Doxorubicin Injection

Doxorubicin, an anthracycline antibiotic, has long been a key component in cancer treatment. Known for its anti-cancer properties, this potent compound is used to fight various types of cancerous tumors.

Doxorubicin was first developed in the 1960s by scientists using natural materials. The FDA approved it in the 1970s, and its inclusion in treatment plans represented a progression in cancer care methods.

Doxorubicin plays a role in cancer treatment due to its effectiveness against a wide range of cancer types. By inserting itself between DNA strands, it hinders the ability of cancer cells to grow rapidly, ultimately slowing down tumor progression.

Doxorubicin's structure stands out due to its anthraquinone core connected to an amino sugar, making it very responsive to acids. Usually, it is prepared as a hydrochloride salt to improve its solubility and durability in formulations.

Doxorubicins chemical stability and tendency to generate radicals are fundamental to how it works but they also require careful handling. This substance is easily recognizable by its red hue, especially when dissolved.

Doxorubicin disrupts the processes of DNA replication and transcription by inserting itself between DNA bases. This disruption plays a role in its ability to target and destroy rapidly dividing cancer cells.

Besides DNA intercalation, Doxorubicin triggers stress in the cell, causing apoptosis. This controlled cell demise is crucial, for eliminating cancer cells. Serves as a key method by which Doxorubicin delivers its healing benefits.

• Lymphomas are usually treated with doses ranging from 25 to 75 mg/m².
• For leukemia the dosage can vary depending on the protocol typically falling between 30 to 60 mg/m².
• Solid tumors receive doses between 60 to 75 mg/m² adjusted based on the type and stage of cancer.

Doxorubicin is given through an IV to quickly spread throughout the bloodstream and reach its therapeutic potential.

The course of treatment for Doxorubicin, may span across cycles, usually given once every 21 to 28 days, to help cells recover and minimize negative impacts.

1. Breast Cancer: Doxorubicin is employed in the treatment of breast cancer¹[1]²[2]³3.

2. Bladder Cancer: It is effective against bladder cancer³3.

3. Lung Cancer: Doxorubicin is used for lung cancer treatment³3.

4. Ovarian Cancer: It plays a role in managing ovarian cancer³3.

5. Stomach Cancer: Doxorubicin is indicated for stomach cancer³3.

6. Thyroid Cancer: It is used in the treatment of thyroid cancer¹[1]³3.

7. Lymphomas:

   • Hodgkin Lymphoma: Doxorubicin is effective against Hodgkin lymphoma¹1.
   • Non-Hodgkin Lymphoma: It is also used for non-Hodgkin lymphoma¹[1]²[2]³3.

8. Leukemia:

   • Acute Lymphoblastic Leukemia (ALL): Doxorubicin is approved for treating ALL²2.
   • Acute Myeloid Leukemia (AML): It is also used in the management of AML²2.

9. Soft Tissues and Bones:

   • Doxorubicin is effective against cancers affecting soft tissues, including muscles and tendons, as well as bones⁴4.

1. Uterine Sarcoma:
   • Off-label use: Intravenous administration of 60 mg/m² on day 1 every 21 days (maximum cumulative dose: 480 mg/m²)¹1.
   • Alternatively, a dose of 50 mg/m² over 15 minutes on day 1 every 21 days (maximum cumulative dose: 450 mg/m²) in combination with ifosfamide/mesna¹1.

Patients often encounter feelings of nausea, throwing up, and hair loss. These symptoms are usually temporary. It can be handled with proper care and support.

Dealing with long-term heart damage continues to be a hurdle, calling for constant monitoring and proactive measures.

To provide care, it involves the preventive use of anti-nausea medications, routine heart assessments, and educating patients on how to manage symptoms.

Prolonged Doxorubicin usage may result in heart issues showing up as either cardiomyopathy or congestive heart failure. It's crucial to detect these problems by regularly conducting echocardiograms.

One uncommon but significant outcome is the chance of developing cancers, like acute myeloid leukemia, which poses a contradictory risk linked to this lifesaving treatment.

Doxorubicin is recognized for its ability to interact with other drugs, affecting how well they work and potentially increasing harmful side effects. Importantly, when used alongside medications that can harm the liver, Doxorubicin's removal from the body may be slowed down, making its toxic effects more severe. When taken together with drugs that protect the heart, such as dexrazoxane, it may help reduce related risks.

Interactions can greatly influence the way Doxorubicin behaves in the body. For example, enzymes in the liver called CYP450 play a role in breaking down Doxorubicin. Therefore, medications that either slow down or speed up these enzymes can lead to a decrease or increase in Doxorubicin levels. This requires monitoring and adjustments to the dosage accordingly.

Patients who are prescribed Doxorubicin need to be watched for any indications of decreased bone marrow function, heart related issues and liver damage. It is advisable to conduct heart evaluations as there is a potential risk of developing cardiomyopathy that varies with the dosage administered.

Patients with heart problems, recent heart attacks, severe liver issues, and persistent low blood cell counts from past treatments should avoid using Doxorubicin.

It is important to be careful with patients who have existing liver or kidney issues, as these conditions can affect how Doxorubicin works in the body. Adjusting the dosage may be necessary to prevent any effects.

Because of its toxicity, it is crucial to treat Doxorubicin with great care. Healthcare professionals need to wear gloves and eyewear to avoid skin or mucous membrane contact. It is also important to follow procedures for preparation and disposal to avoid accidental exposure.

Facilities need to make sure they dispose of Doxorubicin and any items that have come into contact with the drug correctly to prevent risks. Adhering to specific disposal procedures to reduce environmental pollution is important.

Elderly individuals might show sensitivity to Doxorubicin, requiring careful adjustments in dosage and close monitoring, for potential toxicity, especially concerning heart problems and decreased bone marrow function.

Doxorubicin falls under pregnancy category D, suggesting harm to the fetus. Pregnant individuals should only use Doxorubicin when absolutely necessary and should be informed about the possible risks to the fetus. It is recommended that breastfeeding mothers stop nursing, as Doxorubicin is excreted in breast milk.

In the field of oncology, when Doxorubicin is administered to children, there is greater concern for potential delayed heart-related side effects. It is crucial to conduct heart evaluations and adjust medication doses based on the child's body surface area to ensure both safety and effectiveness.

An acute overdose can lead to suppression of bone marrow function, heart-related issues, and inflammation of the mucous membranes. Individuals might display a range of symptoms, from a decrease in white blood cell count to irregular heartbeats and difficulties with heart function.

In case of an overdose, it is essential to act. Treatment options involve giving growth factors for bone marrow suppression and taking specific actions to address heart-related issues, such as using medications to protect the heart.

To maintain its effectiveness, store doxorubicin in a dry place at room temperature away from light and moisture. Due to its delicate nature, keep the drug in its packaging until ready for use.

When Doxorubicin is kept in storage conditions, it retains its effectiveness for the specified period indicated on the packaging. Typically, its shelf life ranges from one to two years, varying based on the formulation and how it is stored.