicin can be decreased when combined with Efavirenz. |
Elagolix | The serum concentration of Doxorubicin can be increased when it is combined with Elagolix. |
Elbasvir | Elbasvir may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Gemtuzumab ozogamicin | The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Doxorubicin. |
Gilteritinib | The metabolism of Doxorubicin can be decreased when combined with Gilteritinib. |
Ginkgo biloba | The metabolism of Doxorubicin can be decreased when combined with Ginkgo biloba. |
Glasdegib | The serum concentration of Doxorubicin can be increased when it is combined with Glasdegib. |
Glatiramer | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Glatiramer. |
Glecaprevir | The serum concentration of Doxorubicin can be increased when it is combined with Glecaprevir. |
Glimepiride | Glimepiride may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Glipizide | Doxorubicin may decrease the excretion rate of Glipizide which could result in a higher serum level. |
Glyburide | The metabolism of Doxorubicin can be decreased when combined with Glyburide. |
Glycerol phenylbutyrate | The metabolism of Doxorubicin can be increased when combined with Glycerol phenylbutyrate. |
Glycyrrhizic acid | Doxorubicin may decrease the excretion rate of Glycyrrhizic acid which could result in a higher serum level. |
Golimumab | The metabolism of Doxorubicin can be increased when combined with Golimumab. |
Grazoprevir | Grazoprevir may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Griseofulvin | The metabolism of Doxorubicin can be increased when combined with Griseofulvin. |
Guselkumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Guselkumab. |
Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen | The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Doxorubicin. |
Haloperidol | The serum concentration of Haloperidol can be increased when it is combined with Doxorubicin. |
Heparin | The risk or severity of bleeding can be increased when Heparin is combined with Doxorubicin. |
Hepatitis A Vaccine | The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Doxorubicin. |
Hepatitis B Vaccine (Recombinant) | The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Doxorubicin. |
Human adenovirus e serotype 4 strain cl-68578 antigen | The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Doxorubicin. |
Hydralazine | The metabolism of Doxorubicin can be decreased when combined with Hydralazine. |
Hydrochlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Doxorubicin. |
Hydrocodone | The metabolism of Hydrocodone can be decreased when combined with Doxorubicin. |
Hydrocortamate | The metabolism of Doxorubicin can be increased when combined with Hydrocortamate. |
Hydrocortisone | The metabolism of Doxorubicin can be increased when combined with Hydrocortisone. |
Hydrocortisone acetate | The metabolism of Doxorubicin can be increased when combined with Hydrocortisone acetate. |
Hydrocortisone butyrate | The metabolism of Doxorubicin can be increased when combined with Hydrocortisone butyrate. |
Hydrocortisone succinate | The metabolism of Doxorubicin can be increased when combined with Hydrocortisone succinate. |
Hydroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Doxorubicin. |
Hydroxychloroquine | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Hydroxychloroquine. |
Hydroxyurea | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Hydroxyurea. |
Ibritumomab tiuxetan | The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Doxorubicin. |
Ibrutinib | The metabolism of Ibrutinib can be decreased when combined with Doxorubicin. |
Icosapent ethyl | The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Doxorubicin. |
Idarubicin | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Idarubicin. |
Idelalisib | The metabolism of Idelalisib can be decreased when combined with Doxorubicin. |
Ifosfamide | The metabolism of Doxorubicin can be increased when combined with Ifosfamide. |
Iloperidone | The metabolism of Iloperidone can be decreased when combined with Doxorubicin. |
Iloprost | The risk or severity of bleeding can be increased when Iloprost is combined with Doxorubicin. |
Imatinib | The serum concentration of Doxorubicin can be increased when it is combined with Imatinib. |
Imipramine | The metabolism of Imipramine can be decreased when combined with Doxorubicin. |
Indinavir | The metabolism of Doxorubicin can be decreased when combined with Indinavir. |
Indocyanine green acid form | Doxorubicin may decrease the excretion rate of Indocyanine green acid form which could result in a higher serum level. |
Indomethacin | The risk or severity of adverse effects can be increased when Indomethacin is combined with Doxorubicin. |
Inebilizumab | The risk or severity of infection can be increased when Doxorubicin is combined with Inebilizumab. |
Infigratinib | The metabolism of Doxorubicin can be decreased when combined with Infigratinib. |
Infliximab | The metabolism of Doxorubicin can be increased when combined with Infliximab. |
Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen | The therapeutic efficacy of Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen | The therapeutic efficacy of Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) | The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) | The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) | The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) | The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) | The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Doxorubicin. |
Interferon alfa-2a | The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Doxorubicin. |
Interferon alfa-2b | The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Doxorubicin. |
Interferon alfa-n1 | The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Doxorubicin. |
Interferon alfa-n3 | The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Doxorubicin. |
Interferon alfacon-1 | The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Doxorubicin. |
Interferon beta-1b | The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Doxorubicin. |
Interferon gamma-1b | The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Doxorubicin. |
Ipecac | The metabolism of Ipecac can be decreased when combined with Doxorubicin. |
Irbesartan | The metabolism of Doxorubicin can be decreased when combined with Irbesartan. |
Irinotecan | The metabolism of Irinotecan can be decreased when combined with Doxorubicin. |
Isavuconazole | The serum concentration of Doxorubicin can be increased when it is combined with Isavuconazole. |
Isavuconazonium | The serum concentration of Doxorubicin can be increased when it is combined with Isavuconazonium. |
Isoniazid | The metabolism of Doxorubicin can be decreased when combined with Isoniazid. |
Isradipine | The metabolism of Doxorubicin can be decreased when combined with Isradipine. |
Istradefylline | The serum concentration of Doxorubicin can be increased when it is combined with Istradefylline. |
Itraconazole | The serum concentration of Doxorubicin can be increased when it is combined with Itraconazole. |
Ivacaftor | The serum concentration of Doxorubicin can be increased when it is combined with Ivacaftor. |
Ivosidenib | The metabolism of Doxorubicin can be increased when combined with Ivosidenib. |
Ixabepilone | The serum concentration of Doxorubicin can be increased when it is combined with Ixabepilone. |
Ixazomib | The metabolism of Ixazomib can be decreased when combined with Doxorubicin. |
Ixekizumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Ixekizumab. |
Janssen COVID-19 Vaccine | The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Doxorubicin. |
Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) | The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Doxorubicin. |
Ketazolam | The metabolism of Doxorubicin can be decreased when combined with Ketazolam. |
Ketoconazole | The serum concentration of Doxorubicin can be increased when it is combined with Ketoconazole. |
Labetalol | The metabolism of Labetalol can be decreased when combined with Doxorubicin. |
Lacosamide | The metabolism of Doxorubicin can be decreased when combined with Lacosamide. |
Lanreotide | The metabolism of Doxorubicin can be decreased when combined with Lanreotide. |
Lansoprazole | Lansoprazole may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Lapatinib | The serum concentration of Doxorubicin can be increased when it is combined with Lapatinib. |
Lasmiditan | The serum concentration of Doxorubicin can be increased when it is combined with Lasmiditan. |
Ledipasvir | The serum concentration of Doxorubicin can be increased when it is combined with Ledipasvir. |
Lefamulin | The serum concentration of Doxorubicin can be increased when it is combined with Lefamulin. |
Leflunomide | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Leflunomide. |
Lenalidomide | The risk or severity of adverse effects can be increased when Lenalidomide is combined with Doxorubicin. |
Lenvatinib | Lenvatinib may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Lepirudin | The risk or severity of bleeding can be increased when Lepirudin is combined with Doxorubicin. |
Lesinurad | The metabolism of Doxorubicin can be increased when combined with Lesinurad. |
Letermovir | The metabolism of Doxorubicin can be decreased when combined with Letermovir. |
Nefazodone | The metabolism of Doxorubicin can be decreased when combined with Nefazodone. |
Nelarabine | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Nelarabine. |
Nelfinavir | The metabolism of Doxorubicin can be decreased when combined with Nelfinavir. |
Neratinib | The serum concentration of Doxorubicin can be increased when it is combined with Neratinib. |
Netupitant | The serum concentration of Doxorubicin can be increased when it is combined with Netupitant. |
Nevirapine | The metabolism of Nevirapine can be decreased when combined with Doxorubicin. |
Niacin | The metabolism of Doxorubicin can be decreased when combined with Niacin. |
Nicardipine | The metabolism of Doxorubicin can be decreased when combined with Nicardipine. |
Nicergoline | The metabolism of Nicergoline can be decreased when combined with Doxorubicin. |
Nifedipine | Doxorubicin may decrease the excretion rate of Nifedipine which could result in a higher serum level. |
Nilotinib | The serum concentration of Doxorubicin can be increased when it is combined with Nilotinib. |
Nilvadipine | The metabolism of Doxorubicin can be decreased when combined with Nilvadipine. |
Nimesulide | The risk or severity of bleeding can be increased when Nimesulide is combined with Doxorubicin. |
Nintedanib | The metabolism of Doxorubicin can be decreased when combined with Nintedanib. |
Nitrendipine | Doxorubicin may decrease the excretion rate of Nitrendipine which could result in a higher serum level. |
Nitrofurantoin | Nitrofurantoin may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Norethisterone | The metabolism of Doxorubicin can be decreased when combined with Norethisterone. |
Norgestimate | The serum concentration of Doxorubicin can be increased when it is combined with Norgestimate. |
Nortriptyline | The metabolism of Nortriptyline can be decreased when combined with Doxorubicin. |
Noscapine | The metabolism of Doxorubicin can be decreased when combined with Noscapine. |
Novobiocin | Novobiocin may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Nuvaxovid | The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Doxorubicin. |
Obinutuzumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Obinutuzumab. |
Ocrelizumab | Ocrelizumab may increase the immunosuppressive activities of Doxorubicin. |
Octreotide | The serum concentration of Doxorubicin can be increased when it is combined with Octreotide. |
Ofatumumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Ofatumumab. |
Ofloxacin | Doxorubicin may decrease the excretion rate of Ofloxacin which could result in a higher serum level. |
Olanzapine | The metabolism of Olanzapine can be decreased when combined with Doxorubicin. |
Olaparib | The metabolism of Doxorubicin can be decreased when combined with Olaparib. |
Oliceridine | The metabolism of Oliceridine can be decreased when combined with Doxorubicin. |
Olmesartan | Olmesartan may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Omeprazole | The metabolism of Doxorubicin can be increased when combined with Omeprazole. |
Ondansetron | The metabolism of Ondansetron can be decreased when combined with Doxorubicin. |
Opium | The metabolism of Opium can be decreased when combined with Doxorubicin. |
Oritavancin | The metabolism of Doxorubicin can be increased when combined with Oritavancin. |
Orphenadrine | The metabolism of Doxorubicin can be decreased when combined with Orphenadrine. |
Osilodrostat | The metabolism of Doxorubicin can be decreased when combined with Osilodrostat. |
Osimertinib | The metabolism of Osimertinib can be decreased when combined with Doxorubicin. |
Oteseconazole | The serum concentration of Doxorubicin can be increased when it is combined with Oteseconazole. |
Ouabain | Ouabain may decrease the cardiotoxic activities of Doxorubicin. |
Oxaliplatin | The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Doxorubicin. |
Oxcarbazepine | The metabolism of Doxorubicin can be increased when combined with Oxcarbazepine. |
Oxetacaine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Oxetacaine. |
Oxprenolol | The metabolism of Oxprenolol can be decreased when combined with Doxorubicin. |
Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Oxybuprocaine. |
Oxybutynin | The metabolism of Doxorubicin can be decreased when combined with Oxybutynin. |
Oxycodone | The metabolism of Oxycodone can be decreased when combined with Doxorubicin. |
Oxymorphone | The metabolism of Oxymorphone can be decreased when combined with Doxorubicin. |
Ozanimod | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Ozanimod. |
Paclitaxel | The serum concentration of Doxorubicin can be increased when it is combined with Paclitaxel. |
Pacritinib | The serum concentration of Doxorubicin can be increased when it is combined with Pacritinib. |
Palbociclib | The serum concentration of Doxorubicin can be increased when it is combined with Palbociclib. |
Palifermin | The therapeutic efficacy of Palifermin can be decreased when used in combination with Doxorubicin. |
Paliperidone | The serum concentration of Doxorubicin can be increased when it is combined with Paliperidone. |
Palonosetron | The metabolism of Palonosetron can be decreased when combined with Doxorubicin. |
Panobinostat | The metabolism of Panobinostat can be decreased when combined with Doxorubicin. |
Pantoprazole | Pantoprazole may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Paritaprevir | Paritaprevir may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Parnaparin | The risk or severity of bleeding can be increased when Parnaparin is combined with Doxorubicin. |
Paroxetine | The metabolism of Paroxetine can be decreased when combined with Doxorubicin. |
Pasireotide | The metabolism of Doxorubicin can be decreased when combined with Pasireotide. |
Pazopanib | The metabolism of Doxorubicin can be decreased when combined with Pazopanib. |
Pegaspargase | The risk or severity of adverse effects can be increased when Pegaspargase is combined with Doxorubicin. |
Pegcetacoplan | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Pegcetacoplan. |
Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Doxorubicin. |
Peginterferon alfa-2a | The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Doxorubicin. |
Peginterferon alfa-2b | The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Doxorubicin. |
Peginterferon beta-1a | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Peginterferon beta-1a. |
Pemetrexed | The risk or severity of adverse effects can be increased when Pemetrexed is combined with Doxorubicin. |
Penbutolol | The metabolism of Penbutolol can be decreased when combined with Doxorubicin. |
Penicillamine | The risk or severity of adverse effects can be increased when Penicillamine is combined with Doxorubicin. |
Pentamidine | The metabolism of Pentamidine can be decreased when combined with Doxorubicin. |
Pentobarbital | The metabolism of Doxorubicin can be increased when combined with Pentobarbital. |
Pentosan polysulfate | The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Doxorubicin. |
Pentostatin | The risk or severity of adverse effects can be increased when Pentostatin is combined with Doxorubicin. |
Pentoxifylline | The risk or severity of bleeding can be increased when Pentoxifylline is combined with Doxorubicin. |
Perampanel | The metabolism of Doxorubicin can be increased when combined with Perampanel. |
Perhexiline | The metabolism of Perhexiline can be decreased when combined with Doxorubicin. |
Perphenazine | The metabolism of Perphenazine can be decreased when combined with Doxorubicin. |
Pertussis vaccine | The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Doxorubicin. |
Pertuzumab | The risk or severity of cardiotoxicity can be increased when Doxorubicin is combined with Pertuzumab. |
Pexidartinib | The metabolism of Pexidartinib can be decreased when combined with Doxorubicin. |
Phenformin | The metabolism of Phenformin can be decreased when combined with Doxorubicin. |
Phenindione | The risk or severity of bleeding can be increased when Phenindione is combined with Doxorubicin. |
Phenobarbital | The metabolism of Doxorubicin can be increased when combined with Phenobarbital. |
Phenol | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Phenol. |
Phenprocoumon | The metabolism of Phenprocoumon can be decreased when combined with Doxorubicin. |
Phenylalanine | The risk or severity of adverse effects can be increased when Phenylalanine is combined with Doxorubicin. |
Phenylbutazone | The metabolism of Doxorubicin can be increased when combined with Phenylbutazone. |
Phenytoin | The metabolism of Doxorubicin can be increased when combined with Phenytoin. |
Pibrentasvir | The serum concentration of Doxorubicin can be increased when it is combined with Pibrentasvir. |
Pimavanserin | The metabolism of Doxorubicin can be decreased when combined with Pimavanserin. |
Pimecrolimus | The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Doxorubicin. |
Pimozide | The metabolism of Pimozide can be decreased when combined with Doxorubicin. |
Pindolol | The metabolism of Pindolol can be decreased when combined with Doxorubicin. |
Piperaquine | The metabolism of Doxorubicin can be decreased when combined with Piperaquine. |
Piperazine | The metabolism of Piperazine can be decreased when combined with Doxorubicin. |
Pipotiazine | The metabolism of Pipotiazine can be decreased when combined with Doxorubicin. |
Pirfenidone | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Pirfenidone. |
Pitavastatin | Doxorubicin may decrease the excretion rate of Pitavastatin which could result in a higher serum level. |
Zuclopenthixol | The metabolism of Doxorubicin can be decreased when combined with Zuclopenthixol. |
Zopiclone | The metabolism of Zopiclone can be decreased when combined with Doxorubicin. |
Zonisamide | The serum concentration of Doxorubicin can be increased when it is combined with Zonisamide. |
Zolpidem | The metabolism of Zolpidem can be decreased when combined with Doxorubicin. |
Ziprasidone | The metabolism of Doxorubicin can be decreased when combined with Ziprasidone. |
Zimelidine | The metabolism of Doxorubicin can be decreased when combined with Zimelidine. |
Zidovudine | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Zidovudine. |
Zanubrutinib | The metabolism of Zanubrutinib can be decreased when combined with Doxorubicin. |
Zafirlukast | The metabolism of Doxorubicin can be decreased when combined with Zafirlukast. |
Yohimbine | The metabolism of Yohimbine can be decreased when combined with Doxorubicin. |
Yellow fever vaccine | The risk or severity of infection can be increased when Yellow fever vaccine is combined with Doxorubicin. |
Ximelagatran | The risk or severity of bleeding can be increased when Ximelagatran is combined with Doxorubicin. |
Warfarin | The serum concentration of Warfarin can be increased when it is combined with Doxorubicin. |
Voxilaprevir | The serum concentration of Doxorubicin can be increased when it is combined with Voxilaprevir. |
Voxelotor | The serum concentration of Doxorubicin can be increased when it is combined with Voxelotor. |
Vortioxetine | The metabolism of Vortioxetine can be decreased when combined with Doxorubicin. |
Vorinostat | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Vorinostat. |
Voriconazole | The metabolism of Doxorubicin can be decreased when combined with Voriconazole. |
Vorapaxar | The serum concentration of Doxorubicin can be increased when it is combined with Vorapaxar. |
Voclosporin | The serum concentration of Doxorubicin can be increased when it is combined with Voclosporin. |
Vitamin E | The metabolism of Doxorubicin can be increased when combined with Vitamin E. |
Vismodegib | Vismodegib may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Vinorelbine | The metabolism of Vinorelbine can be decreased when combined with Doxorubicin. |
Vinflunine | The metabolism of Vinflunine can be decreased when combined with Doxorubicin. |
Vindesine | The metabolism of Vindesine can be decreased when combined with Doxorubicin. |
Vincristine | The metabolism of Vincristine can be decreased when combined with Doxorubicin. |
Vinblastine | The metabolism of Doxorubicin can be increased when combined with Vinblastine. |
Viloxazine | The metabolism of Doxorubicin can be decreased when combined with Viloxazine. |
Vilazodone | The metabolism of Vilazodone can be decreased when combined with Doxorubicin. |
Vilanterol | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Vilanterol. |
Vibrio cholerae CVD 103-HgR strain live antigen | The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Doxorubicin. |
Vernakalant | The metabolism of Vernakalant can be decreased when combined with Doxorubicin. |
Verapamil | The serum concentration of Doxorubicin can be increased when it is combined with Verapamil. |
Venlafaxine | The metabolism of Venlafaxine can be decreased when combined with Doxorubicin. |
Venetoclax | The serum concentration of Doxorubicin can be increased when it is combined with Venetoclax. |
Vemurafenib | The serum concentration of Doxorubicin can be increased when it is combined with Vemurafenib. |
Velpatasvir | The serum concentration of Doxorubicin can be increased when it is combined with Velpatasvir. |
Vedolizumab | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Vedolizumab. |
Varicella zoster vaccine (recombinant) | The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Doxorubicin. |
Varicella zoster vaccine (live/attenuated) | The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Doxorubicin. |
Vardenafil | The metabolism of Vardenafil can be decreased when combined with Doxorubicin. |
Vandetanib | The serum concentration of Doxorubicin can be increased when it is combined with Vandetanib. |
Valproic acid | The metabolism of Doxorubicin can be decreased when combined with Valproic acid. |
Valbenazine | The metabolism of Valbenazine can be decreased when combined with Doxorubicin. |
Ursodeoxycholic acid | Ursodeoxycholic acid may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Urokinase | The risk or severity of bleeding can be increased when Urokinase is combined with Doxorubicin. |
Upadacitinib | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Upadacitinib. |
Umeclidinium | The metabolism of Umeclidinium can be decreased when combined with Doxorubicin. |
Umbralisib | The serum concentration of Doxorubicin can be increased when it is combined with Umbralisib. |
Ubidecarenone | The risk or severity of cardiotoxicity can be decreased when Ubidecarenone is combined with Doxorubicin. |
Typhoid Vi polysaccharide vaccine | The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Doxorubicin. |
Typhoid Vaccine Live | The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Doxorubicin. |
Typhoid vaccine | The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Doxorubicin. |
Tucatinib | The metabolism of Tucatinib can be decreased when combined with Doxorubicin. |
Troleandomycin | The metabolism of Doxorubicin can be decreased when combined with Troleandomycin. |
Troglitazone | The metabolism of Doxorubicin can be increased when combined with Troglitazone. |
Trimipramine | The metabolism of Trimipramine can be decreased when combined with Doxorubicin. |
Trilostane | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Trilostane. |
Triflusal | The risk or severity of bleeding can be increased when Triflusal is combined with Doxorubicin. |
Trifluridine | The risk or severity of adverse effects can be increased when Trifluridine is combined with Doxorubicin. |
Triclabendazole | The metabolism of Doxorubicin can be decreased when combined with Triclabendazole. |
Trichlormethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Doxorubicin. |
Triamcinolone | The metabolism of Doxorubicin can be increased when combined with Triamcinolone. |
Tretinoin | The risk or severity of adverse effects can be increased when Tretinoin is combined with Doxorubicin. |
Trazodone | The serum concentration of Doxorubicin can be decreased when it is combined with Trazodone. |
Trastuzumab emtansine | The metabolism of Trastuzumab emtansine can be decreased when combined with Doxorubicin. |
Trastuzumab | The risk or severity of cardiotoxicity can be increased when Trastuzumab is combined with Doxorubicin. |
Tramadol | The metabolism of Tramadol can be decreased when combined with Doxorubicin. |
Trabectedin | The metabolism of Trabectedin can be decreased when combined with Doxorubicin. |
Tositumomab | The risk or severity of adverse effects can be increased when Tositumomab is combined with Doxorubicin. |
Toremifene | The serum concentration of Doxorubicin can be increased when it is combined with Toremifene. |
Topotecan | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Topotecan. |
Topiramate | The metabolism of Doxorubicin can be increased when combined with Topiramate. |
Tolvaptan | The metabolism of Tolvaptan can be decreased when combined with Doxorubicin. |
Tolterodine | The metabolism of Tolterodine can be decreased when combined with Doxorubicin. |
Tofacitinib | The metabolism of Tofacitinib can be decreased when combined with Doxorubicin. |
Tocilizumab | The metabolism of Doxorubicin can be increased when combined with Tocilizumab. |
Tixocortol | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Tixocortol. |
Tivozanib | Tivozanib may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Tirofiban | The risk or severity of bleeding can be increased when Tirofiban is combined with Doxorubicin. |
Tipranavir | The serum concentration of Doxorubicin can be decreased when it is combined with Tipranavir. |
Tiotropium | The metabolism of Tiotropium can be decreased when combined with Doxorubicin. |
Tioguanine | The risk or severity of adverse effects can be increased when Tioguanine is combined with Doxorubicin. |
Tinzaparin | The risk or severity of bleeding can be increased when Tinzaparin is combined with Doxorubicin. |
Tinidazole | Tinidazole may decrease the excretion rate of Doxorubicin which could result in a higher serum level. |
Timolol | The metabolism of Timolol can be decreased when combined with Doxorubicin. |
Ticlopidine | The metabolism of Ticlopidine can be decreased when combined with Doxorubicin. |
Tick-borne encephalitis vaccine (whole virus, inactivated) | The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Doxorubicin. |
Ticagrelor | The serum concentration of Doxorubicin can be increased when it is combined with Ticagrelor. |
Thiotepa | The metabolism of Thiotepa can be decreased when combined with Doxorubicin. |
Thioridazine | The metabolism of Thioridazine can be decreased when combined with Doxorubicin. |
Thiamylal | The metabolism of Doxorubicin can be increased when combined with Thiamylal. |
Theophylline | The metabolism of Theophylline can be decreased when combined with Doxorubicin. |
Thalidomide | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Thalidomide. |
Tetracycline | The metabolism of Doxorubicin can be decreased when combined with Tetracycline. |
Tetracaine | The risk or severity of methemoglobinemia can be increased when Doxorubicin is combined with Tetracaine. |
Tetrabenazine | The metabolism of Tetrabenazine can be decreased when combined with Doxorubicin. |
Testosterone | The metabolism of Doxorubicin can be increased when combined with Testosterone. |
Teriflunomide | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Teriflunomide. |
Terfenadine | The metabolism of Doxorubicin can be decreased when combined with Terfenadine. |
Pregnancy and Lactation
Pregnancy
Based on findings in animals and its mechanism of action, Doxorubicin Hydrochloride Injection/for Injection can cause fetal harm when administered to a pregnant woman; avoid the use of Doxorubicin Hydrochloride Injection/for Injection during the 1st trimester. Available human data do not establish the presence or absence of major birth defects and miscarriage related to the use of doxorubicin hydrochloride during the 2nd and 3rd trimesters. Doxorubicin hydrochloride was teratogenic and embryotoxic in rats and embryotoxic in rabbits when administered during organogenesis at doses approximately 0.07 times (based on body surface area) the recommended human dose of 60 mg/m2 . Advise pregnant women of the potential risk to a fetus.
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Lactation
Doxorubicin was measured in the milk of one lactating patient after therapy with 70 mg/m2 of doxorubicin hydrochloride given as a 15-minute intravenous infusion. The peak milk concentration at 24 hours after treatment was 4.4-fold greater than the corresponding plasma concentration. Doxorubicin was detectable in the milk up to 72 hours. There are no data on the effects of doxorubicin hydrochloride on the breastfed child or the effects on milk production. Because of the potential for serious adverse reactions in the breastfed child, advise women not to breastfeed during treatment with Doxorubicin Hydrochloride Injection/for Injection and for 10 days after the final dose.
What special precautions should I follow?
Before receiving a doxorubicin injection,
- tell your doctor and pharmacist if you are allergic to doxorubicin, daunorubicin (Cerubidine, DaunoXome), epirubicin (Ellence), idarubicin (Idamycin), any other medications, or any of the ingredients in doxorubicin injection. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: certain chemotherapy medications such as cytarabine (DepoCyt), dexrazoxane (Zinecard), mercaptopurine (Purinethol), streptozocin (Zanosar); phenobarbital (Luminal Sodium); or phenytoin (Dilantin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Other medications may also interact with doxorubicin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have or have ever had any other medical conditions.
- you should know that doxorubicin may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Women who are pregnant or breastfeeding should tell their doctors before they begin receiving this drug. You should not become pregnant or breast-feed while you are receiving doxorubicin injection. If you become pregnant while receiving doxorubicin, call your doctor. Use a reliable method of birth control to prevent pregnancy. Doxorubicin may harm the fetus.
- do not have any vaccinations without talking to your doctor.
Contraception
Females
Doxorubicin Hydrochloride Injection/for Injection can cause fetal harm when administered to pregnant women . Advise female patients of reproductive potential to use highly effective contraception during treatment with Doxorubicin Hydrochloride Injection/for Injection and for 6 months after treatment. .
Males
Doxorubicin hydrochloride may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Due to the potential for genotoxicity, advise males with female partners of reproductive potential to use effective contraception during treatment with Doxorubicin Hydrochloride Injection/for Injection and for 3 months after treatment. Males with pregnant partners should use condoms during treatment and for at least 10 days after the final dose .Infertility
Females
In females of reproductive potential, Doxorubicin hydrochloride may cause infertility and result in amenorrhea. Premature menopause can occur. Recovery of menses and ovulation is related to age at treatment.
Males
Doxorubicin hydrochloride may result in oligospermia, azoospermia, and permanent loss of fertility. Sperm counts have been reported to return to normal levels in some men. This may occur several years after the end of therapy.
Pediatric Use
Based on postmarketing reports, pediatric patients treated with doxorubicin hydrochloride are at risk for developing late cardiovascular dysfunction. Risk factors include young age at treatment (especially < 5 years), high cumulative doses and receipt of combined modality therapy. Long-term periodic cardiovascular monitoring is recommended for all pediatric patients who have received doxorubicin hydrochloride. Doxorubicin hydrochloride, as a component of intensive chemotherapy regimens administered to pediatric patients, may contribute to prepubertal growth failure and may also contribute to gonadal impairment, which is usually temporary.
There are no recommended dose adjustments based on age. Doxorubicin clearance was increased in patients aged 2 years to 20 years as compared to adults, while doxorubicin clearance was similar in infants less than 2 years as compared to adults
Geriatric Use
Clinical experience in patients who were 65 years of age and older who received doxorubicin hydrochloride-based chemotherapy regimens for metastatic breast cancer showed no overall differences in safety and effectiveness compared with younger patients.
Hepatic Impairment
The clearance of doxorubicin was reduced in patients with elevated serum total bilirubin levels. Doxorubicin Hydrochloride Injection/for Injection is contraindicated in patients with severe hepatic impairment (defined as Child-Pugh Class C or serum bilirubin levels greater than 5 mg/dL). Reduce the dose of Doxorubicin Hydrochloride Injection/for Injection in patients with serum total bilirubin levels greater than 1.2 mg/dL.
Few cases of overdose have been described.
A 58-year-old man with acute lymphoblastic leukemia received 10-fold overdose of doxorubicin hydrochloride (300 mg/m2) in one day. He was treated with charcoal filtration, hemopoietic growth factor (G-CSF), proton pump inhibitor and antimicrobial prophylaxis. The patient suffered sinus tachycardia, grade 4 neutropenia and thrombocytopenia for 11 days, severe mucositis and sepsis. The patient recovered completely 26 days after the overdose.
A 17-year-old girl with osteogenic sarcoma received 150 mg of doxorubicin hydrochloride daily for 2 days (intended dose was 50 mg per day for 3 days). The patient developed severe mucositis on days 4–7 after the overdose and chills and pyrexia on day 7. The patient was treated with antibiotics and platelets and recovered 18 days after the overdose.
References