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Doxorubicin Hydrochloride: Brands, Price & Uses in Bangladesh
Established / FDA-Approved Uses Doxorubicin Hydrochloride injection is a cytotoxic anthracycline antibiotic indicated, usually as part of combination chemotherapy regimens and more.
About Doxorubicin Hydrochloride
Indications of Doxorubicin Hydrochloride
Established / FDA-Approved Uses
Doxorubicin Hydrochloride injection is a cytotoxic anthracycline antibiotic indicated, usually as part of combination chemotherapy regimens, in the treatment of:
- Acute lymphoblastic leukemia (ALL)
- Acute myeloblastic leukemia (AML)
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Wilms' tumor
- Neuroblastoma
- Soft tissue sarcoma and osteosarcoma
- Breast carcinoma
- Ovarian carcinoma
- Transitional cell bladder carcinoma
- Thyroid carcinoma
- Gastric carcinoma
- Bronchogenic carcinoma (certain types)
Guideline-Supported / Combination Regimen Use
Doxorubicin Hydrochloride is a core component of many standard multi-drug protocols (for example ABVD for Hodgkin lymphoma, CHOP for non-Hodgkin lymphoma, and AC/EC regimens for early and advanced breast cancer). In these settings it is used together with other cytotoxic agents rather than as monotherapy.
Off-Label Use
Doxorubicin Hydrochloride is sometimes used off-label, at the discretion of the treating oncologist, in other soft-tissue and rare tumor types where anthracycline-based chemotherapy is considered beneficial. Such use should only occur under specialist oncology supervision.
Dosage & Administration of Doxorubicin Hydrochloride
General Principles
Doxorubicin Hydrochloride must be prescribed and administered only under the supervision of a physician experienced in cytotoxic chemotherapy. Dose is calculated based on body surface area (BSA) and adjusted according to protocol, hematologic status, hepatic function, and cumulative lifetime dose already received.
Typical Adult Dosing by Regimen
| Regimen | Typical Dose |
|---|---|
| Single-agent | 60–75 mg/m² IV as a single dose every 21 days |
| Combination therapy | 40–60 mg/m² IV every 21–28 days, or 20–30 mg/m² on days 1–3 every 3–4 weeks, per specific protocol |
| Weekly schedule | 20 mg/m² IV once weekly (used in select regimens) |
Pediatric Dosing
Dosing in children is protocol-specific and based on body surface area (or body weight in infants), following recognized pediatric oncology treatment protocols (e.g., for acute leukemias, Wilms' tumor, neuroblastoma, and sarcomas). Cardiac monitoring is especially important given lifelong cumulative dose exposure starting at a young age.
Cumulative Dose Limit
Total cumulative lifetime dose should generally not exceed 550 mg/m² (or 450 mg/m² in patients who have received prior mediastinal/chest irradiation or concomitant potentially cardiotoxic therapy such as cyclophosphamide or trastuzumab), because of the sharply rising risk of irreversible cardiomyopathy beyond this threshold.
Hepatic Impairment Dose Adjustment
| Serum Bilirubin | Dose Reduction |
|---|---|
| 1.2–3 mg/dL | Reduce dose by 50% |
| >3 mg/dL | Reduce dose by 75% |
Administration
Doxorubicin Hydrochloride is given by slow intravenous injection into the tubing of a freely running IV infusion, or as a short IV infusion, over several minutes. It must never be given intramuscularly or subcutaneously. Extreme care must be taken to confirm a fully patent IV line, since extravasation causes severe local tissue necrosis (see Precautions and Warnings).
Side Effects of Doxorubicin Hydrochloride
Very Common
- Myelosuppression (leukopenia, neutropenia, thrombocytopenia, anemia) — usually dose-limiting
- Alopecia (hair loss), often complete but reversible after treatment
- Nausea and vomiting
- Mucositis / stomatitis
- Red-orange discoloration of urine for 1–2 days after dosing (harmless)
Common
- Fatigue, anorexia, diarrhea
- Skin hyperpigmentation, nail changes
Serious (see also Precautions and Warnings)
- Cumulative, dose-dependent cardiotoxicity, including arrhythmias and delayed, potentially irreversible cardiomyopathy/heart failure
- Severe local tissue necrosis if extravasation occurs during administration
- Secondary malignancies, including secondary acute myeloid leukemia
- Severe infection due to neutropenia
- Tumor lysis syndrome in patients with large tumor burden
Contraindications of Doxorubicin Hydrochloride
Doxorubicin Hydrochloride is contraindicated in patients with:
- Known hypersensitivity to Doxorubicin Hydrochloride or other anthracyclines.
- Severe myocardial insufficiency or severe pre-existing cardiac disease.
- Recent myocardial infarction.
- Severe cardiac arrhythmias.
- Prior treatment with maximum cumulative doses of Doxorubicin Hydrochloride or other anthracyclines/anthracenediones.
- Severe hepatic impairment.
- Persistent, severe myelosuppression from prior cytotoxic therapy or radiotherapy.
Frequently Asked Questions about Doxorubicin Hydrochloride
What is Doxorubicin Hydrochloride used for?
Doxorubicin Hydrochloride is a chemotherapy medicine used, usually in combination with other anticancer drugs, to treat cancers such as leukemias, lymphomas, sarcomas, and breast, ovarian, bladder, and other cancers.
How is Doxorubicin Hydrochloride given?
Doxorubicin Hydrochloride is given only by intravenous injection or infusion by trained healthcare staff, into a securely running IV line. It is never given by mouth, into a muscle, or under the skin.
What is the most serious risk with Doxorubicin Hydrochloride?
The most serious risks are heart damage (cardiotoxicity) that is related to the total lifetime dose received and can appear months or years later, and severe drops in blood cell counts that increase the risk of infection and bleeding. Your doctor will monitor your heart function and blood counts before and during treatment.
Can Doxorubicin Hydrochloride be used during pregnancy or breastfeeding?
Doxorubicin Hydrochloride should not be used during pregnancy unless your doctor decides the benefit clearly outweighs the risk to the baby, because it can cause fetal harm. Breastfeeding should be stopped before starting Doxorubicin Hydrochloride and should not restart without your doctor's advice.
Why does my urine turn red-orange after treatment?
Doxorubicin Hydrochloride and its metabolites are excreted in urine, which can cause a harmless red-orange discoloration for one to two days after each dose. This is expected and not a cause for concern.
What should I do if I think a dose was too high or there was an overdose?
An overdose or suspected overdose of Doxorubicin Hydrochloride is a medical emergency. Seek immediate medical attention or contact emergency services, as it can cause severe drops in blood counts and serious heart problems that require hospital care.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.