Treatment with doxorubicin should be performed under the supervision of physicians with experience
use of antitumor drugs.
- To reduce the risk of toxic cardiac damage, it is recommended that a regular monitoring of its function be performed before starting therapy with doxorubicin, including an assessment of the left ventricular ejection fraction from echocardiography or multichannel radioisotope angiography and ECG monitoring. An early clinical diagnosis of heart failure due to the use of the drug is very important for its successful treatment. If signs of chronic cardiotoxicity are detected, treatment with doxorubicin is immediately stopped.
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Acute cardiotoxicity in most cases is transient (reversible), and usually it is not considered as an indication for the abolition of doxorubicin therapy. Late (delayed) cardiotoxicity (cardiomyopathy) depends on the total dose. The probability of myocardial dysfunction is about 1-2% at a total dose of 300 mg /
m2; the probability of this slowly increases at a total cumulative dose of 450-550 mg /
m2. Then the risk of developing congestive heart failure increases dramatically, so it is recommended not to exceed the total total dose of 550 mg /
m2. If the patient has any additional risk of cardiotoxicity (for example, history of heart disease, prior therapy with anthracyclines or anthracenedions, previous radiotherapy of the mediastinum, simultaneous use of other potentially cardiotoxic drugs such as
cyclophosphamide and 5-fluorouracil), then toxic effects can occur at lower cumulative doses, and cardiac function monitoring should be particularly stringent. Doxorubicin-induced cardiotoxicity develops primarily during the course of therapy or within two months after its termination, however, delayed side effects may occur (several months or even years after the end of therapy).
- During the treatment with doxorubicin, it is necessary to evaluate hematological parameters before and during each cycle of therapy, including determination of the number of leukocytes, platelets, hemoglobin, blood elements and liver function tests.
- When the first signs of doxorubia extravasation appear (burning or soreness at the injection site), the infusion should be stopped immediately and then resumed infusion into another vein before the full dose is administered.Local activities to eliminate the consequences of extravasation. It is advisable to use ice packs.
- If possible, avoid insertion into the veins over the joints or into the veins of the extremities with disturbed venous or lymphatic drainage.
- With the use of doxorubicin due to the rapid lysis of tumor cells, hyperuricemia can occur, and therefore it is recommended that patients determine the concentration of uric acid, potassium, calcium and creatinine during therapy. Such measures as increased hydration, alkalinization of urine and prophylactic appointment of allopurinol to prevent hyperuricemia allow to minimize the risk of complications associated with tumor lysis syndrome. In the treatment of hyperuricemia and gout, it may be necessary to adjust the doses of antidotal drugs as a result of an increase in the concentration of uric acid against the background of drug treatment.
- Patients with advanced neutropenia / leukopenia should be carefully monitored to identify signs of infection.
- Refusal from immunization, if it is not approved by the doctor in the interval from 3 months to 1 year after taking the drug; otherthe family members of the patient living with it should refuse immunization with oral polio vaccine; Avoid contact with people who received a polio vaccine, or wear a face mask covering the nose and mouth.
- Men and women of childbearing age, during treatment with doxorubicin and at least 3 months afterwards, should use reliable contraceptive methods.
- When working with doxorubicin, the rules for handling cytotoxic substances must be observed. It is recommended to treat the contaminated surface with a dilute solution of sodium hypochlorite (containing 1% chlorine). If the product gets on the skin, immediately flush the skin with soap and water or a solution of sodium bicarbonate; In case of contact with eyes, pull eyelids and rinse eyes (eyes) with plenty of water for at least 15 minutes.