Doxorubicin: Adverse effects

Cardiotoxicityis the main one that everyone expects you to know but the list is long.

• Acute cardiotoxicity:Atrioventricular block, bradycardia, bundle branch block, ECG abnormalities, extrasystoles (atrial or ventricular), sinus tachycardia, ST-T wave changes, supraventricular tachycardia, tachyarrhythmia, ventricular tachycardia
• Delayed cardiotoxicity:LVEF decreased, CHF (manifestations include ascites, cardiomegaly, dyspnea, edema, gallop rhythm, hepatomegaly, oliguria, pleural effusion, pulmonary edema, tachycardia); myocarditis, pericarditis

Other adverse effects include:

• Central nervous system: Malaise
• Dermatologic: Alopecia, itching, photosensitivity, radiation recall, rash; discoloration of saliva, sweat, or tears
• Endocrine & metabolic: Amenorrhea, dehydration, infertility (may be temporary), hyperuricemia
• Gastrointestinal: Abdominal pain, anorexia, colon necrosis, diarrhea, GI ulceration, mucositis, nausea, vomiting
• Genitourinary: Discoloration of urine
• Hematologic: Leukopenia/neutropenia (75%; nadir: 10-14 days; recovery: by day 21); thrombocytopenia and anemia
• Local: Skin “flare” at injection site, urticaria
• Neuromuscular & skeletal: Weakness

Postmarketing and/or case reports: Anaphylaxis, azoospermia, bilirubin increased, chills, coma (when in combination with cisplatin or vincristine), conjunctivitis, fever, gonadal impairment (children), growth failure (prepubertal), hepatitis, hyperpigmentation (nail, skin & oral mucosa), infection, keratitis, lacrimation, myelodysplastic syndrome, neutropenic fever, neutropenic typhlitis, oligospermia, onycholysis, peripheral neurotoxicity (with intra-arterial doxorubicin), phlebosclerosis, radiation recall pneumonitis (children), secondary acute myelogenous leukemia, seizure (when in combination with cisplatin or vincristine), sepsis, shock, Stevens-Johnson syndrome, systemic hypersensitivity (including urticaria, pruritus, angioedema, dysphagia, and dyspnea), toxic epidermal necrolysis, transaminases increased, urticaria.