On the part of the organs of hematopoiesis: dose-dependent, reversible leukopenia and neutropenia. Thrombocytopenia and anemia are also possible. Leukopenia usually reaches its lowest value 10-14 days after the administration of the drug, the restoration of the blood picture is usually observed on day 21.
From the cardiovascular system: manifestation of early (acute)
cardiotoxicity of doxorubicin is primarily sinus tachycardia and / or anomalies on the ECG (nonspecific changes in ST-T waves). There may also be tachyarrhythmias (including ventricular tachycardia), ventricular extrasystole, as well as bradycardia, atrioventricular blockade and bundle bundle blockade. The appearance of these phenomena is not always a prognostic factor in the development of subsequently delayed cardiotoxicity, they are rarely clinically significant, and do not require the abolition of doxorubicin therapy. Later (delayed) myocardial damage is manifested by a decrease in the left ventricular ejection fraction without clinical symptoms and / or with symptoms of congestive heart failure (dyspnea), dyspnea, pulmonary edema, peripheral edema, cardiomegaly and hepatomegaly, oliguria,ascites, exudative pleurisy, gallop rhythm). Also subacute phenomena (pericarditis / myocarditis) can be noted. The most severe form of anthracycline-induced cardiomyopathy is the life-threatening CHF, which is a toxicity that limits the cumulative dose of the drug. Phlebitis, thrombophlebitis, thromboembolic complications, including pulmonary embolism (in some cases, with a fatal outcome).
From the digestive system: anorexia, nausea, vomiting, stomatitis and esophagitis (in severe cases can develop ulceration of the mucous membranes of the gastrointestinal tract), hyperpigmentation oral mucosa, abdominal pain, bleeding from the gastrointestinal tract, diarrhea, colitis . Increase the concentration of total bilirubin and the activity of "liver" transaminases in the blood serum.
From the urinary system: staining the urine in red for 1-2 days after the administration of doxorubicin.
From the sense organs: conjunctivitis, keratitis, lacrimation.
From the side of the reproductive system: amenorrhea (after the end of the therapy there is a restoration of ovulation,however, premature menopause may occur); oligospermia, azoospermia (in a number of cases the number of spermatozoa is restored to normal level, this can happen several years after the end of therapy).
From the skin and skin appendages: in most cases, reversible complete alopecia develops. The resumption of hair growth usually begins 2-3 months after the drug is discontinued. Hyperpigmentation of the skin and nails, photosensitivity, hives, rash, itching may also occur. Some patients who received radiation therapy after doxorubicin administration (usually after 4-7 days) showed hypersensitivity of the irritated skin, erythema with the formation of vesicles, edema, severe pain, wet epidermitis in places corresponding to irradiation fields.
Allergic reactions: skin rash, dermatitis, urticaria, flushing of the skin of the palms and soles, bronchospasm, anaphylaxis (rarely).
Local reactions: erythematous striation often occurs during the vein into which the infusion was made, then local phlebitis or thrombophlebitis may occur.Also, phlebosclerosis may develop, especially if
doxorubicin is reentered into a small vein. In the event of a drug falling into the surrounding tissues, local soreness, severe inflammation of the subcutaneous tissue and necrosis of the tissues may occur.
With intra-arterial administration: in addition to systemic toxicity, gastric and duodenal ulcers can be observed (probably due to reflux of drugs in the gastric artery); narrowing of the bile duct due to drug-induced sclerosing cholangitis.
With intravesical injection: cystitis, staining the urine in red.
Other: malaise, asthenia, fever, chills, hot flushes to the face, hyperuricemia or nephropathy associated with increased uric acid formation, development of acute lymphocytic or myelocytic leukemia.