Pegylated Doxorubicin Hydrochloride is an anthracycline medicine for cancer treatment. Its common brand names are Adriamycin and Pegdoxine. The medicine is available in the form of liposomal injections having a strength of 20mg/10ml.

FDA Approval: 07/09/1993

Uses

Pegylated Doxorubicin Hydrochloride is a cytotoxic antibiotic medication that is used in the treatment of patients with:

• Axillary lymph node involvement following resection of primary breast cancer, as a component of multi-agent adjuvant chemotherapy.

Other cancers:

• Acute Lymphoblastic Leukemia
• Acute Myeloblastic Leukemia
• Hodgkin Lymphoma
• Non-Hodgkin Lymphoma
• Metastatic Breast Cancer
• Metastatic Wilms’ Tumor
• Metastatic Neuroblastoma
• Metastatic Soft Tissue Sarcoma
• Metastatic Bone Sarcoma
• Metastatic Ovarian Carcinoma
• Metastatic Transitional Cell Bladder Carcinoma
• Metastatic Thyroid Carcinoma
• Metastatic Gastric Carcinoma
• Metastatic Bronchogenic Carcinoma

Working

Since Doxorubicin Hydrochloride is a chemotherapy medicine, it blocks certain enzymes. Here’s how it causes cancer cell death by doing so.

• STEP-1
  Type II Topoisomerase: These are the enzymes that participate in the overwinding or underwinding of DNA. It is essential for the replication of DNA, chromosome condensation, and chromosome segregation.
• STEP-2
  Doxorubicin Hydrochloride Enters: It works by blocking the Type II Topoisomerase enzyme that is needed by the cancer cells for cell division and proliferation.
• STEP-3
  Cell Death: The antitumor effect of this drug against a wide spectrum of tumors inhibits polymerase activity and produces free radical damage to DNA. This leads to cell death.

Side Effects

Pegylated Doxorubicin Hydrochloride may cause some side effects during the therapy. That’s because the drug is new to your body’s mechanisms. To solve the same, the doctor may prescribe over-the-counter medications. If not, contact your doctor to report the side effects.

Injection-site problems

• Pain at the site of injection
• Swelling on the arm
• Redness
• Itching and skin rash

Common side effects

• Hair loss
• Nausea
• Vomiting
• Shortness of breath
• Joint pain
• Fever
• Chills
• Fast heartbeat
• Darkening of the nails
• Diarrhea
• Sores in the mouth
• Thinning of hair
• Abdominal pain
• Swelling of the feet

Rare side effects

• Painful urination
• Blood in the urine
• Red bumps or spots on the skin
• Tarry stools
• Unusual bruising
• Drowsiness

Warnings & Precautions

• Pregnancy
  When given to pregnant females, Doxorubicin HCl may lead to severe effects. Experts believe that this drug is embryotoxic for rabbits even at lower doses. It is advisable to know the potential risks of the medicine before taking it during pregnancy.
• Nursing
  Clinical trials show that Doxorubicin HCl was found in the milk of a lactating female. This means the drug may get excreted through breast milk in humans. It is thus advised to avoid breastfeeding during the therapy.
• Geriatric Use
  As per the trials, geriatric patients did not show any different results than patients of young age. However, the chance of hypersensitivity may be more in older patients. To avoid complications, dose changes may be made by the medical team.
• Cardiomyopathy
  Experts believe that Doxorubicin Hydrochloride may result in myocardial damage in some patients. To reduce the chances of the same, dexrazoxane might be used. In severe conditions, patients may require dose changes.
• Secondary Malignancies
  Patients administering this drug may become prone to secondary malignancies. These usually include tumors like acute myelogenous leukemia. Researchers claim that such a condition can potentially develop within 2 to 3 years of Doxorubicin therapy.
• Severe Myelosuppression
  As per the clinical studies, some patients may develop symptoms of myelosuppression. This is why doctors recommend close monitoring of blood cell count.
• Hepatic Impairment
  Patients who already have the liver disease may require dose adjustments. This drug is not indicated for use in people having a severe hepatic impairment.
• Tumor Lysis Syndrome
  In certain patients, Doxorubicin HCl may cause tumor lysis syndrome. To examine the same, the doctor may monitor blood uric acid levels regularly.

Interactions

Drug-drug or drug-disease interactions are the reasons why your doctor asks for your health history. Before prescribing the medicine, such interactions are taken into account. Some patients may even require dose changes due to some disease or medicine.

Interaction with medicines: Drugs like anagrelide, baricitinib, citalopram, adalimumab, ribociclib, infliximab, osimertinib, deferiprone, efavirenz, hydroxychloroquine, and quinidine are expected to cause interactions with Doxorubicin Hydrochloride. Other medicines may also have an impact. It is important to contact the doctor to know about the potential interactions.

Interaction with diseases: Conditions that may change the working of this drug are infections, myelosuppression, cardiomyopathy, and hepatic impairment. The oncologist may also consider other severe diseases. Disease interactions may cause complications during or after the therapy.

Interaction with alcohol and food: Certain herbs like Perforate St. John's Wort may cause reductions in the drug’s serum concentration. Similarly, Grapefruit & its products may interact with Doxorubicin. They can increase concentration.

Overdose

The recommended dose of Pegylated Doxorubicin Hydrochloride is as follows. The drug is administered intravenously over 60 minutes until disease progression or unacceptable toxicity.

• Ovarian Cancer: A dose of 50 mg/m2 every 28 days
• AIDS-Related Kaposi's Sarcoma: A dose of 20 mg/m2 every 21 days
• Multiple Myeloma: A dose of 50 mg/m2 on day 4 of each 21-day cycle for eight cycles

In overdose cases, experts advise avoiding delaying and reaching out to the nearest doctor. Symptoms that are associated with an overdose may include fainting, headache, and irregular heartbeat.

NOTE: This information must not be interpreted to be a substitute for any medical treatment/advice/prescription. Also, this drug is not indicated for self-use. Kindly contact your doctor for more details.