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Doxorubicin is a chemotherapy drug| given to treat many different types of cancer|. It used to be called Adriamycin, and some doctors and nurses still use this name.
Doxorubicin is a red fluid.
Doxorubicin is given by injection or drip (infusion) in one of the following ways:
Chemotherapy| is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you begin your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has doxorubicin and may be different if you're having more than one type of chemotherapy drug|.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and hair in other areas of the body. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss|.
Scalp cooling| is a method of reducing hair loss that may be helpful for some people. You can ask your doctor or nurse if it's available at your hospital.
This may begin soon after the treatment is given and can last for up to 24 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting|. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Doxorubicin can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections|. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Doxorubicin can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion| if your platelet count is low.
Doxorubicin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired| and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
Some anti-sickness drugs can cause constipation|. Let your doctor or nurse know if this is a problem.
Your mouth may become sore| or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different|. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Your urine may become a pink-red colour. This may last up to 48 hours after you’ve had your treatment. It is normal and is due to the colour of the doxorubicin.
During treatment with doxorubicin and for several months afterwards, you'll be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate or drive machinery.
This is very rare with standard doses but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, sometimes before each treatment.
Doxorubicin can cause diarrhoea|. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
Sometimes areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.The skin over the vein used for the injection may also become discoloured.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
You may have a sudden feeling of warmth and some reddening in your face. This can happen for a short period of time while the drug is being given.
If this happens when doxorubicin is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having doxorubicin, as it may harm the developing baby. It’s important to use effective contraception while having this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There is a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our doxorubicin fact sheet which has been compiled using information from a number of reliable sources, including:
Content last reviewed: 1 December 2011
Next planned review: 2013
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
Watch our slideshow with tips for coping with a poor appetite
Watch our slideshow with tips for coping with a sore mouth
Watch our video about coping with fatigue
Watch our slideshow about avoiding infection when you have reduced immunity
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© Macmillan Cancer Support 2013
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