Doxorubicin, Injection

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KEY POINTS

• This medicine is given by IV to treat many kinds of cancer, leukemia, or lymphomas.
• You may get infections more easily when you are taking this medicine. This medicine may cause certain severe blood and bone marrow problems that affect your body's ability to stop bleeding or fight infection.
• This medicine may cause serious or life-threatening heart problems during treatment or months to years after stopping treatment. This medicine may also cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Keep all appointments for tests to see how this medicine affects you.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antineoplastic (anticancer); chemotherapy

Generic and brand names: doxorubicin, injection

What is this medicine used for?

This medicine is given by IV infusion (slow drip through a needle into a large vein) to treat:

• AIDS-related Kaposi's sarcoma
• Acute lymphocytic leukemia
• Acute myeloid leukemia (AML)
• Bladder cancer
• Bone cancer
• Breast cancer
• Hodgkin's and non-Hodgkin's lymphomas
• Lung cancer
• Neuroblastoma
• Soft tissue cancer
• Stomach cancer
• Thyroid cancer
• Wilms tumor
• Ovarian cancer

It may be used alone or with other anticancer medicines.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Gout
• Heart problems
• Kidney or liver disease
• Previous doxorubicin, daunorubicin, epirubicin, idarubicin or radiation (X-ray) therapy

Tell your healthcare provider if you have any signs of infection such as cough, shortness of breath, sore throat, fever, chills, or mouth sores before starting this medicine.

This medicine may make you sterile (unable to have children) whether you are a man or a woman. If you plan to have children someday, talk with your healthcare provider before you start treatment.

Females of childbearing age: This medicine is not usually given to pregnant women because it can harm the baby. If you are pregnant, tell your healthcare provider. Do not become pregnant while you are receiving this medicine because it may harm the baby. Use an effective birth control method while you are taking this medicine and for 6 months after stopping it. Talk to your healthcare provider if you need birth control. Contact your healthcare provider at the first sign of pregnancy. Do not breast-feed while receiving this medicine.

Males: This medicine may damage your sperm. Use condoms or other effective birth control during treatment with this medicine and for 6 months after stopping it.

How do I use it?

This medicine is given by IV infusion (slow drip through a needle into a large vein) by healthcare providers experienced in providing chemotherapy. You will receive this medicine where you can be carefully monitored.

If this medicine leaks from your veins into nearby tissue, it may cause severe redness, pain, swelling, or blisters. Alert your healthcare provider right away if you have pain during treatment.

You may need several treatments with this medicine. Blood and bone marrow tests are used to determine how many courses of treatment you will need.

What should I watch out for?

You will need to have blood and bone marrow tests regularly to see how this medicine affects you. Keep all appointments for tests.

This medicine may cause serious or life-threatening heart problems during treatment or months to years after stopping treatment. These heart problems may be permanent. Your risk may be higher if you:

• Already have heart problems
• Have had radiation therapy to your chest
• Have received certain other anticancer medicines
• Take other medicines that can also cause heart problems

Your healthcare provider will monitor your heart before, during, and after treatment. Contact your healthcare provider right away if you have any symptoms of heart problems.

If you develop a fever or other signs of infection, or have any unusual bruising or bleeding, contact your healthcare provider right away. This medicine may cause certain severe blood and bone marrow problems. This can affect your body's ability to stop bleeding or fight infection. You may get infections more easily when you are taking this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your healthcare provider's approval first. To decrease your risk of bruising or bleeding, use a soft brush to brush your teeth. Be careful while shaving, cutting fingernails or toenails, or when using sharp objects. Avoid sports and activities that may cause injuries.

This medicine may increase your long-term risk of developing other blood cancers. Talk with your healthcare provider about this.

This medicine may cause your urine to turn a red color for up to 2 days and your clothing might be stained. This is temporary and is not harmful.

If your child is receiving this medicine, wear latex gloves when changing diapers to prevent contact with the child's urine or feces for at least 5 days after the last dose or as instructed by your healthcare provider.

Females: This medicine may cause you to stop having periods. Talk with your healthcare provider about this.

Hair loss is common during treatment with this medicine. Your hair will grow back when treatment is stopped. Nausea and vomiting are also common during treatment. Contact your healthcare provider if these become severe.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you have received this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Redness, swelling or pain at the injection site; irregular, fast, or slow heart rate; chest pain or shortness of breath that continues; cough; fever; sore throat; burning or pain with urination; unusual bruising or bleeding; swelling, tingling, or numbness in your hands, legs, or feet; unusual tiredness or weakness; yellowing of the skin and eyes; black, bloody, or tarry bowel movements; severe stomach pain; severe or continued nausea, vomiting, or diarrhea; severe mouth sores. Most serious side effects are found through lab tests.

Other: Loss of appetite, hair loss, headache, constipation, diarrhea, nausea, vomiting, watery eyes, facial flushing, darkening of your nails or skin.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Antiarrhythmic medicines (to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), dronedarone (Multaq), Ibutilide (Corvert), and quinidine
• Antibiotics such as azithromycin (Zithromax, Zmax), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), gemifloxacin (Factive), isoniazid, levofloxacin (Levaquin), rifabutin (Mycobutin), rifampin (Rifadin), rifapentine (Priftin), and telithromycin (Ketek)
• Antidepressants such as clomipramine (Anafranil), desipramine (Norpramin), duloxetine (Cymbalta), fluoxetine (Prozac), imipramine (Tofranil), nefazodone, and sertraline (Zoloft)
• Antifungal medicines such as amphotericin b (Abelcet, AmBisome, Amphotec), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), terbinafine (Lamisil), and voriconazole (Vfend)
• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), haloperidol, iloperidone (Fanapt), paliperidone (Invega), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), clobazam (Onfi), phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline)
• Antiviral medicines such as ledipasvir/sofosbuvir (Harvoni) and simeprevir (Olysio)
• Aprepitant (Emend)
• Bladder control medicines such as darifenacin (Enablex) and mirabegron (Myrbetriq)
• Bosentan (Tracleer)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera, Verelan)
• Carvedilol (Coreg)
• Cholesterol-lowering medicines such as atorvastatin (Lipitor) and lomitapide (Juxtapid)
• Cimetidine (Tagamet)
• Cinacalcet (Sensipar)
• Colchicine (Colcrys)
• Conivaptan (Vaprisol)
• Dexamethasone
• Diphenhydramine (Benadryl)
• Eliglustat (Cerdelga)
• HIV medicines such as atazanavir (Reyataz), cobicistat (Tybost), darunavir (Prezista), delavirdine (Rescriptor), indinavir (Crixivan), lopinavir/ritonavir, nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), stavudine (Zerit), tipranavir (Aptivus), and zidovudine (Retrovir)
• Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune) and tacrolimus (Astagraf, Prograf, Protopic)
• Lorcaserin (Belviq)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, and quinine
• Medicines to treat or prevent blood clots such as aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, and warfarin (Coumadin)
• Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• Mifepristone (Korlym, Mifeprex)
• Natural remedies such as black cohosh, dong quai, echinacea, and St. John’s wort
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Other cancer medicines such as abiraterone (Zytiga), actinomycin-D (Cosmegen), busulfan (Busulfex, Myleran), ceritinib (Zykadia), crizotinib (Xalkori), cyclophosphamide (Cytoxan), cytarabine (Cytosar, DepoCyt), docetaxel (Docefrez, Taxotere), enzalutamide (Xtandi), idelalisib (Zydelig), imatinib (Gleevec), lapatinib (Tykerb), mercaptopurine (Purinethol), mitotane (Lysodren), nilotinib (Tasigna), paclitaxel (Abraxane, Taxol), streptozocin (Zanosar), sunitinib (Sutent), trastuzumab (Herceptin), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Pain medicines such as methadone (Dolophine, Methadose) and morphine (Kadian, MS Contin)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Ranolazine (Ranexa)

Do not have any vaccines without getting your healthcare provider's approval first.

Grapefruit or grapefruit juice may affect the way this medicine works and may increase the risk of side effects. Talk with your healthcare provider about this.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.