From the 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:
the 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 manifested decrease in left ventricular ejection fraction without clinical symptoms and / or symptoms of congestive heart failure (CHF) (dyspnoea, pulmonary edema, peripheral edema, hepatomegaly and cardiomegaly, oliguria, ascites, pleural effusion, 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 or esophagitis (in severe cases ulceration of the mucous membranes of the gastrointestinal tract), hyperpigmentation of the 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:
urine in red for 1 to 2 days after the administration of doxorubicin.
From the sense organs:
conjunctivitis, keratitis, lachrymation.
On the part of the reproductive system:
amenorrhea (at the end of therapy, ovulation recovers, but 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:
Often there is erythematous striation along 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.