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Overview: Doxorubicin is an injection given by a health care provider to treat certain cancers. Common side effects can include hair loss, nausea, and vomiting. Serious side effects are less common but may include heart problems, blood disorders, tissue damage, mouth sores, or an allergic reaction. Call your health care provider right away if you get a fever, rash, swelling, chest pain, or feel your heart skipping beats. 

Uses

What is doxorubicin used for?

Doxorubicin is used to treat certain people with cancer, including the following types of cancer.

Doxorubicin may also be used for other conditions as determined by your health care provider.

How does doxorubicin work (mechanism of action)?

Doxorubicin works by stopping DNA in cancer cells from working properly. By preventing the DNA from working, doxorubicin can stop or slow the growth of cancer cells and make tumors shrink. 

How is doxorubicin supplied (dosage forms)?

Brands and other names

  • Adriamycin
  • Rubex

Dosage forms and strengths

Doxorubicin is available in an injectable form that is given by a health care provider.

How should I store doxorubicin?

Doxorubicin is usually given by a health care provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of doxorubicin?

The most common side effects of doxorubicin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Hair loss
  • Nausea or vomiting
  • Diarrhea
  • Mouth sores (see below)

There may be other side effects of doxorubicin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of doxorubicin?

While less common, the most serious side effects of doxorubicin are described below, along with what to do if they happen.

Severe Allergic Reactions. Doxorubicin may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Failure. Doxorubicin may increase your risk of heart failure. This risk of heart failure can be during treatment or several years after you stop using doxorubicin. The risk may be higher if you get higher doses, use it for a long time, or if you take other medicines that have a risk of heart failure. Tell your health care provider right away if you have any of the following symptoms of heart failure.

  • Shortness of breath or trouble breathing, especially while lying down
  • Swelling in your feet, ankles, or legs
  • Unusually fast weight gain
  • Unusual tiredness

Heart Rhythm Changes. Doxorubicin may cause heart rhythm problems that can lead to an irregular heartbeat and fainting. In rare cases, this may cause the heart to suddenly stop beating (cardiac arrest). Some people have a higher risk of this, including people with existing heart disease or who take other medicines that affect the heart. Get emergency help if you have any of the following signs of heart rhythm changes.

  • Chest pain
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding, or skipping heartbeat

Cancer. Doxorubicin may cause you to have a new cancer, such as acute myeloblastic leukemia (AML) or myelodysplastic syndrome (MDS). Tell your health care provider about any new symptoms that you may get.

Blood Disorders. Doxorubicin can cause blood disorders, such as low platelet levels (thrombocytopenia) and low white blood cell levels (leukopenia and neutropenia). Keep all of your appointments with your health care provider to have your blood cell counts checked. Get help right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Easy bruising or bleeding
  • Frequent infection
  • Headache

Tumor Lysis Syndrome. Doxorubicin can cause a fast breakdown of cancer cells. This can lead to a condition called tumor lysis syndrome, which can be serious. It is important to drink plenty of water while receiving doxorubicin and to keep all appointments for blood work so your health care provider can see how your body is responding to doxorubicin. Tell your health care provider right away if you have any of the following signs of tumor lysis syndrome.

  • Nausea and vomiting
  • Weakness
  • Swelling or fluid retention
  • Shortness of breath
  • Muscle cramps
  • Seizures

Tissue Damage. Doxorubicin is given as an infusion into a vein. If the medicine does not go into your vein, it could damage nearby tissue. Your infusion may need to be stopped, and you may need treatment to prevent further tissue damage. Tell your health care provider right away if you have pain, swelling, warmth, or skin color changes where the medicine is being or was given.

Mouth Sores. Sores in the mouth may be common with doxorubicin, but they can be severe. Call your health care provider if you have any of the following.

  • Severe mouth sores, redness, or swelling
  • Pain that keeps you from eating or drinking

Warnings & Precautions

Who should not use doxorubicin?

Allergies to Ingredients. People who are allergic to any of the following should not use doxorubicin.

  • Adriamycin
  • Doxorubicin
  • Rubex
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in doxorubicin.

Heart Problems. If you have certain heart problems or have had a heart attack within the past four to six weeks, you should not use doxorubicin. Talk with your health care provider about any heart problems you have had.

Weak Immune System. If you have a weak immune system from medicine or chemotherapy, you should not use doxorubicin. Talk with your health care provider about any medicines you take or have recently taken. Your health care provider may do tests to see if your immune system is working well enough to use this medicine.

Liver Problems. Doxorubicin should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough to use this medicine.

What should I know about doxorubicin before using it?

Doxorubicin is usually given by a health care provider in a hospital or clinic. 

After receiving doxorubicin, your pee may be red in color for one or two days. This is normal. If the red color lasts longer than a few days or if you notice blood or blood clots in your urine, tell your health care provider right away.

If you or your partner can become pregnant, you should use effective birth control while you are using doxorubicin and for six months after your last dose. Talk to your health care provider about your birth control options. If you or your partner become pregnant while using doxorubicin, tell your health care provider right away. 

Doxorubicin may make it hard for you to get pregnant or get your partner pregnant. Doxorubicin may also cause early menopause. If you have concerns, talk to your health care provider.

What should I tell my health care provider before using doxorubicin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if doxorubicin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Blood disorders, such as low platelets or low white blood cells
  • Current or prior infection
  • Prior or future radiation therapy
  • Prior cancer and cancer treatments

Other Medicines and Supplements. Doxorubicin may interact with other medicines and supplements. Before using doxorubicin, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Doxorubicin may cause harm to an unborn baby. Tell your health care provider if you are pregnant, think you are pregnant, or plan to become pregnant.

Breastfeeding. Doxorubicin passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop doxorubicin.

Interactions

Does doxorubicin interact with foods or drinks?

You should avoid eating grapefruit or drinking grapefruit juice while using doxorubicin. Grapefruit can interfere with your body’s ability to break down doxorubicin. This can lead to high levels of the medicine and an increased risk of side effects. 

It is unknown if drinking alcohol will affect doxorubicin, but heavy drinking can slow your immune response and make it harder for your body to fight cancer. 

Does doxorubicin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using doxorubicin.

  • St. John’s wort, which is a supplement that may be used to treat depression
  • Verapamil (Verelan, Verelan PM), which is a medicine used for high blood pressure or chest pain
  • Any medicine for seizures, such as carbamazepine, phenobarbital, or phenytoin
  • Any medicine to treat cancer such as mercaptopurine, paclitaxel, or trastuzumab
  • Dexrazoxane, a medicine that is used to prevent heart problems caused by certain medicines

Many other medicines may alter the blood levels of doxorubicin. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with doxorubicin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much doxorubicin?

If you or someone else has used too much doxorubicin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of doxorubicin?

Doxorubicin is usually given by a health care provider in a hospital. Your health care provider will make sure you are receiving doxorubicin as scheduled. Missing doses of doxorubicin can cause it to not work as well over time. So it is important not to miss or skip doses.

If you miss an appointment to get your doxorubicin dose, call to make another appointment as soon as possible.