Adriamycin Solution

Drugs

Generic Name: Doxorubicin hydrochloride
Product Name: Adriamycin Solution

Indication of Adriamycin Solution
Action of Adriamycin Solution
Dose Advice of Adriamycin Solution
Schedule of Adriamycin Solution
Common side effects of Adriamycin Solution
Uncommon side effects of Adriamycin Solution

Indication of Adriamycin Solution:

Adriamycin Solution is used to produce regression in a number of neoplastic conditions such as:
- Acute leukaemia.
- Wilmis tumour.
- Neuroblastoma.
- Soft tissue sarcomas.
- Breast carcinoma.
- Hodgkin's and non-hodgkin's lymphoma.
- Bronchogenic carcinoma.
- Thyroid carcinoma.
- Hepatoma.
- Ovarian carcinoma.

Other cancers that have been found to have some response include:

- Stomach cancer.
- Cervical cancer.
- Head and neck.
- Testicular cancer.
- Myeloma.
- Endometrial cancer.

Adriamycin Solution can also be used in the management of non-metastatic carcinoma of the bladder, where it is administered intravesically.

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Action of Adriamycin Solution:

Doxorubicin is from the family of chemotherapy drugs known as anthracyclines. Anthracyclines act directly on DNA, blocking its production and inhibiting the enzyme responsible for DNA repair. Cells do not have to be actively dividing to be affected by Doxorubicin, as is the case with some chemotherapy drugs. Doxorubicin also suppresses the immune system.

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Dose Advice of Adriamycin Solution:

Adriamycin Solution should be administered with care to reduce the chance of perivenous infiltration.
The recommended dosage regime is:
- 60-75mg/m2 body surface area.
- Dose should be administered as a single intravenous injection at 21 day intervals.

Alternative dosing regime:
- 25-30mg/m2 on three successive days.
- Repeat every 3-4 weeks.
Recommended cumulative lifetime dose is 550mg/m2.

Administration:
Adriamycin Solution can be slowly administered into the tubing of a freely running sodium chloride infusion. The dose should be administered over not less than 3-5 minutes.
A burning or stinging sensation is indicative of extravasation and requires immediate cessation of injection.

Intravesical administration:
- Catheterise and empty bladder.
- Add 80mg Doxorubicin to normal saline to achieve a final volume of 100ml.
- Instil via catheter into bladder.
- Patient should be instructed to lie on one side, then alternate sides every 15 minutes.
- Bladder should be emptied after 1 hour.
- Repeat procedure monthly.

Children:
- Adult dosage regimes may be appropriate for children.
- Children should be periodically monitored for evidence of cardiac toxicity after cessation of treatment.

Hepatic impairment:
- Dosage adjustment should be made depending on serum bilirubin levels and bromsulfophthalein (BSP) retention.
- If bilirubin is 20-50micromol/L and BSP is 9-15%: give half the normal dose.
- If bilirubin is over 50micromol/L and BSP is over 15%: give one quarter of the normal dose.

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Schedule of Adriamycin Solution:

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Common side effects of Adriamycin Solution:

Cardiotoxicity, manifesting as cardiomyopathy or cardiac failure may occur during or up to years after therapy.
Extravasation (escape of Adriamycin Solution from vein into surrounding tissue) may result in skin death, severe inflammation and ulcers.

Other side effects that may occur include:
- Hair loss.
- Nausea and vomiting.
- Mucositis (inflammation of mouth and oesophagus).
- Diarrhoea.
- Dehydration.
- Reduction in white blood cell numbers, which can increase infection risk.
- Red discolouration of urine.

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Uncommon side effects of Adriamycin Solution:

- Rash.
- Darkening of nail beds, soles and palmar creases.
- Recurrence of skin reaction from previous radiotherapy.
- Chills and fever.
- Generalised muscle weakness.
- Loss of appetite.
- Allergic reactions.
- Decreased platelets, which increases bleeding risk.
- Drowsiness.
- Conjunctivitis.
- Kidney damage.
- Bleeding from inside surface of large intestine.
- Cessation of periods/decreased sperm production (temporary).

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