High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues; does not cross the blood-brain barrier.
Half-Life: 16.7 hr.
Contraindicated in:
Use Cautiously in:
History of cardiac disease or high cumulative doses of anthracyclines;
Depressed bone marrow reserve;
CV: CARDIOMYOPATHY, ECG changes
Derm: alopecia, photosensitivity
Endo: prepubertal growth failure with temporary gonadal impairment (children only)
GI: diarrhea, esophagitis, nausea, stomatitis, vomiting
GU: red urine, sterility
Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA
Local: phlebitis at IV site
tissue necrosis
Resp: recall pneumonitis
Misc: hypersensitivity reactions, SECOND MALIGNANCY
Drug-drug:
Hepatic Impairment
Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Monitor for development of signs of cardiac toxicity, which may be either acute and transient (ST segment depression, flattened T wave, sinus tachycardia, extrasystoles) or late onset (usually occurs 16 mo after initiation of therapy) and characterized by intractable HF (peripheral edema, dyspnea, rales/crackles, weight gain). Chest x-ray, echocardiography, ECG, and radionuclide angiography may be ordered before and periodically during therapy. Cardiotoxicity is more prevalent in children <2 yr and older adults and when cumulative dose >300 mg/m2. Dexrazoxane may be used to prevent cardiotoxicity in patients receiving cumulative doses of >300 mg/m2.
Assess injection site frequently for redness, irritation, or inflammation during and for up to 2 hr after completion of infusion. Doxorubicin is a vesicant but may infiltrate painlessly even if blood returns on aspiration of infusion needle. Severe tissue damage may occur if doxorubicin extravasates. If extravasation occurs, stop infusion immediately, restart, and complete dose in another vein. Local infiltration of antidote is not recommended. If extravasation is suspected, intermittent application of ice to site for 15 min 4 times daily for 3 days may be useful. Because of the progressive nature of extravasation reactions, close observation and plastic surgery consultation are recommended. Blistering, ulceration, and/or persistent pain are indications for wide excision surgery, followed by split-thickness skin grafting. May use dexrazoxane to treat extravasation. Administer 1st infusion of dexrazoxane as soon as possible within 6 hr of extravasation. Remove ice packs for >15 min before and during dexrazoxane administration. Recommended dose of dexrazoxane for day 1 is 1000 mg/m2 (up to 2000 mg); the dose for day 2 is 1000 mg/m2 (up to 2000 mg); the dose for day 3 is 500 mg/m2 (up to 1000 mg). Dexrazoxane is administered as an IV infusion over 12 hr. If swelling, redness, and/or pain persists beyond 48 hr, immediate consultation for possible debridement is indicated.
Lab Test Considerations:
Monitor CBC with differential before and periodically during therapy. WBC nadir occurs 1014 days after administration, and recovery usually occurs by the 21st day. Thrombocytopenia and anemia may also occur. ↑ dosing interval and/or ↓ dose is recommended if ANC is <1000 cells/mm3 and/or platelet count is <50,000 cells/mm3
.Administer under supervision of a physician experienced in use of cancer chemotherapeutic agents.
Monitor cumulative dose of doxorubicin and other anthracyclines received; risk for cardiomyopathy ↑ as the cumulative dose ↑ (>250 mg/m2 in pediatric patients <18 yr and 550 mg/m2 in patients >18 yr).
IV Administration:
Instruct patient to notify health care provider promptly if fever; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in stools, urine, or emesis; ↑ fatigue; dyspnea; or orthostatic hypotension occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs, because these may precipitate gastric bleeding.
Instruct patient to report pain at injection site immediately.
Instruct patient to notify health care provider immediately if irregular heartbeat, shortness of breath, swelling of lower extremities, or skin irritation (swelling, pain, or redness of feet or hands) occurs.