Doxorubicin (pronounced docks-e-rou-bi-sin) is a chemotherapy drug that is given as a treatment for many different types of cancer. It used to be called Adriamycin and some doctors and nurses still use this name. This information describes doxorubicin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Doxorubicin is a red fluid.

Doxorubicin is given:

• by injection into a vein (intravenously) through a fine tube (cannula) placed into the vein in your arm
• through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of your arm.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given doxorubicin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Hair loss usually starts 3–4 weeks after the first dose of doxorubicin, although it may happen earlier. Hair may be lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and all your hair will regrow once the treatment ends. To help reduce hair loss, scalp cooling may be suitable for some people.

Feeling sick (nausea) and vomiting If this occurs it may begin a few hours after the treatment is given and last for up to a day. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Lowered resistance to infection Doxorubicin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• Your temperature goes above 38ºC (100.5ºF)
• You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Doxorubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with doxorubicin you may become anaemic. This may make you feel tired and breathless. You may need to have a transfusion of blood if the number of red blood cells becomes too low.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you do have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Discoloured urine Your urine may become a pink-red colour. This may last up to 48 hours after you have had the doxorubicin, and is due to the colour of the drug. It is quite normal.

Skin changes Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Sensitivity to the sun While you are having doxorubicin, and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily. You can still go out in the sun, but you should wear a high protection factor suncream and protective clothing and a hat.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Changes in the way your heart works Higher doses of doxorubicin may cause changes in the muscle of the heart. This can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected if you receive standard doses. Tests to see how well your heart is working may sometimes be carried out before the drug is given.

Diarrhoea can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Skin changes The skin may become red and sore in areas which have previously been treated with radiotherapy. Let your doctor know if this happens. The skin over the vein used for the injection may become discoloured.

Changes in nails Your nails may become darker. White lines may appear on them. These changes usually grow out over a few months once treatment has finished.

If doxorubicin leaks into the tissue around the vein it can cause damage. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site it is very important that you tell your nurse or doctor.

If the area around the injection site becomes red or swollen at any time you should either tell the doctor or nurse on the ward, or, if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Some people have hot flushes when the drug is being given.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking doxorubicin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Doxorubicin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2006.
• British National Formulary (52nd edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2006.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.