Intravenous, intravesical or intra-arterial.
Doxorubicin can be used both as a monotherapy, and in combination with other antitumor drugs in different doses depending on the scheme of therapy. Correction of the dose when suppressing the function of the bone marrow, depending on the blood values, namely:
Leucocytes, in 1 μl more than 5000 - the doxorubicin dose is 100%;
Leucocytes, in 1 μl 4000 - 5000 - doxorubicin dose 75%;
Leucocytes, in 1 μl 3000 - 4000 - doxorubicin dose 50%;
Leucocytes, in 1 μl 2000 - 3000 - the dose of doxorubicin is 25%;
Leukocytes, in 1 μl less than 2000 - doxorubicin dose 0%;
Platelets, in 1 μl more than 150,000 - dose of doxorubicin 100%;
Platelets, in 1 μl 100,000 - 150,000 - dose of doxorubicin 75%;
Platelets, in 1 μl 75,000 - 100,000 - dose of doxorubicin 50%;
Platelets, in 1 μl 50000 - 75000 - doxorubicin dose 25%;
Platelets, in 1 μl less than 50,000 - doxorubicin dose 0%;
For individual dose selection, reference should be made to the literature.
Dosing regimen:
- as a monotherapy, the recommended dose per cycle is 60-75 mg /m2 every three weeks. Typically, the drug is administered once during the cycle, but the cyclic dose can be divided into several administrations (for example: administered for the first 3 consecutive days, or on the first and the eighth day of the cycle), with cycles repeated every 3-4 weeks;
- To reduce the toxic effect of doxorubicin, especially cardiotoxicity, a weekly regimen of 10-20 mg /m2;
-
in combination with other antineoplastic agents
doxorubicin is administered at a cyclic dose of 30-60 mg / m
2 every 3-4 weeks.
Violation of the function of the liver. In patients with hyperbilirubinemia, the doxorubicin dose should be reduced in accordance with the concentration of total bilirubin: by 50% at a serum bilirubin concentration of 12-30 mg / l; on 75% at a concentration of bilirubin in blood serum above 30 mg / l.
Other special patient groups:
it is recommended that lower doses be given or longer intervals between cycles in patients who previously received massive antitumor therapy, as well as in children, elderly patients, obese patients (if body weight is more than 130% of "ideal", there is a decrease in systemic clearance of doxorubicin ), as well as patients with tumor infiltration of the bone marrow.
Preparation of the solution: doxorubicin lyophilizate is dissolved in 5 ml of water for injection. The resulting solution with the required amount of doxorubicin is further diluted with 0.9% sodium chloride solution or water for injection to a concentration of not more than 1 mg / ml. The reconstituted solution of the preparation is recommended to be used immediately after preparation.
Intravenous administration
The drug is injected intravenously slowly (within 3-5 minutes) into the injection port of the intravenous infusion system, during a rapid infusion of 5% dextrose solution or 0.9% sodium chloride solution. Before injection, make sure that the needle or catheter is positioned exactly in the vein. Avoid the introduction of small veins and veins over the joints,care should be taken not to perform venipuncture and subsequent administration of doxorubicin on the limbs, where there are violations of venous and lymphatic outflow. The total dose of doxorubicin should not exceed 550 mg /m2. Patients who received previous radiotherapy for the mediastinal / pericardial region or who took other cardiotoxic drugs, if necessary, increase the total dose of doxorubicin more than 450 mg / m2 The drug should be administered under strict monitoring of heart function. Re-introduction of the drug is possible only if all signs of toxicity (especially gastrointestinal and hematological) disappear.
Introduction to the bladder
The recommended dose for intravesical administration is 30-50 mg per installation, with intervals between administrations from 1 week to 1 month, depending on the purpose of therapy-treatment or prevention. The recommended concentration of the solution is 1 mg / 1 ml of water for injection or 0.9% solution of sodium chloride. After completion of the installation, to ensure a uniform effect of the drug on the mucosa of the bladder, patients should flip from side to side every fifteen minutes. As a rule, the drug should be in the bladder for 1-2 hours.At the end of the installation, the patient should empty the bladder. To prevent excessive dilution of the drug with urine, patients should be warned that they should refrain from taking liquid for 12 hours before the installation. Systemic absorption of doxorubicin during installation in the bladder is very low. In cases of local toxic effects (chemical cystitis, which may be manifested by dysuria, polyuria, nicturia, painful urination, hematuria, discomfort in the bladder, necrosis of the bladder wall), the dose to be reinstalled should be dissolved in water for injection, and then up to 50-100 ml with 0.9% sodium chloride solution. Particular attention should be paid to problems associated with catheterization (for example, with obstruction of the urethra caused by massive intravesical tumors). Intraarterial administration:
Patients with hepatocellular carcinoma to provide intensive local effects while reducing the overall toxic effect,
doxorubicin can be injected intraarterially into the main hepatic artery at a dose of 30-150 mg / m
2 with an interval of 3 weeks to 3 months. Higher doses should be used only in those cases when the extracorporeal elimination of the drug is simultaneously carried out. Since this method is potentially dangerous, and when it is used, widespread necrosis of the tissue can occur, intraarterial administration can only be performed by physicians who are proficient in this technique.