Adriamycin (Doxorubicin)

ADRIAMYCIN (doxorubicin) – Please discuss all information with your vet

Adriamycin (doxorubicin) is a broad spectrum chemotherapy drug used to fight many forms of cancer and has been used for decades. Adriamycin is an orange-red liquid, which is diluted and painlessly administered directly into a vein. The slow intravenous administration of Adriamycin usually takes about 15 to 20 minutes. The patient lies quietly on a padded table during administration and rarely needs any form of sedation.

The dose is calculated by a measurement called Body Surface Area, which your veterinarian can calculate based on your dog’s weight. Baseline complete blood count should be done before the first administration of adriamycin. You should also check with your vet about testing for kidney function and liver function. Your vet may also prescribe medicine to administer for nausea, vomiting or diarrhea which can occur (see below).

Please note: One of the major side effects of adriamycin is the potential to affect heart function. When it occurs, it usually develops after several doses. Breeds that are prone to having underlying heart conditions, dogs with a large heart on xray and dogs with a previous history of heartworm infection should have baseline EKG (heart rhythm tracing) and possibly echocardiograms (heart ultrasound) before receiving adriamycin. This is not mandatory for every dog but needs to be discussed with your veterinarian and oncologist.

Other side effects

Hair loss: Pets rarely lose their hair, and if they do, they are not bothered by it as much as people are. In most pet animals, hair does not grow continually though out their lives like it does in people. Therefore, hair loss in pets is rare. Exceptions are certain breeds of dogs, such as poodles, Old English Sheepdogs and other breeds whose hair grows continually. In general, if your pet needs to visit a groomer periodically to be clipped, then your pet may experience some degree of hair loss as a result of chemotherapy. Cats may, however, lose all or most of their whiskers. Please ask your pet’s doctor about the possibility of hair loss in your pet.

Reduction in the Number of White Blood Cells (Neutropenia): There are various types of cells in the blood. The decrease in the number of infection-fighting white blood cells is known as neutropenia. Many chemotherapeutic agents impair the bone marrow’s ability to produce cells. As a result, neutropenia may occur seven to ten days after chemotherapy. Neutropenia, alone, is not a danger to your pet. However, your pet’s ability to fight off infection is impaired by neutropenia. Therefore, prior to each chemotherapy treatment, your pet should have a blood test performed called a complete blood count (CBC). Should your pet have a significant reduction in the number of white blood cells, your veterinarian may wish to perform periodic blood tests, and/or prescribe antibiotics to protect your pet from infection.

Stomach or Intestinal (Gastrointestinal) Discomfort: Many patients experience some form of stomach or intestinal discomfort two or seven days after a chemotherapy treatment. Your veterinarian will prescribe medication to try to prevent or treat the discomfort. Below are listed some steps you can take at home.

Upset stomach (Nausea)
  1. If your pet begins to show any signs of upset stomach (drooling, “smacking” lips) or loss of appetite, administer the medicine your doctor prescribed for nausea.
  2. Offer ice cubes every few hours
  3. After 12 hours, feed your pet small, frequent meals instead of one large meal.
  4. Call your veterinarian if you have concerns, or if the condition persists for more than 24 hours
Vomiting
  1. Do not give your pet any food or water for 12 hours
  2. After 12 hours, offer your pet ice cubes, then water, then small bland meals
  3. Call your veterinarian if you have concerns, or if the condition persists for more than 24 hours
Loss of Appetite
  1. If your pet begins to show any signs of upset stomach or loss of appetite, administer the medicine your doctor prescribed for nausea.
  2. Offer your pet four small meals a day.
  3. Add warm broth, animal fats, and favorite foods to increase flavor and appeal
Diarrhea
  1. If your pet begins to show signs of diarrhea, administer the medicine your doctor prescribed for diarrhea.
  2. Keep water available at all times.
  3. If your pet is also not eating, offer chicken or beef broth.
  4. Ask your veterinarian about giving Pepto Bismol (dogs only), 1 tablespoon per 10 lbs of body weight every 4 to 6 hours.
  5. Call your veterinarian if you have concerns, or if the condition persists for more than 24 hours.

Tissue damage: If Adriamycin is accidentally given outside the vein, severe tissue reactions can result, leading to tissue destruction. Therefore, Adriamycin is handled with the utmost care, and should only be administered by highly trained professionals. Secure intravenous access is paramount. If irritation of the injection site develops in the form of pain, swelling or redness, apply ice packs for 15 minutes every three hours. Call your veterinarian as soon as possible, and certainly if the condition persists for more than 24 hours.

Allergic Reactions: Allergic reaction to chemotherapeutic agents is rare, and not a problem you will have to treat at home. Should your pet have an allergic reaction to Adriamycin, it would develop upon administration, and your veterinarian and the hospital staff are trained to treat patients for allergic reaction.

Heart Damage: Adriamycin, in some rare cases, can irreversibly damage the heart muscle. The dose of Adriamycin prescribed for your pet is below the dose that usually causes heart disease. Less than 10% of patients develop heart disease as a result of Adriamycin chemotherapy. Your veterinarian will discontinue the use of Adrimycin if heart disease is detected at any time.

Find out from your oncologist what can be done to minimize the risk of heart toxicity. Ask about the use of Co Enzyme Q-10 to protect against heart disease from adriamycin. There is also a medication called Zinecard ® (dexrazoxane) which is used in humans to prevent toxicity from adriamycin. Ask your oncologist if your dog is a candidate for this medication if available.