Doxorubicin

Indications
 Intravenous
AIDS-related Kaposi's sarcoma
Adult: As pegylated liposome: 20 mg/m2 BSA infused over 30 min once every 2-3 wk.
Hepatic impairment: Moderate impairment (serum-bilirubin: 12-30 mcg/mL): Half the normal dose; severe impairment (serum-bilirubin >30 mcg/mL): Quarter of the usual dose.
Intravenous
Ovarian carcinoma
Adult: As pegylated liposome: 50 mg/m2 BSA infused over 1 hr once every 4 wk.
Hepatic impairment: Moderate impairment (serum-bilirubin: 12-30 mcg/mL): Half the normal dose; severe impairment (serum-bilirubin >30 mcg/mL): Quarter of the usual dose.
Intravenous
Metastatic breast cancer
Adult: 60-75 mg/m2 BSA once every 3 wk in combination with cyclophosphamide given as an infusion over 1 hr diluted in 0.9% sodium chloride or 5% glucose.
Hepatic impairment: Moderate impairment (serum-bilirubin: 12-30 mcg/mL): Half the normal dose; severe impairment (serum-bilirubin >30 mcg/mL): Quarter of the usual dose.
Irrigation
Local malignant neoplasms in the bladder
Adult: 50 ml of a 1 mg/ml solution instilled into the bladder for 1 hr once a mth.
Hepatic impairment: Moderate impairment (serum-bilirubin: 12-30 mcg/mL): Half the normal dose; severe impairment (serum-bilirubin >30 mcg/mL): Quarter of the usual dose.

Special Populations: Reduce dose to 50% in patients with moderate liver dysfunction (serum-bilirubin concentration: 12-30 mcg/mL) and to 25% of usual adult dose in patients with severe liver impairment (serum-bilirubin concentration: >30 mcg/mL).
Contraindications
 Cardiac disease, neonates, pregnancy and lactation, prior irradiation to mediastinum. IM/SC admin. Severe myelosuppression due to previous treatment with antitumour agents or radiotherapy.
Warnings / Precautions
 Elderly, children, hepatic impairment. Monitor blood counts and ECG.
Adverse Reactions
 Leucopenia, thrombocytopenia, nausea, vomiting, diarrhoea. Rarely facial flushing, rash, alopecia. Blurred vision, headache, seizures, paraesthesia, confusion, malaise, lethargy, skin pigmentation.
Potentially Fatal: Bone marrow suppression, cardiotoxicity.
Overdose Reactions
 Acute overdosage may increase the toxic effects of mucositis, leukopenia and thrombocytopenia. Treatment includes hospitalisation of the severely myelosuppressed patient, antimicrobials, platelet transfusions and symptomatic treatment of mucositis. Use of haemopoietic growth factor (G-CSF, GM-CSF) may be considered. Cumulative dosage increases risk of cardiomyopathy and resultant congestive heart failure which may be managed with digitalis preparations, diuretics, and after load reducers such as ACE inhibitors.
Drug Interactions
 Doxorubicin interacts with a number of other drugs e.g. antibiotics (aminoglycosides), steroids, aminophylline and propranolol.
Potentially Fatal: Cholestasis induced by mercaptopurine may be potentiated by concurrent administration of the drug. Toxicity may be increased if streptozocin is given concurrently.
See Below for More doxorubicin Drug Interactions
Mechanism of Actions
 Doxorubicin is a cytotoxic anthracycline antibiotic. The cytotoxic action results from its binding to DNA and inhibition of nucleic acid synthesis. Doxorubicin has been shown to produce regression in a variety of disseminated malignancies.
Absorption: Rapidly cleared from the blood after IV admin.
Distribution: Distributed into tissues including lungs, liver, heart, spleen and kidneys (IV); crosses the placenta; enters breast milk.
Metabolism: Hepatic; rapidly converted to doxorubicinol.
Excretion: Bile (as unchanged drug); 12 min, 3.3 hr, 30 hr (mean elimination half-lives).
Storage Conditions
 Intravenous: Powder for inj: Store at 15-30°C. Solution for inj & liposomal formulations: Refrigerate at 2-8°C. Do not freeze. Irrigation: Powder for inj: Store at 15-30°C. Solution for inj & liposomal formulations: Refrigerate at 2-8°C. Do not freeze.
ATC Classification
 L01DB01 - doxorubicin ; Belongs to the class of cytotoxic antibiotics, anthracyclines and related substances. Used in the treatment of cancer.
Storage
 Intravenous: Powder for inj: Store at 15-30°C. Solution for inj & liposomal formulations: Refrigerate at 2-8°C. Do not freeze. Irrigation: Powder for inj: Store at 15-30°C. Solution for inj & liposomal formulations: Refrigerate at 2-8°C. Do not freeze.
Available As
  • Doxorubicin 10 mg
  • Doxorubicin 50 mg

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