Doxorubicin

FDA label

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Renal Undefined

Hepatic Bilirubin 1.2–3 mg/dL: reduce dose 50%; 3.1–5 mg/dL: reduce 75%; >5 mg/dL or Child-Pugh C: contraindicated (do not initiate/discontinue).

Consider lower dose or longer intervals in heavily pretreated, elderly, or obese patients. CBC before each dose; delay for unresolved severe myelosuppression. Discontinue if cardiomyopathy develops. No age-based dose adjustment in peds.

Instructions

• Hazardous drug — special handling/disposal.
• Dilute in NS or D5W; protect from light; use within 1 h.
• IV injection over 3–10 min via central line or free-flowing peripheral line (peripheral ≤10 min); continuous infusion via central line only; slow rate if venous streaking or facial flushing.
• Extravasation: stop immediately, aspirate before removing needle, do not flush or apply pressure, ice 15 min 4 times/day × 3 days, elevate limb; consider dexrazoxane (adults).
• Do not admix with other drugs (precipitates with heparin or fluorouracil); avoid alkaline solutions.

Available strengths

• inj 2 mg/mL

Contraindications

• Severe myocardial insufficiency
• Recent myocardial infarction (within 4–6 weeks)
• Severe persistent drug-induced myelosuppression
• Severe hepatic impairment (Child-Pugh C or bilirubin >5 mg/dL)

Cautions

• Cardiomyopathy and arrhythmias
• Secondary malignancies (AML/MDS)
• Extravasation and tissue necrosis
• Severe myelosuppression
• Hepatic impairment (reduced clearance)
• Tumor lysis syndrome
• Potentiation of radiation toxicity / radiation recall
• Embryo-fetal toxicity

Adverse reactions

• Alopecia
• Nausea
• Vomiting

Pregnancy Can cause fetal harm—avoid in 1st trimester; contraception during and 6 months after (females) / 3 months after (males).

Lactation Present in human milk (exceeds plasma levels); do not breastfeed during treatment and for 10 days after the final dose.