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General Information For Doxorubicin (Adriamycin)

Doxorubicin is used widely in the treatment of cancers, including breast, ovarian, bladder and lung cancer, as well as non-Hodgkin's lymphoma, Hodgkin's disease and sarcoma. Doxorubicin is the chemical name for the drug. One of the most common brands of doxorubicin is Adriamycin.

One way in which doxorubicin works is by binding to the cancer cells' DNA (the genetic code) and blocking an important enzyme (called topo-isomerase II). This causes the DNA to get tangled up and the cancer cells cannot divide and grow.

Doxorubicin is a red liquid that you have as an injection into a vein (intravenously) or as a drip (infusion) through a fine tube put into a vein (cannula). Or you may have it through a central line.

Chemotherapy is usually given as a course of several cycles of treatment. The treatment plan for doxorubicin depends on which cancer you are having treatment for. To find out more about the way doctors plan chemotherapy treatment click on Planning Chemotherapy.

The side effects associated with doxorubicin are listed below. Use the links (underlined) to find out more about each side effect. We are still developing this section. For more information on side effects where there is no link, please look under your own specific type of cancer or click on search at the top of any page.

Common Side Effects

Many people have one or more of the following side effects

  • Fatigue - patients say this is the most disruptive side effect of all. Tiredness often carries on after treatment has ended. Most people find their energy levels are back to normal from 6 months to a year after their treatment finishes.
  • Temporary effect on the bone marrow. The bone marrow makes blood cells and this can cause 
    -Drop in white blood cell count. This increases the risk of severe bacterial infection. You may have headache, cough, sore throat, aches and pains, fever, pain when passing urine or feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact a doctor if you think you have an infection. 
    -Drop in red blood cell count (anaemia) - you may feel tired, look pale or be short of breath. You may need a blood transfusion or treatment to bring up your red cell count. 
    -Drop in platelets in the blood causing bleeding or bruising - you may have bruises, a rash of red spots, bleeding gums or nosebleeds.

These effects on your bone marrow can begin about 7 days after each treatment and usually return to normal at about 21-28 days. Your doctor will check your blood counts regularly to see how well your bone marrow is working. Contact your doctor if you have any of these side effects.

  • Feeling or being sick Doxorubicin can cause severe sickness. If you do get it, it may 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- Almost all people treated with doxorubicin have complete head and body hair loss. It usually begins 2 - 5 weeks after the treatment starts. Remember - this is only temporary. A cold cap may help to stop you losing your hair, but you need to talk to your doctor about how advisable this is with your type of cancer. 
  • Sore mouth and throat. This can happen about 2-3 days after each treatment. You may have red sore skin in your mouth and mouth ulcers. It usually clears up within 3 weeks of treatment.
  • Your urine may become a pink or red color for one or two days after treatment.
  • Black or brown discoloration may occur in the creases of your skin. This is particularly common in children.
  • Sensitivity to the sun. You should cover up and stay in the shade while you are having treatment with this drug. If you must be exposed to the sun, use a high factor sun cream.
  • Watery eyes. This happens to about 1 in 4 people and may last for several days after the beginning of each treatment. Very rarely, you may get sore eyes (conjunctivitis).
  • Your ability to become pregnant or father a child may be affected. It is important to talk to your doctor about your fertility before starting treatment. Women may stop having periods (amenorrhoea). This may be temporary.
  • Doxorubicin may have a harmful effect on a developing baby. You should not become pregnant or father a child whilst taking this drug. Discuss contraception with your doctor before you start your treatment if there is any possibility that you or your partner could become pregnant.

Occasional Side Effects of Doxorubicin

Some people have one or more of the following side effects

  • While you are having the chemotherapy infusion, doxorubicin may leak into the body tissues around the vein and cause a sore to develop. It is important to tell the nurse or doctor if you have: 
    -Stinging or burning around the vein 
    -Leakage of fluid from the cannula site 
    -Red or swollen injection site after your treatment
  • Allergic reaction. 3 people in 100 have an allergic reaction to doxorubicin. You may experience a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins. This should clear up within a few days.
  • Radiation recall reaction. Doxorubicin can affect areas of skin that have been treated with radiotherapy in the past. These areas can become dry with flaking skin and you may have some pain and burning similar to sun burn.
  • Heart damage. Doxorubicin can cause temporary damage to the muscles of the heart, which may change the rhythm of the heartbeat. In most cases this will return to normal after the treatment is completed. Your heart will be checked before you start treatment.
  • Diarrhea - drink plenty of fluids and if it becomes severe or persistent tell your doctor or nurse - you could become dehydrated.
  • Loss of appetite
  • Nails may become darker and white lines may appear on them
  • Fever and chills

Side Effects with High Doses of Doxorubicin

With high doses of doxorubicin or many treatments with doxorubicin there is a small risk that you may get

  • Permanent damage to the heart
  • Development of a second cancer


  • Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. This depends on: 
    -How many times you've had the drug before 
    -Your general health 
    -How much of the drug you have (the dose) 
    -The way you take the drug (tablets or drip) 
    -Other drugs you are having
  • Some side effects are upsetting or inconvenient, but not damaging to your health
  • Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because: 
    -Your side effect may need treating 
    -Your drug dose may have to be lowered to try to prevent the side effect
  • Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - drugs can react together
  • Discuss side effects. Tell your doctor about your side effects so they can help you manage them

People you can talk to about your side effects: Your chemotherapy nurse, clinic or ward nurse will have given 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.

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