What Are the Different Doxorubicin Side Effects?
[English name] adriamycin [Other names] Doxorubicin, 14-hydroxy daunorubicin, 14-hydroxydaunomycin, Adriamycin, doxorubicin-power, doxorubicin, hydroxy red Bimycin, hydroxyl daunorubicin, doxorubicin, adriamycin, afriamycin, doxorubicin, 14-hydroxydaunomycin, 14-hydroxydaunomycin, etc. Broad antitumor spectrum, suitable for acute leukemia (lymphocytic and granulocyte), malignant lymphoma, breast cancer, bronchial lung cancer (undifferentiated small cell and non-small cell), ovarian cancer, soft tissue sarcoma, osteoblast Tumor, rhabdomyosarcoma, Ewing sarcoma, blastoma, neuroblastoma, bladder cancer, thyroid cancer, prostate cancer, head and neck squamous cell carcinoma, testicular cancer, gastric cancer, liver cancer, etc.
- 1 Bone marrow hematopoiesis, manifested by platelet and leukopenia.
- 2 Cardiotoxicity, heart failure may occur in severe cases.
- 3 Nausea, vomiting,
- [Chemical name] (2R, 4S) -4- (3-Amino-2,3,6-trideoxy--L-lyxo-hexopyranosyloxy) -2-hydroxyacetyl-1,2,3,4-tetrahydro-2, 5,12-trihydroxy-7-methoxynaphthacene-6,11-dione
- [CA registration number] [23214-92-8]
- [Structural formula]
- medicine interactions
- 1. Various bone marrow inhibitors, especially nitrosoureas, high-dose cyclophosphamide or methotrexate, mitomycin, or radiation therapy. If used with the product, the latter amount and total dose should be appropriate Less.
- 2. If the product is used with streptozotocin, the latter can extend the half-life of the product, so the dose of the former should be reduced.
- 3. Any drug that may cause liver damage, if used with this product, can increase the liver toxicity of this product; mixed application with heparin, cephalosporin, etc. will easily cause precipitation.
- 4. This product is cross-resistant to daunorubicin. It is not cross-resistant to methotrexate, fluorouracil, cytarabine, nitrogen mustard, mitomycin, bleomycin, cyclophosphamide, and nitrosourea, and it is not cross-resistant to cyclophosphamide and fluorouracil. , Methotrexate, cisplatin, and nitrosourea drugs have the same degree of synergy.
- 5. Caution with live virus vaccine during medication.
- 6. This product can reduce the anticoagulant effect of heparin. ACD and pukamycin used together with this product may cause fatal cardiotoxicity; combined with propranolol, it can strengthen the inhibition of mitochondrial respiratory enzyme activity and increase cardiotoxicity.
- [Dosing Instructions]
- 1. Combined with large doses of cyclophosphamide, the fraction and total amount of this product should be reduced as appropriate.
- 2. This product is disabled during mediastinal or thoracic radiotherapy. For those who have previously received mediastinal radiation therapy, each dose and total dose of doxorubicin should also be reduced.
- 3. People who have used sufficient daunorubicin or this product in the past can not use this product again.
- 4. This product can be used for intraperitoneal administration and bladder perfusion, but not for intrathecal injection.
- 5. Prevent the product from leaking out of blood vessels. Once it occurs, the local infiltration drug should be drawn as far as possible, and the local immediate injection of 50 to 100 mg of hydrocortisone, or sodium bicarbonate and cold compress.
- [Usage and Dosage] Dissolve the sodium chloride injection immediately before use, and the concentration is generally 2mg / ml. Slow intravenous or arterial injection.
- 1. Usual dose for adults: 50 60mg once, once every 3 4 weeks or 20 30mg per week, for 3 weeks in a row, repeat after 2 3 weeks of discontinuation. Myocardial toxicity, myelosuppression, and gastrointestinal reactions (including oral ulcers) administered in divided doses every week were lighter than those given once every 3 weeks. Children use about half as much as adults. The total dose should not exceed 400 mg / m 2 in terms of body surface area. 30 ~ 40mg can be used in the bladder or chest each time.
- 2. Combined chemotherapy:
- ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), mainly used for Hodgkin's lymphoma;
- CAF (cyclophosphamide, the product and fluorouracil), mainly used for breast cancer;
- CAOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), mainly used for malignant lymphoma;
- FAM (fluorouracil, the product and mitomycin), mainly used for gastric cancer;
- AC (the product and cytarabine), mainly used in adult acute myeloid leukemia;
- AOP (the product, vincristine and prednisone), mainly used for the induction of remission of lymphoblastic acute leukemia;
- ACP (the product, cyclophosphamide and cisplatin), mainly used for ovarian and bronchial lung cancer, head and neck cancer, bladder cancer, etc .;
- CY-VA-DIC (cyclophosphamide, vincristine, this product and dacarbazine), mainly used for soft tissue sarcoma and osteosarcoma;
- MACC (methotrexate, this product, cyclophosphamide and cyclohexyl nitrosourea), mainly used for undifferentiated small cell lung cancer or lung adenocarcinoma.
- [Formulations and specifications] Doxorubicin for injection: 10mg; 50mg.
- Adverse reactions
- 1. Common hair loss (about 90% of patients), myelosuppression (white blood cells drop to the lowest point about 10 to 14 days after administration, and most gradually return to normal levels within 3 weeks, anemia and thrombocytopenia are rare) Mouth ulcers, loss of appetite, nausea, or even vomiting.
- 2. A small number of patients may have skin redness or pigmentation in the original radiation field after injection of this product. If the injection fluid overflows, it can cause redness, swelling, pain, or even cellulitis and local necrosis.
- 3. Leukemia and malignant lymphoma patients when using this product, especially those who use the product for the first time, can cause hyperuricemia due to a large number of destruction of tumor cells, resulting in joint pain or renal function damage.
- 4. This product has cardiotoxicity, which can cause late-onset severe heart failure, which can sometimes occur after half a year of withdrawal. When there is myocardial damage, rapid heart rate, arrhythmia, conduction block, or jet heart failure can occur. These situations can happen suddenly and there is no sign of abnormality in conventional ECG. Myocardial toxicity is closely related to the cumulative dose. For the total amount of 450 to 550 mg / m 2 , the incidence rate is about 1% to 4%. For the total amount of more than 550 mg / m 2 , the incidence rate increases significantly, up to 30%. Cardiotoxicity can be exacerbated by the combined use of other drugs. Newer data suggest that high doses of cyclophosphamide and trastuzumab have similar effects.
- Contraindications
- 1. This product can pass through the placenta, which may cause miscarriage. Therefore, it is strictly prohibited to apply it within the first 3 months of pregnancy. After using this product in pregnant women, toxic reactions to the fetus can sometimes appear up to several years later.
- 2. Disable the product during mediastinal or thoracic radiotherapy.
- 3. The following conditions should be disabled: white blood cells below 3500 / l or platelets below 50,000 / l in peripheral blood, obvious infection or fever, cachexia, dehydration, electrolyte or acid-base balance disorders, gastrointestinal obstruction, obvious People with jaundice or impaired liver function, patients with decompensated heart and lung function, patients with chickenpox or shingles.
- 4. Those who are allergic to this product are prohibited. [1]
- 1. This product has carcinogenic effects in animals, and also has potential mutagenic and carcinogenic effects in humans. The product has a significant effect on animal reproductive function, but in humans, its inhibitory effect is greatly reduced in rats.
- 2. Although there is less renal excretion of this product, red urine can appear within 1 to 2 days after administration, and usually disappears after 2 days. Patients with renal insufficiency should be alert to the appearance of hyperuricemia after using this product; patients with gout, if using this product, the amount of allopurinol should be increased accordingly.
- 3. Elderly patients, children under 2 years old and patients with existing heart disease should be used with extreme caution.
- 4. A small number of patients can cause jaundice or other liver dysfunction after administration, and the amount of liver dysfunction should be reduced.
- 5. Check during medication:
- Before and after treatment, measure cardiac function, monitor electrocardiogram, echocardiogram, serum enzymes and other myocardial function tests;
- Follow-up examination of peripheral blood (at least once a week) and liver function test;
- should always check for oral ulcers, diarrhea and jaundice, advise patients to drink plenty of water to reduce the possibility of hyperuricemia, check serum uric acid or renal function if necessary.
- 6. The cardiotoxicity of doxorubicin mostly occurs 1 to 6 months after discontinuation. Vitamin B6 and coenzyme Q10 should be applied early to reduce its toxicity to the heart.
- 7. During the medication period, the blood image should be reviewed regularly to avoid bone marrow suppression. [1]
|
|
|
|
|
|
---|---|---|---|---|---|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3. Lung, chest or respiratory toxicity-thickened pleura |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3. Biochemical toxicity-inhibit or induce phosphatase |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3. Hematological toxicity-changes in red blood cell count |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2. Gastrointestinal toxicity-excessive exercise, diarrhea 3. Chronic disease-related toxicity-death |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3. Nutrition and metabolic system toxicity-weight loss or weight loss rate |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
| ||
|
|
|
|
| |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Lung, chest or respiratory toxicity-tumor 3. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
2. Skin and accessory toxicity-tumor |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2. Reproductive toxicity-abnormal development of the cardiovascular circulatory system 3. Reproductive toxicity-abnormal development of the urinary system |
|
|
|
|
|
2. Reproductive toxicity-changes in testis, epididymis, and vas deferens 3. Reproductive toxicity-decline in male fertility |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2. Reproductive toxicity-abnormal development of the musculoskeletal system |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2. Reproductive toxicity-changes in testis, epididymis, and vas deferens |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
- Material toxicity reference: [2-162]