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 , 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 1–6 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.
Lab Test Considerations:
Monitor CBC with differential before and periodically during therapy. WBC nadir occurs 10–14 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:
Doxorubicin hydrochloride is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses for 20 min 4 times day for 1–2 days. Initiate antidote (dexrazoxane or topical dimethyl sulfoxide) based on time frame of noting extravasation. If extravasation is noted ≤6 hr of doxorubicin hydrochloride infusion, administer dexrazoxane 1000 mg/m2 over 1–2 hr on Days 1 and 2 (max dose = 2000 mg/day), followed by 500 mg/m2 over 1–2 hr on Day 3 (max dose = 1000 mg/day). Hold cold compresses 15 min before initiating and after completing dexrazoxane infusion. Concurrent treatment with topical dimethyl sulfoxide should not be used with dexrazoxane because it may ↓ dexrazoxane's effectiveness.If extravasation is noted >6 hr after completion of doxorubicin hydrochloride infusion, apply dimethyl sulfoxide by saturating a gauze pad and painting on an area twice the size of the extravasation. Allow site to air-dry and repeat application every 8 hr for 7 days. Do not cover the area with dressing.
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.