→Appendix 1: anthracyclines
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▶Common or very common Alopecia. anaemia. anxiety.
appetite decreased. arrhythmias. arthralgia. asthenia.
bone marrow depression. breast pain. cachexia.
cardiovascular disorder. chest discomfort. chills.
constipation. cough. decreased leucocytes. dehydration.
depression. diarrhoea. dizziness. drowsiness. dry mouth.
dysphagia. dyspnoea. dysuria. electrolyte imbalance.
epistaxis. eye inflammation. fever. gastrointestinal
discomfort. gastrointestinal disorders. headache.
hyperhidrosis. hypersensitivity. hypertension.
hyperthermia. hypotension. increased risk of infection.
influenza like illness. infusion related reaction. insomnia.
malaise. mucosal abnormalities. muscle complaints.
muscle tone increased. muscle weakness. nail disorder.
nausea. nerve disorders. neutropenia. oedema. oral
Immune system and malignant disease
disorders. pain. scrotal erythema. sensation abnormal.
sepsis. skin reactions. skin ulcer. syncope. taste altered.
thrombocytopenia. vasodilation. vision blurred. vomiting
. weight decreased
▶Uncommon Confusion. embolism and thrombosis
▶Rare or very rare Secondary oral neoplasms. severe
cutaneous adverse reactions (SCARs)
▶Frequency not known Asthma. congestive heart failure.
secondary malignancy. throat tightness
SIDE-EFFECTS, FURTHER INFORMATION Extravasation can
cause tissue necrosis.
Cardiomyopathy Higher cumulative doses are
associated with cardiomyopathy and it is usual to limit
total cumulative doses to 450 mg/m2.
Liposomal formulations Liposomal formulations of
doxorubicin may reduce the incidence of cardiotoxicity
and lower the potential for local necrosis, but infusion
reactions, sometimes severe, may occur. Hand-foot
syndrome (painful, macular reddening skin eruptions)
occurs commonly with liposomal doxorubicin and may be
dose limiting. It can occur after 2–3 treatment cycles and
may be prevented by cooling hands and feet and avoiding
socks, gloves, or tight-fitting footwear. It may also occur
with non-liposomal formulations.
Elevated bilirubin concentrations
Doxorubicin is
largely excreted in the bile and an elevated bilirubin
concentration is an indication for reducing the dose.
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Manufacturer advises
effective contraception during and for at least 6 months
after treatment in men or women.
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Avoid (teratogenic and toxic in animal
studies). See also Pregnancy and reproductive function in
Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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For liposomal formulation,
manufacturer advises caution. For solution for injection or
infusion, manufacturer advises caution in mild to moderate
impairment; avoid in severe impairment.
Dose adjustments Manufacturer advises dose reduction
according to bilirubin concentration.
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Consult product literature in severe
impairment.
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Patients should be assessed
before treatment, by echocardiography. Cardiac
monitoring during treatment may assist in determining
safe dosage.
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