Doxorubicin

Doxorubicin is a chemotherapy drug. One way that it works is by blocking an enzyme called topo isomerase 2 that cancer cells need in order to divide and grow.

Doctors use doxorubicin to treat many types of cancer, including breast cancer, ovarian cancer, and bladder cancer, as well as non Hodgkin's lymphoma, Hodgkin’s lymphoma and sarcoma.

You have doxorubicin into your bloodstream. It is a red liquid. 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 just before your course of treatment starts and it stays in place as long as you need it.

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. There is detailed information about the way doctors plan chemotherapy in the planning 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 cancer drug side effects section or use the search box at the top of any page.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre 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 (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick – it may be severe and can 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 not harmful
• 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
• Very rarely, you may get sore eyes 
• Women may stop having periods (amenorrhoea) but 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 having a baby is important to you
• Doxorubicin may have a harmful effect on a developing baby – discuss contraception with your doctor or nurse before you start your treatment if there is any possibility that you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of these.

• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
• 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 – 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
• Nails may become darker and white lines may appear on them
• A high temperature (fever) and chills

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

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may get more side effects 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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give 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.

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.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines 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.

It is 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 not many people in the UK have oral vaccines 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.