Parenteral Manual

DOXOrubicin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ADRIAMYCIN
Classification: 
Antineoplastic antibiotic (anthracycline) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
September 2023
Indications: 
  • Leukemias                                    - Sarcomas                        - Wilms tumor
  • Neuroblastoma                            - Germ cell tumors
  • Hodgkins disease                       - Non-Hodgkin's lymphomas

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as 2 mg/mL solution which is clear and red in color
  • Color change to blue/purple indicates decomposition, discard solution.  Refrigerate unopened vials. Note: refrigeration may result in formation of a gelled product; if gelling occurs, place vials at room temperature for 2 to 4 hours to return the product to a slightly viscous, mobile solution.
  • Diluted solutions in dextrose or saline, stable for48 hours room temperature or 14 days refrigerated
  • Protect from light once drug is further diluted for infusion
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations

- Additives/Above Cassette Compatible: vincristine (at low concentrations)

- Y-site Compatible: bleomycin, cisplatin, cyclophosphamide, dexamethasone, diphenhydramine, droperidol, filgrastim, hydromorphone, leucovorin, lorazepam, methotrexate, methylprednisolone, metoclopramide, morphine, ondansetron, paclitaxel, prochlorperazine, ranitidine, sodium bicarbonate (diluted), teniposide, vinblastine, vincristine

- Incompatible: allopurinol, amphotericin B, furosemide, heparin, piperacillin/tazobactam, propofol, TPN

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Push

YES; doses <30 mg/m2ONLY
Infusion time: give into running IV over > 10 minutes
Flush with at least 20 mL of IV fluid after to clear line of any drug
IV Intermittent Infusion YES; doses >30 mg/m2
Usual dilution: dilute in 50 mL D5W or NS
Infusion time: 15-30 minutes
IV Continuous Infusion YES, MUST USE CENTRAL LINE
Usual dilution: dilute to a volume sufficient to infuse at approximately 20 mL/hr over 24 - 96 hour period
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 30 mg/m2 weekly
  • 60 -75 mg/m2  every 3 weeks
  • 25 mg/m2/day x 2 - 3 days every 3 weeks

Use ideal body weight for dosage calculations if patient is obese or has ascites Children <0.5 m2 or <2 years should be dosed on a mg/kg basis.  (To obtain mg/kg dose, divide mg/m2 dose by 30.) Decrease dose by half if radiation to the whole lung or whole abdomen within 6 weeks Total cumulative lifetime dose should generally not exceed 450 mg/m2or 350 mg/m2 with concomitant use of radiation to the mediastinum, 300 mg/m2 in children >2 years of age and <12 years, and 10 mg/kg in children <2 years of age

** Dosage may differ according to protocol

Dose adjustment in hepatic impairement:

Serum Bilirubin

Dose

25-50 micromol/L

50% of usual dose

51-85 micromol/L

25% of usual dose

>85 micromol/L

Contraindicated
Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Transient arrhythmias, hypotension
  • NOTE: erythema along the vein (with or without urticaria) is likely a flare reaction, not necessarily extravasation and may respond to antihistamines, or slowing of infusion.
  • Fever, chills, facial flush if given too rapidly
  • Anaphylaxis (rare)
  • Nausea and vomiting (moderate - high emetogenic potential depending on dose), anorexia, abdominal pain
  • Recall dermatitis may occur in previously irradiated areas (rare)
  • VESICANT:   will cause tissue damage and necrosis if extravasated.  Usual first sign is pain.  Refer to policy for administration of vesicant chemotherapy and Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Delayed (within a few days to weeks):

  • Myelosuppression; nadir: 10 - 14 days
  • Alopecia
  • Irreversible cardiotoxicity related to total life-time cumulative dose (see above), congestive heart failure, cardiomyopathy
  • Mucositis
  • Hyperpigmentation of skin and nail beds may occur
  • Red coloration of urine, 1-2 days post administration

 - Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 

  • Do NOT substitute conventional doxorubicin for or with liposomal doxorubicin; products are different and are NOT interchangeable.

  • Monitor hematologic status
  • ECG and echocardiogram must be done before treatment begins and follow cardiac function regularly with subsequent doses; cumulative doses must be recorded (consult chemotherapy protocol for specific intervals)
  • Contraindicated in impaired cardiac function (see specific protocol for details)
  • Longer continuous infusions (24-96 hours) are thought to reduce incidence of long-term cardiac toxicity, although further study in children is necessary.
  • Mucositis and gastrointestinal side effects are worse with continuous infusions
  • Avoid contact with skin.  Wash thoroughly with water
  • Use with caution in patients who have had thoracic radiation and do not use at the same time as radiation therapy

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