Xorubin Aqua

Indications

Doxorubicin Hydrochloride is an anticancer (chemotherapy) medicine. It is used, usually together with other medicines, to treat many cancers, including breast cancer, lymphomas (Hodgkin and non-Hodgkin), acute leukaemias, soft tissue and bone sarcomas, and cancers of the ovary, bladder, stomach, lung and thyroid. Some products are a special liposomal form used for ovarian cancer, multiple myeloma and Kaposi sarcoma.

How It Works

Doxorubicin belongs to a group of medicines called anthracyclines. It slips between the strands of DNA inside cancer cells and blocks an enzyme the cells need to copy their DNA, so the cells cannot divide and they die. It also affects healthy cells that divide quickly, such as those in the bone marrow, mouth, gut and hair roots, which causes many of its side effects.

Dosage and Administration

Doxorubicin is given only in hospital by a doctor or nurse trained in cancer treatment, as a drip or injection into a vein. The dose is worked out by the cancer specialist for each patient, based on body size, the type of cancer, other medicines in the plan, blood counts, and liver and heart function. It is usually given in cycles every 3 weeks or as prescribed. There is a limit to the total amount a person can receive in a lifetime because of the risk to the heart. The liposomal form is not interchangeable with ordinary doxorubicin.

Interactions

Many interactions are possible, so the cancer team must know about every medicine and herbal product being taken. Trastuzumab, Cyclophosphamide, Paclitaxel and radiotherapy to the chest can increase the risk of heart damage. Other chemotherapy medicines increase the effect on the bone marrow. Verapamil, Ciclosporin and some antifungals may raise doxorubicin levels. Live vaccines must not be given during treatment.

Contraindications

• Allergy to doxorubicin or other anthracyclines.
• Severe bone marrow suppression (very low blood counts).
• Severe liver disease.
• Serious heart disease, recent heart attack or heart failure.
• Previous treatment that has already reached the lifetime limit of anthracyclines.
• Breastfeeding.

Side Effects

Common: nausea and vomiting, hair loss, mouth sores, tiredness, low blood counts (raising the risk of infection, bleeding and anaemia), loss of appetite and diarrhoea. Urine is often red or orange for 1 to 2 days after each dose; this is harmless. Darkening of nails and skin can occur. The liposomal form can cause redness, peeling and pain of the palms and soles.

Get urgent medical help for: fever of 38°C or more, chills or other signs of infection; unusual bleeding or bruising; chest pain, breathlessness, swelling of the ankles or a fast or irregular heartbeat; pain, redness or swelling where the drip went in; or signs of a serious allergic reaction during the infusion.

Pregnancy and Lactation

Doxorubicin can harm an unborn baby. Women and men should use reliable contraception during treatment and for some months afterwards, as advised by the cancer team. Tell the doctor at once if pregnancy occurs. Do not breastfeed during treatment.

Precautions and Warnings

• Heart function is checked (for example with an echocardiogram) before and during treatment, because heart damage can appear during treatment or years later.
• Blood counts and liver function are checked before each cycle.
• Leaking of the medicine out of the vein can badly damage the skin; report any pain at the drip site straight away.
• It can rarely lead to a second cancer, such as leukaemia, later in life.
• Avoid people with infections, keep good mouth hygiene, and do not have live vaccines.

Overdose

Overdose is managed in hospital. It can cause severe mouth sores, very low blood counts with infection or bleeding, and heart damage. Treatment is supportive care and close monitoring.

Therapeutic Class

Anticancer medicine (anthracycline cytotoxic antibiotic).

Storage

Kept and prepared by the hospital pharmacy. Solution is usually stored in a refrigerator at 2 to 8°C, and powder below 25°C, protected from light, as stated on the pack. Do not freeze. Out of the reach of children.