Doxorubicin

• What doxorubicin is
• How you have treatment
• Common side effects
• Occasional side effects
• High dose side effects
• Important points to remember
• Immunisations and chemotherapy

Doxorubicin is used to treat many types of cancer, including breast cancer, ovarian cancer, and bladder cancer, as well as non-Hodgkin's lymphoma, Hodgkin’s disease and sarcoma.

One way in which doxorubicin works is by binding to the cancer cells’ DNA (the genetic code) and blocking an important enzyme (called topo-isomerase II). This makes the DNA get tangled up and the cancer cells cannot divide and grow.

Doxorubicin is a red liquid that you have as an injection or drip into a vein (intravenously) through a central line, a PICC line or a cannula.

Chemotherapy is often given as a course of several cycles of treatment. The treatment plan for doxorubicin depends on which cancer you have. There is detailed information about planning chemotherapy treatment in our chemotherapy section.

The side effects associated with doxorubicin are listed below. You can use the links to find out more about each side effect. Where there is no link, please look in the chemotherapy side effects section or use the search box at the top of any page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick may be severe - it may begin a few hours after treatment and last for a few days. It is usually possible to control this side effect with anti-sickness injections and tablets. If you are still being sick, tell your doctor or nurse
• Hair loss occurs in almost everyone who has doxorubicin and usually includes all head and body hair. It usually begins 2 to 5 weeks after the treatment starts but will grow back once the treatment ends. A cold cap may help to stop your hair falling out but you need to talk to your doctor about how advisable this is with your type of cancer.
• A sore mouth and throat may happen about 5 days after each treatment and may last for a couple of weeks - you may have mouth ulcers and red sore skin in your mouth
• Your urine may become a pink or red colour for one or two days after treatment - this is nothing to worry about
• Black or brown lines may appear in the creases of your skin - this is particularly common in children
• Sensitivity to sunlight - don’t sit out in the sun, and cover up or use sun block on exposed skin
• Watery eyes occur in about 1 in 4 people and may last for several days after the beginning of each treatment
• Very rarely, you may get sore eyes (conjunctivitis)
• Women may stop having periods (amenorrhoea). This may be temporary
• Loss of fertility - we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you.
• Doxorubicin may have a harmful effect on a developing baby - discuss contraception with your doctor before you start your treatment if there is any possibility that you or your partner could become pregnant

Some people have one or more of the following side effects

• Inflammation around the drip site - if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• An allergic reaction occurs in 3 people in 100 (3%) - you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which should clear up within a few days
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot - this goes away on its own but keep affected areas out of the sun
• Damage to heart muscle, which is usually temporary but for a small number of people may be permanent - your doctor will check your heart before and after your treatment
• Diarrhoea - drink plenty of fluids and if it becomes severe or continues tell your doctor or nurse, as you could get dehydrated
• Loss of appetite
• Nails may become darker and white lines may appear on them
• Fever and chills

If you have a high dose, or many treatments, of doxorubicin there is a small risk that you may get a second cancer some years later.

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.