Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Doxorubicin (Adriamycin)

🚨 Cardiotoxicity alert: The lifetime cumulative dose of doxorubicin should usually not exceed 500 mg/m². 💡 Risk rises significantly beyond this threshold due to anthracycline-induced cardiomyopathy. 👉 Always check baseline and serial LVEF (echocardiogram or MUGA scan).

📖 About

Doxorubicin (Adriamycin) is a potent anthracycline chemotherapy drug.
Acts by interfering with DNA processes and generating free radicals.
Broadly used in both solid tumours and haematological malignancies.

🧬 Mechanism of Action

📌 DNA intercalation: slips between DNA base pairs → blocks replication & transcription.
📌 Topoisomerase II inhibition: prevents DNA unwinding → halts cell division.
📌 Free radical generation: oxidative damage to lipids, proteins & DNA → apoptosis.
❤️ Cardiotoxicity partly linked to free radical damage in myocardium (low antioxidant defences).

🎯 Indications

Breast & ovarian cancer
Bladder cancer (systemic or intravesical use)
Lymphomas (Hodgkin & non-Hodgkin)
Leukaemias (ALL, AML)
Soft-tissue sarcomas, Osteosarcoma, Ewing’s sarcoma
Wilms’ tumour, Neuroblastoma
Multiple myeloma, Thyroid carcinoma, Endometrial carcinoma
Other rare paediatric & adult tumours

💉 Administration

IV infusion is standard – extravasation is dangerous → tissue necrosis ⚠️.
Can be given intravesically for bladder tumours (superficial carcinoma, prophylaxis after TURBT).
Dose calculated on body surface area (BSA), usually in cycles.
Often combined with other drugs (e.g., ABVD regimen for Hodgkin lymphoma).

⚠️ Cautions

Baseline cardiac assessment essential (echo or MUGA scan).
Avoid in severe liver disease (hepatic metabolism).
Care with prior chest radiotherapy or other cardiotoxic drugs (trastuzumab, cyclophosphamide).

🚫 Contraindications

Active infection or neutropenia (low WCC).
Severe hepatic impairment.
Severe pre-existing cardiac disease.

🔄 Interactions

Other cardiotoxic agents (trastuzumab, cyclophosphamide, paclitaxel) ↑ risk of heart failure.
Digoxin pre-treatment has been shown in some studies to reduce cardiotoxicity.
Check BNF for full list of drug–drug interactions.

🌡️ Patient advice: Seek urgent medical help if temperature >37.5°C OR if feeling acutely unwell (shaky, sore throat, cough, diarrhoea, urinary symptoms) → may indicate neutropenic sepsis.

💥 Side Effects

🔴 Red-orange urine discolouration (benign, but warn patients!)
📉 Myelosuppression (↓ WCC, Hb, platelets)
💇 Alopecia
❤️ Cardiotoxicity: cumulative, dose-related cardiomyopathy & CHF
GI upset: nausea, vomiting, mucositis
Skin/tissue necrosis if extravasated

📚 References

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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