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DOXOrubicin

( Docs-oh-RUBE-i-sin )
Other Name(s): Adriamycin®
Appearance: Red solution

Medication Information Sheet
DOXOrubicin (Docs-oh-RUBE-i-sin)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Adriamycin®

Appearance:
Red solution

What is this medication for?
  • For treating leukemia, lymphoma, cancers of the breast, bladder, uterus and other cancers.
What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s), such as: 
    • heart problems (including irregular heartbeat)
       
    • liver problems
       
    • have received prior chemotherapy and/or radiation treatment
       
    • any allergies especially to doxorubicin or related drugs (e.g. epirubicin and others)
How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding.
     
  • If there is any chance that you or your partner may become pregnant, you and your partner together must: 
    • ► Use 2 effective forms of birth control at the same time while taking this drug. Do not use hormone-based birth control (e.g. pills, vaginal rings) if you have breast cancer. Keep using birth control methods for at least 6 months after your last dose (general recommendation). Talk to your healthcare team to figure out the best method(s) for you and/or your partner.
       
  • Do not breastfeed while using this drug.
     
  • This medication may affect fertility (ability to get pregnant)
How is this medication given?
  • This drug is given by injection into a vein.
     
  • Talk to your health care team about your treatment schedule.
     
  • If you missed your treatment appointment, talk to your health care team to find out what to do.
What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain or fever:

    • If you feel unwell, take your temperature before taking any medications for pain or fever. They may hide a fever. 
       
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
       
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding. Talk to your health care team before you start or stop these medications.
       
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

  • Your skin may be more sensitive to the sun.  You can have an itchy rash and other skin reactions when you are exposed to the sun.  When you are in the sun, wear long sleeved shirts, long pants and a hat to protect yourself.  Apply sunscreen with UVA and UVB protection and an SPF of at least 30.
     
  • It is normal for your urine (pee) to be red for up to 2 days after your doxorubicin treatment.  Tell your health care team is your pee stays red for more than 2 days.
What are the side effects of this medication?

You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to do When to contact health care team
Very Common Side Effects (in 50 or more out of 100 people)

Hair thinning or loss 

  • Use a gentle soft brush and avoid hair sprays, bleaches, dyes and perms.
  • In most cases, your hair will grow back after treatment, but the texture or colour may change. 
Talk to your health care team if this bothers you

Unusual bruising or bleeding (may be severe)

  • Watch for bleeding (such as unusual nosebleeds or bleeding from the gums) or bruising easily (this is rare).
  • Very rarely, severe symptoms can happen. If you notice black coloured stools (poo), red or pink coloured urine (pee), red or brown coloured mucus when you cough, severe headache/confusion or bleeding that will not stop, you need to talk to your health care team or go to the nearest emergency room right away.

See the Low Platelet Count pamphlet for more information.

Fever, chills, infection (may be severe)

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (or 100.4°F) or higher for at least one hour.

While you are getting treatment:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often to prevent infection.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.

 


If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

 

Get emergency medical help right away

Nausea and vomiting (may be severe)

May occur in hours to days after your treatment. It is easier to prevent nausea than to treat it if it happens. 

To help prevent nausea:

  • Take anti-nausea medication(s) as prescribed to you by your doctor.
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours

Mouth sores (may be severe)

You may have round, painful, white or gray sores inside your mouth. They can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard swallow, eat or to brush your teeth. They usually last 1 to 2 weeks.

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often. Do not use mouthwashes with alcohol.
  • Instead, try a homemade mouthwash:
  • Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.

If you have mouth sores:

  • Check with your health care team as soon as you notice mouth or lip sores or if it hurts to swallow.
  • Avoid hot, spicy, acidic, hard or crunchy foods.  Your doctor may prescribe a mouthwash to relieve mouth sores and prevent infection.

See the Mouth Care pamphlet for more information.

Talk to your health care team as soon as possible

 

Side effects and what to do When to contact health care team
Common Side Effects (in 25 to 49 out of 100 people)

Low appetite

  • You may not feel like eating or you may lose weight.
  • Try to eat foods that you like and eat small meals throughout the day. 
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your health care team if you have a low appetite.
  • See our Loss of appetite pamphlet for more information.
Talk to your health care team if no improvement or if severe

 

Side effects and what to do When to contact health care team
Less Common Side Effects (in 10 to 24 out of 100 people)

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

Talk to your health care team if no improvement or if severe

Reactions at the injection site 

What to look for?

  • Your skin may become red, itchy, bruised, and/or swollen where the injection was given.
  • Site reactions are usually mild and go away within one to three days.

What to do?

  • Tell your nurse right away if there is any burning, stinging or other pain while doxorubicin is being injected into your vein.
  • You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction in your treatment.
  • Talk to your health care team to find out which treatment is right for you.
Talk to your health care team as soon as possible

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • Irregular heartbeat, shortness of breath, fainting spells or swelling in your legs or belly
  • Pain in your chest, belly or arm
  • Pain, swelling or hardening of a vein in your arm or leg
  • Difficulty breathing or coughing up blood
  • Severe rash, itchiness, flushing, dizziness, chest or throat tightness (during or shortly after doxorubicin is given)
  • Lower back pain, body swelling, peeing less than usual and unusual weight gain
  • Muscle twitching, severe weakness or cramping, feeling confused or restless
  • Yellowish skin or eyes, unusually dark pee or pain on the right side of your belly.
  • Redness/rash in areas where you’ve previously received radiation

Talk to your health care team about your risk of getting other cancers after this treatment. 
 

Who do I contact if I have questions or need help?           

My cancer health care provider is: ________________________________________________

During the day I should contact:__________________________________________________

Evenings, weekends and holidays:________________________________________________

 

Other Notes:

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For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.