Intravenous Admixture and Sterile Compounding

PHM1270 - M223

Angela Busbee

December 16, 2014

Doxorubicin Trade name: Adriamycin, Rubex

Chemotherapy drug class: antitumor antibiotics

One of the most powerful chemotherapy drugs invented that is used to treat a wide variety of cancers

FDA approved for use alone or in combination with other drugs

US approval: 1974

Doxorubicin Treats the following cancers:

Acute lymphoblastic leukemia (ALL)

Acute myeloid leukemia (AML)

Breast Cancer (adjuvant therapy when it has spread to lymph nodes after surgery

Gastric cancer

Hodgkin lymphoma

Neuroblastoma

Non-hodgkin lymphoma

Ovarian cancer

Doxorubicin Treats the following cancers:

Small cell lung cancer

Soft tissue and bone sarcomas

Thyroid cancer

Transitional cell bladder cancer

Wilms tumor

Researched for treatment of other types cancer.

Doxorubicin Dosage forms and strengths of doxorubicin hydrochloride:

Vials clear red solution

10 mg/5 mL, 20 mg/10 mL, 50 mg/25 mL, 150 mg/75 mL, and 200 mg/100 mL

Vials red-orange lyophilized powder

10 mg, 20 mg, 50 mg, and 150 mg

Storage

Refrigerated 2° to 8°C (36° to 46°F)

Protect from light

Retain in carton until used

Discard unused portion

Doxorubicin Therapy routine for Breast Cancer, ovary, prostate,

stomach, thyroid; small cell cancer of lung, liver; squamous cell cancer of head and neck; multiple myeloma, Hodgkin's disease, lymphomas, ALL, AML

60-75 mg/m² IV q21Days OR

60 mg/m² IV q14Days OR

40-60 mg/m² IV q21-28Days OR

20 mg/m²/dose qweek

Doxorubicin Limit lifetime cumulative dose to <550 mg/m² to

reduce risk of cardio toxicity (congestive heart failure & cardiomyopathy)

Monitor: CBC, cardiac function, LFTs (liver function tests)

Doxorubicin Is it an effective treatment?

Considered largely as the drug of choice for first-line therapy of metastatic breast cancer

Response rates of 29% to 43% with median survival rate of 2 years

Reason to use docetaxel and doxorubicin for metastatic breast cancer is that there is a partial clinical cross-resistance between the two drugs.

Doxorubicin Phase 1 trial of doxorubicin followed by docetaxel is a

very active combination with overall response rate of 90% in the highest feasible dose without G-CSF support

Doxorubicin Data on secondary cancers after breast cancer cure

rate:

Patients taking drug rate of second cancers at:

10 years was 3.8%

15 years was 7%

Doxorubicin Side effects:

Nausea or vomiting

Pain at injection site

Temporary Low blood counts of white & red blood cells and platelets

Mouth sores

Alopecia (hair loss on scalp or body)

Eyes watering (first week of treatment)

Urine color red, red-brown, orange, or pink in first 1-2 days after dose administered

Doxorubicin First two weeks of taking drug:

Nail beds darken

Skin darkens where previous radiation treatment was administered

Fertility issues

Serious: can cause issue with pumping of heart that may occur 7-8 years after treatment.

Lifetime limit on amount patients may receive.

Doxorubicin Precautions while taking:

Aspirin and their products should not be taken without physician approval

No vaccinations without physician approval

Use contraceptives (barrier type recommended -condoms) & do not get pregnant

Do not breast feed

Not to be taken by patients with congestive heart failure, if you have already taken high doses of this drug, or have bone marrow suppression or other blood count issues

Doxorubicin Administered:

IV Push (syringe) in not less than 3 to 5 minutes

IVPB (IV admixture) over 15 to 60 minutes

Must not be given via intramuscular or subcutaneous route

Doxorubicin

The End

Bibliography doxorubicin (Rx) Adriamycin, Caelyx, Rubex. (1994 - 2014). Retrieved from

Medscape: http://reference.medscape.com/drug/doxorubicin-342120 Doxorubicin Cancer Treatment. (2014). Retrieved from CancerTreatment.net:

http://doxorubicin.cancertreatment.net/ Doxorubicin Hydrochloride. (2014, 09 17). Retrieved from National Cancer

Institute at the National Institutes of Health: http://www.cancer.gov/cancertopics/druginfo/doxorubicinhydrochloride

Diéras, M. V. (1997, 08 01). Review of Docetaxel/Doxorubicin Combination in Metastatic Breast Cancer - See more at: http://www.cancernetwork.com/review-article/review-docetaxeldoxorubicin-combination-metastatic-breast-cancer#sthash.o4sOCNSV.dpuf. Retrieved from cancerNetwork.com: http://www.cancernetwork.com/review-article/review-docetaxeldoxorubicin-combination-metastatic-breast-cancer

Doxorubicin. (n.d.). Retrieved from Chemocare.com: http://chemocare.com/chemotherapy/drug-info/doxorubicin.aspx#.VIS15tLF9e8

Bibliography Laboratories, B. (2014, 02). HIGHLIGHTS OF PRESCRIBING INFORMATION.

Retrieved from Adriamycin - Boehringer Ingelheim: http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Ben+Venue_Bedford+Labs/55390-237-01+ADR+50MG/5539023701

McAuley, P. D. (2012, 05 02). Drug: Doxorubicin HCL - Adriamycin®. Retrieved from GLOBALRPh.com: http://www.globalrph.com/doxorubicin.htm#DOSAGE_AND_ADMINISTRATION

Secondary Malignancies. (n.d.). Retrieved from CancerConnection.com: http://news.cancerconnect.com/secondary-malignancies/

Woolston, M. C. (n.d.). Chemotherapy and Side Effects. Retrieved from HealthDay News for Healthier Living: http://consumer.healthday.com/encyclopedia/cancer-8/mis-cancer-news-102/chemotherapy-and-side-effects-648006.html