This page tells you about the drug doxorubicin (Adriamycin) and its possible side effects. There is information about
Doxorubicin is a type of chemotherapy drug called an anthracycline. It slows or stops the growth of cancer cells. One way that doxorubicin works is by blocking an enzyme called topo isomerase 2 that cancer cells need to divide and grow.
Doxorubicin may be used in combination with other chemotherapy drugs.
You have doxorubicin into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having cancer drugs.
You usually have chemotherapy as a course of several cycles of treatment. The number of cycles you have depends on your treatment plan. The treatment plan for doxorubicin depends on which type of cancer you have.
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.
You have blood tests before treatment and regularly during your treatment. The tests check how well your bone marrow, liver, heart and kidneys are working.
We've listed the side effects associated with doxorubicin. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They 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)
The side effects may be different if you are having doxorubicin with other medicines.
Tell your doctor, nurse or pharmacist straight away if any of the side effects get severe.
Doxorubicin treatment into the bladder tends not to cause side effects, except for some soreness and irritation of the bladder.
More than 10 in every 100 people have one or more of the side effects listed below.
- Feeling or being sick may be severe and can begin a few hours after treatment and last for a few days. It is usually possible to control sickness with anti sickness injections and tablets. If you are still being sick, tell your doctor or nurse and don't operate machinery or drive
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- 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 grows 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 whether this is advisable 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 won't harm you
- 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. Remember to cover up or use sun block on exposed skin
- Watery eyes occur in about 1 in 4 people (25%) and may last for several days after the beginning of each treatment
- Women may stop having periods (amenorrhoea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child 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 may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these.
- An 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, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- 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, 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)
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your nurse straight away
- An allergic reaction occurs in 3 people in 100 (3%) – you may feel dizzy, hot, and breathless and have a sudden rash of pink, itchy bumps on your skin and reddening of the skin along the veins, which should clear up within a few days. Let your doctor or nurse know straight away if you have this
- Reddening of the skin in areas where you have had radiotherapy in the past – the skin may get dry, flaky and sore. This effect 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
- High uric acid levels in your blood due to cancer cells being broken down by the body – you will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctor or nurse may give you medicines to control this
- Nails may become darker and white lines may appear on them
- A high temperature (fever) and chills
Fewer than 1 in 100 people have these effects.
- An increased risk of a second cancer some years later if you have a high dose of doxorubicin or many doxorubicin treatments
- Sore eyes
- Inflammation of a vein in the leg – let your doctor or nurse know if you have a sore, red, swollen area on your leg
- Bleeding into the stomach or bowel – let your doctor or nurse know straight away if you vomit blood or have blood in your stools
- Tummy pain
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Other medicines or treatments
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
If you have had radiotherapy
Tell your doctor if you have had radiotherapy treatment to the upper part of your body. This could increase the risk of heart damage from doxorubicin and your doctor will need to take this into account.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You shouldn't 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, yellow fever and Zostavax (shingles vaccine).
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 safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at
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