多柔比星 / 阿黴素

用途

• Antineoplastic
• Lymphoma, sarcomas, carcinomas
• Antineoplastic
• Lymphoma, soft tissue sarcomas
• Antineoplastic

給藥方式

可能的副作用

• Bone marrow suppression (nadir 5-10 days)
• Cardiac toxicity (acute arrhythmias and cumulative cardiomyopathy)
• Nephrotoxicity (particularly in cats)
• Gastroenteritis (anorexia, vomiting, diarrhea)
• Alopecia
• Stomatitis
• Immediate hypersensitivity/anaphylaxis (primarily in dogs)
• Severe tissue ulceration and necrosis (if extravasated)

注意事項與禁忌

• Pre-existing severe myelosuppression
• Impaired cardiac function
• Patients who have reached the total cumulative dose limit of doxorubicin and/or daunorubicin
• Cats with pre-existing renal insufficiency
• > **WARNING: Severe Vesicant & Cardiotoxin** * **Extravasation Risk**: Doxorubicin is extremely irritating to tissues. Perivascular administration can cause severe tissue ulceration and necrosis. Must be administered IV slowly (over at least 10 minutes) via a perfectly placed, free-flowing catheter. If extravasation occurs, treat immediately (e.g., topical DMSO or IV dexrazoxane). * **Cardiotoxicity**: Risk increases greatly when cumulative dose exceeds 240 mg/m2 in dogs (and likely cats). Breeds predisposed to cardiomyopathy (Dobermans, Great Danes, Rottweilers, Boxers) require extremely careful monitoring. * **MDR1/ABCB1 Mutation**: Actively transported by p-glycoprotein. Dogs with MDR1 mutations (Collies, Australian Shepherds, etc.) are at high risk for severe toxicity. Dose reduction of 25-30% is recommended. * **Hypersensitivity**: Immediate reactions (urticaria, facial swelling, hypotension) can occur, especially in dogs. Pretreatment with antihistamines (e.g., diphenhydramine) or dexamethasone is often recommended. * **Handling**: Teratogenic and embryotoxic. Prepare in a biological safety cabinet. Wear gloves. Wash immediately if skin contact occurs.

藥物相互作用

• Antineoplastic agents, other: May potentiate the toxic effects of doxorubicin
• Calcium-channel blockers: Potentially could increase risk for cardiotoxicity associated with doxorubicin
• Carbamazepine: Decreased carbamazepine levels
• Cisplatin: Increased risk of toxicity for both agents; carefully weigh risks versus benefits
• Cyclophosphamide: May increase doxorubicin blood levels (AUC); doxorubicin may potentiate and prolong hematologic toxicity; coma and seizures have been reported in human patients
• Cyclosporine: Can increase doxorubicin and doxorubicinol (active metabolite) levels
• Glucosamine: May reduce doxorubicin effectiveness; use together not recommended in humans
• Phenytoin: Doxorubicin may decrease phenytoin levels
• Phenobarbital: May increase elimination and reduce blood levels of doxorubicin
• Streptozocin: May inhibit doxorubicin metabolism
• Verapamil: May increase doxorubicin levels
• Warfarin: Increased risk for bleeding
• Zidovudine: Increased risk for neutropenia
• Barbiturates: Increases plasma clearance of doxorubicin
• Digoxin: Causes a reduction in serum digoxin levels
• Dexamethasone: Incompatible in syringe/line; leads to precipitate formation
• 5-fluorouracil: Incompatible in syringe/line; leads to precipitate formation
• Heparin: Incompatible in syringe/line; leads to precipitate formation
• Spinosad: Increased risk of toxicity

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