Doxorubicin (Adriamycin) is a chemotherapy drug that is mainly used in the treatment of the following types of cancers.
- Breast cancer
- Hodgkins Disease
- Non-Hodgkin’s disease
- Soft tissue sarcoma
- Ovarian cancer
- Lung cancer
- Bladder cancer
- Thyroid cancer
- Liver cancer
- Stomach cancer
- Wilm’s tumor
- Neuroblastoma
- Acute lymphoid leukemia
Description
Doxorubicin is a red colored medication that will appear as a red fluid when it is mixed and ready to be given. It is given only through the intravenous route. A central line (small catheter into a big vein) or a portocath (similar device which is placed under the skin) is commonly used to administer doxorubicin to the vein.
Side effects
Side effects associated with doxorubicin chemotherapymay vary from person to person. Some patients may experience significant side effects while others may experience very minimal side effects. It is not possible to predict who is going to have more severe side effects. All the side effects described here will not affect everyone. Most patients will have the common side effects like hair loss, while some other side effects may affect few patients, and may not trouble some others. In this section we will discuss the most common side effects and many less common side effects of chemotherapy using doxorubicin.
Common side effects
Bone marrow suppression and lowering of blood counts
Use of doxorubicin like many other chemotherapy drugs can cause suppression of the bone marrow and this can result in decreased production of all types of blood cells made from bone marrow. When the white cell production is affected, the condition is called neutropenia. Since white cells are the main types of cells that fight infection, lowering of white cell count can affect your ability to fight infections. It is important to realize that if you get an infection while your white cell count is low (called neutropenia) you may be at significant risk of having serious problems with the infection. Because of this reason if you ever develop a fever while you are on any type of chemotherapy, it is important to make sure that your white blood count is not low. If on the other hand if your white cell count is low (a condition called febrile neutropenia consisting of fever and low white cell count), many times you will have to be admitted to the hospital for intravenous antibiotic treatment. Lowering of red blood cells can result in a condition called anemia. Since red cells are the major carriers of oxygen from lung to different parts of the body, a decrease in red cells (or red colored material in the red cells called hemoglobin) you may experience fatigue, lack of energy and tiredness. If another type of blood component called platelets go down, you may be at risk of bleeding or bruising, since platelets have a major role in prevention of bleeding. The blood counts may start falling in about a week’s time after treatment, however the lowest points in the blood counts are usually seen around 10 to 14 days after treatment. Usually from this point onwards the blood counts usually recover and reaches normal values within 21-28 days.
The degree of lowering of the blood counts will depend on the type and dose of chemotherapy. Usually your doctor will check the blood counts weekly to monitor your blood counts, however if the blood counts are lower, your doctor may ask you to have blood counts done more often. If the red cells or platelets are very low your doctor may suggest you to have blood or platelet transfusions.
If any time during your course of chemotherapy you experience fever with temperature going above 38C (100.5F), or you develop any unexplained bruising or bleeding, or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital emergency room immediately.
Hair loss
Hair loss is very common side effect of doxorubicin chemotherapy. Most of the patients who receive doxorubicin chemotherapy will have hair loss. This usually starts 3-4 weeks after the first dose of doxorubicin, and may gradually worsen with subsequent doses of doxorubicin containing chemotherapy. Hair loss may sometime be very severe and may result in total hair loss. Hair may also be lost from other areas of the body including eyebrows and eyelashes.
Nausea and vomiting
Nausea is the sick feeling that you get when you are about to have vomiting. Doxorubicin containing chemotherapy treatment may cause nausea and vomiting in some patients, however there are very effective medications available, which can be used to prevent or greatly reduce nausea and vomiting. Commonly the nausea and vomiting may occur few hours after the administration of chemotherapy and may last one or more days. Your doctor will give you prescription for nausea medications, and with prudent use of these nauseas medications only few patients will have significant nausea or vomiting. If the nausea or vomiting gets severe your doctor may admit you to the hospital to give you intravenous fluids and anti-nausea medications.
If you get sick to your stomach with chemotherapy, there are several drugs available for treatment of nausea and vomiting associated with chemotherapy. Commonly used drugs to control nausea and vomiting associated with chemotherapy include Zofran (Ondansetron), Anzemet (Dolasetron mesylate), Kytril granisetron hydrochloride), and Aloxi (palonosetron).
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Mouth ulcers and taste change
You may develop soreness in the mouth, or may notice small ulcers in the inner parts of your cheeks, back of throat or tongue. Drinking plenty of fluids and having good mouth care with gentle brush may decrease the chance of developing mouth sours. If this happens, your physician will give you some lotions to apply to the affected areas. You may also have change or loss of taste for food while undergoing chemotherapy. The food may taste different. This problem usually disappears when the treatment is completed and normal taste will come back
Red colored urine
Your urine may turn pink after chemotherapy treatment with doxorubicin. This effect may last for about 24 hours after the treatment. There is nothing to worry about this discoloration of urine.
Skin color changes
Chemotherapy treatment with doxorubicin may result in darkening of your skin. This is due to excess production of pigments. Your skin color usually returns to normal a few months after the treatment has completed
Sensitivity to sunlight
Your skin may become excessively sensitive to sunlight while you are receiving doxorubicin chemotherapy. This effect may also last for several months after completion of the treatment. You should wear a high protection factor sun cream and protective clothing when going out in the sun.
Tiredness and a general feeling of weakness
You may feel fatigued and tired while undergoing chemotherapy. You must allow plenty of time for rest and sleep while on treatment.
Less common side effects
Damage to heart muscle
Doxorubicin chemotherapy may cause damage to heart muscle in some patients. This usually occurs with higher doses of doxorubicin given over longer periods of time. Such higher doses are not currently used in current clinical practice. It is very unusual for the heart to be affected if you receive standard doses, but could still occur. Your doctor may order tests to determine the strength of contraction of the heart muscles, before treating you with doxorubicin conataining chemotherapy. If you have any heart problems, you must discuss this with your physician, so that he or she can determine if you can take chemotherapy with Doxorubicin.
Diarrhea
Diarrhea may occur during chemotherapy treatment with doxorubicin. This is usually mild and can usually be easily controlled with medications. You should drink plenty of water if you are having diarrhea. If the diarrhea becomes severe, your doctor may have to admit you to the hospital for administration of intravenous fluids, but this is a very rare occurrence.
Skin changes with prior radiation therapy
Patients who had radiation therapy in the past may experience redness and soreness at the area of prior radiation.
Changes in nails
Your nails may change color and become darker when chemotherapy with Doxorubicin is used. White lines or ridges may appear on the nails. The nails will usually grow out of these changes once the treatment is completed.
Leaking out can cause serious damage
If doxorubicin leaks out of the catheter to skin or tissue it can cause severe damage to the area. If you feel any burning or stinging sensation while receiving doxorubicin containing chemotherapy, you must alert to the nurses to this possibility.
Menstruation and fertility
Your menstrual periods may become irregular or stop completely while receiving chemotherapy consisting of doxorubicin. In many cases the menstrual periods may return after completion of chemotherapy, but in many cases it may not. You ability to become pregnant may similarly be affected with doxorubicin containing chemotherapy. Doxorubicin chemotherapy can cause infertility in males as well. It is important to discuss these issue with your doctor prior to starting treatment.
Contraception
It is highly recommended that you should not become pregnant while receiving doxorubicin-containing chemotherapy. Doxorubicin can cause damage to the developing fetus. You should use effective contraception to prevent any chance of pregnancy while receiving doxorubicin-containing chemotherapy. If you are a breast-feeding mother, feeding should be discontinued while on doxorubicin containing chemotherapy. The issues involving breast cancer treatment during pregnancy is discussed in detail in our Pregnancy and breast cancer treatment page.
Use of other drugs with doxorubicin
If you are taking phenobarbital, dilantin or digoxin, you must let your doctor know that you are taking these medications. These drugs may interact with doxorubicin. Apart from these drugs there are other drugs that may interact with doxorubicin, hence it is important discuss all your medications with your physician.
Liver function
Doxorubicin is excreted with the help of liver. If you have any liver disease excretion of doxorubicin can be impaired causing excessive toxicity. If this is the case you should alert your physician so that proper assessment can be done to see if you can take this drug.
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