Doxorubicin

Doxorubicin is a type of chemotherapy. It is also known as Adriamycin.  

You pronounce it docs-oh-roo-bi-sin.

It is a treatment for a number of different cancer types. You might have doxorubicin in combination with other cancer drugs.

How does doxorubicin work?

Doxorubicin is a type of chemotherapy drug called an anthracycline. It slows or stops the growth of cancer cells by blocking an enzyme called topo isomerase 2. Cancer cells need this enzyme to divide and grow.

How do you have doxorubicin?

You usually have doxorubicin into your bloodstream (intravenously).

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Directly into the bladder

Sometimes, doxorubicin may be given directly into the bladder to treat cancer of the bladder lining. This is called intravesical chemotherapy and the side effects are different to doxorubicin given into a vein.

How often do you have doxorubicin?

You usually have this type of chemotherapy as a course of several cycles of treatment . The number of cycles you have depends on your treatment plan.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You also have heart tests such as an ECHO, ECG or both before treatment. You may continue to have heart tests during and after treatment with doxorubicin.

What are the side effects of doxorubicin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Sore mouth

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Skin changes

Doxorubicin can cause the skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Less commonly doxorubicin can cause a rash, itching or you may have areas that appear darker than usual.

Let you healthcare team know of any skin changes that develop. They might be able to prescribe medicine to help or give advice on what creams to use to look after your skin.

Your skin might also be more sensitive to sunlight causing a reaction. It’s not known how often this happens but it’s important to protect your skin. The best way is to find shade, cover up your skin and wear sunscreen.

Heart changes 

It’s very common with doxorubicin to have changes to the heart muscle or rhythm that are picked up on an ECHO, ECG or both. Less commonly doxorubicin can cause damage to the heart muscle. Rarely this can cause heart failure.

You have heart tests to check how well your heart is working before you start treatment. You may also have them during and after treatment.

Heart changes can happen during treatment or some months and years after you have finished treatment.

Symptoms of heart changes can include shortness of breath; ankle swelling; chest pain; fast beating; fluttering or pounding heart.

It’s important to speak with your healthcare team or in an emergency dial 999 about any symptoms you develop.

Liver changes 

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your healthcare team if you are finding it difficult to control your weight. 

This is common with people having treatment for early breast cancer.

Red or pink urine

You might have red or pink urine. This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Nail changes

Your nails may become darker during treatment. They might also be painful, become loose and come off.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• a serious reaction to an infection also known as sepsis. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms

• eye infection (conjunctivitis) – your eye may feel gritty, itchy, sticky from pus, watery and look red

• tummy (abdominal) pain

• inflammation of your throat and food pipe, symptoms might include finding it difficult or painful to swallow, heartburn or you may feel as though something is stuck in your throat

• inflammation around the drip site

Rare side effects

Rarely doxorubicin can cause a blockage in the bloodstream. This is called an embolism. This might be because of a blood clot or air bubble. The symptoms vary depending on the type of embolism. Symptoms might include signs of pain, swelling and redness where the embolism is. Feeling breathless can be a sign of a blood clot on the lung.

An embolism can be life threatening, dial 999 or contact your advice line or doctor straight away if you have any of these symptoms

This side effect can happen in fewer than 1 in 100 people (fewer than 1%).

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have:

• a second cancer called acute leukaemia
• high uric acid levels in your wee - due to the breakdown of cancer cells (you might have medicines to prevent this)
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening, alert your nurse or doctor if notice any of these symptoms
• loss of body fluid (dehydration)
• other eye problems such as changes to your vision and sensitivity to the light
• episodes of feeling warm and reddening of the skin (hot flushes)
• generally feeling unwell
• unexpected bleeding, such as blood in your poo, vaginal bleeding, or coughing up blood. Or if you have any other unusual bleeding. Contact your healthcare team straight away
• doxorubicin leaking in into the body tissues. This can cause severe damage. If you feel any burning or stinging around the drip let your doctor or nurse know straight away

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 7 months after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

If you have had radiotherapy

Tell your doctor if you have had radiotherapy treatment to your chest that might have been near to or involving your heart. This could increase the risk of heart damage from doxorubicin and your doctor will need to take this into account.

Rarely you might have skin changes in an area where you have had radiotherapy. Talk to your team about this. 

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.