Doxorrubicina
Doxorubicin
Doxorubicin Hydrochloride
También conocido como: Doxil · Adriamycin RDF · Adriamycin PFS · Rubex · Caelyx · Myocet · cloridrato de doxorrubicina · doxorubicin hydrochloride liposome · doxorubicini hydrochloridum · liposomal doxorubicin hydrochloride · NSC-123127 · Hydroxydaunorubicin
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Esta dosis se basa en la superficie corporal (mg/m²). Convierta el peso en superficie corporal antes de administrarla.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Antineoplastic | 30 mg/m2 IV every 2-3 weeks | IV | every 2-3 weeks | — | 🌎 NA |
| Lymphoma, sarcomas, carcinomas | 30 mg/m2 (Use 1 mg/kg in dogs weighing <10 kg) | IV | q3wk | Maximum total cumulative dose not to exceed 240 mg/m2 | 🌍 EU |
- Antineoplastic: Depending on the protocol used. Maximum cumulative dose = 240 mg/m2.
- Lymphoma, sarcomas, carcinomas: Administer over a minimum of 10 minutes into side port of freely running 0.9% NaCl.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Antineoplastic | 20-30 mg/m2 IV every 2-4 weeks | IV | every 2-4 weeks | — | 🌎 NA |
| Lymphoma, soft tissue sarcomas | 1 mg/kg or 20-25 mg/m2 | IV | q3-5wk | Maximum total cumulative dose not to exceed 240 mg/m2 | 🌍 EU |
- Antineoplastic: Depending on the protocol used. Maximum cumulative dose is usually 240 mg/m2.
- Lymphoma, soft tissue sarcomas: Nephrotoxicity is a major risk in cats, especially at cumulative dosages >100 mg/m2.
Hurones
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Antineoplastic | 30 mg/m2 IV every 3 weeks | IV | every 3 weeks | — | 🌎 NA |
- Antineoplastic: Depending on the protocol used.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La doxorrubicina es un antibiótico glucósido de la familia de las antraciclinas, siendo uno de los agentes antineoplásicos más utilizados en la oncología veterinaria de pequeños animales. A menudo denominada coloquialmente como el "Diablo Rojo" debido a su color rojo brillante y a su potente perfil de efectos secundarios, se utiliza tanto como agente único como dentro de protocolos de combinación de múltiples fármacos.
- Eficacia de amplio espectro: Altamente eficaz contra una variedad de neoplasias, incluyendo linfomas, carcinomas, leucemias y sarcomas tanto en perros como en gatos.
- Origen: Originalmente aislado de Streptomyces peucetius.
- Perla clínica: Aunque posee propiedades antimicrobianas, su profunda citotoxicidad impide completamente su uso como agente antiinfeccioso. Es un vesicante severo; se debe tener extremo cuidado para asegurar un acceso intravenoso limpio y evitar lesiones devastadoras por extravasación.
Mecanismo de acción
Doxorubicin is a cell-cycle non-specific cytotoxic agent with multiple mechanisms of action:
- Topoisomerase II Inhibition: Intercalates between DNA base pairs and inhibits topoisomerase II → prevents DNA resealing → causes double-strand DNA breaks → triggers apoptosis.
- Macromolecular Synthesis Inhibition: Directly inhibits DNA synthesis, DNA-dependent RNA synthesis, and protein synthesis.
- Free Radical Generation: Undergoes electron reduction to form anthracycline semiquinone free radicals (often iron-mediated) → causes severe oxidative stress and lipid peroxidation.
- Clinical Pearl: The heart is particularly susceptible to doxorubicin-induced oxidative damage because cardiac tissue has inherently low levels of catalase, an enzyme necessary to neutralize hydrogen peroxide. This is the primary mechanism behind its cumulative cardiotoxicity.
Seguridad y advertencias
Contraindicaciones
- Pre-existing severe myelosuppression
- Impaired cardiac function
- Patients who have reached the total cumulative dose limit of doxorubicin and/or daunorubicin
- Cats with pre-existing renal insufficiency
Efectos adversos
- Bone marrow suppression (nadir 5-10 days)
- Cardiac toxicity (acute arrhythmias and cumulative cardiomyopathy)
- Nephrotoxicity (particularly in cats)
- Gastroenteritis (anorexia, vomiting, diarrhea)
- Alopecia
- Stomatitis
- Immediate hypersensitivity/anaphylaxis (primarily in dogs)
- Severe tissue ulceration and necrosis (if extravasated)
Precauciones
WARNING: Severe Vesicant & Cardiotoxin
- Extravasation Risk: Doxorubicin is extremely irritating to tissues. Perivascular administration can cause severe tissue ulceration and necrosis. Must be administered IV slowly (over at least 10 minutes) via a perfectly placed, free-flowing catheter. If extravasation occurs, treat immediately (e.g., topical DMSO or IV dexrazoxane).
- Cardiotoxicity: Risk increases greatly when cumulative dose exceeds 240 mg/m2 in dogs (and likely cats). Breeds predisposed to cardiomyopathy (Dobermans, Great Danes, Rottweilers, Boxers) require extremely careful monitoring.
- MDR1/ABCB1 Mutation: Actively transported by p-glycoprotein. Dogs with MDR1 mutations (Collies, Australian Shepherds, etc.) are at high risk for severe toxicity. Dose reduction of 25-30% is recommended.
- Hypersensitivity: Immediate reactions (urticaria, facial swelling, hypotension) can occur, especially in dogs. Pretreatment with antihistamines (e.g., diphenhydramine) or dexamethasone is often recommended.
- Handling: Teratogenic and embryotoxic. Prepare in a biological safety cabinet. Wear gloves. Wash immediately if skin contact occurs.
Interacciones farmacológicas
May potentiate the toxic effects of doxorubicin
Potentially could increase risk for cardiotoxicity associated with doxorubicin
Decreased carbamazepine levels
Increased risk of toxicity for both agents; carefully weigh risks versus benefits
May increase doxorubicin blood levels (AUC); doxorubicin may potentiate and prolong hematologic toxicity; coma and seizures have been reported in human patients
Can increase doxorubicin and doxorubicinol (active metabolite) levels
May reduce doxorubicin effectiveness; use together not recommended in humans
Doxorubicin may decrease phenytoin levels
May increase elimination and reduce blood levels of doxorubicin
May inhibit doxorubicin metabolism
May increase doxorubicin levels
Increased risk for bleeding
Increased risk for neutropenia
Increases plasma clearance of doxorubicin
Causes a reduction in serum digoxin levels
Incompatible in syringe/line; leads to precipitate formation
Incompatible in syringe/line; leads to precipitate formation
Incompatible in syringe/line; leads to precipitate formation
Increased risk of toxicity
Monitorización
- Efficacy of tumor response
- CBC with platelets (monitor for myelosuppression, nadir at 5-10 days)
- ECG and/or echocardiogram (especially in dogs with pre-existing heart disease or predisposed breeds)
- Hepatic function prior to and during therapy
- Urinalysis, serum creatinine, and BUN (especially in cats due to nephrotoxicity risk)
Farmacocinética
Vida media
Absorción
Not absorbed from the GI tract. Must be administered IV. Extremely irritating to tissues if administered SC or IM.
Distribución
Rapidly and widely distributed after IV injection. Does not appreciably enter the CSF. Highly bound to tissue and plasma proteins. Probably crosses the placenta and is distributed into milk.
Metabolismo
Metabolized extensively by the liver and other tissues via aldo-keto reductase primarily to doxorubicinol, which is active; other inactive metabolites are also formed.
Eliminación
Primarily excreted in the bile and feces. Only about 5% is excreted in the urine within 5 days of dosing. Eliminated in a triphasic manner.
Sobredosis
Inadvertent acute overdosage may be manifested by severe exacerbations of adverse effects (profound myelosuppression, severe GI toxicity, acute cardiotoxicity). A lethal dose for dogs has been reported as 72 mg/m2.
Treatment: Supportive and symptomatic therapy is required. Dexrazoxane may be useful to help prevent cardiac toxicity and should be considered in cases of massive overdose.
Productos disponibles
Formulaciones
- Lyophilized powder for injection
- Aqueous injection
- Liposomal injection
Etiquetado para humanos
- Doxorubicin HCl (Conventional) Lyophilized Powder for Injection: 10 mg, 20 mg, 50 mg, and 150 mg vials (Adriamycin RDF, generic)
- Doxorubicin HCl (Conventional) Injection (aqueous): 2 mg/mL in 5 mL, 10 mL, 25 mL, and 100 mL (Adriamycin PFS, generic)
- Doxorubicin, Liposomal Injection: 20 mg in 10 mL & 50 mg in 30 mL single-use vials (Doxil)
Estado regulador
POM (Prescription Only Medicine). Must be handled by trained personnel.
POM-V. Cytotoxic handling precautions apply.
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Lyophilized powder: Store away from direct sunlight in a dry place. Reconstituted powder (with 0.9% NaCl) is stable for 24 hours at room temperature and 48 hours refrigerated. Aqueous injection: Stable for 18 months when refrigerated (2-8°C) and protected from light.
Información para el cliente
Información importante para los propietarios de mascotas que reciben terapia con Doxorrubicina:
- Orina roja: La doxorrubicina es de color rojo, y es completamente normal que la orina de su mascota se tiña de color naranja a rojo durante 1 a 2 días después del tratamiento. Esto no es sangre y no es dañino.
- Manejo seguro de los desechos: El fármaco se excreta en los desechos de su mascota. Evite el contacto directo de la piel con la orina o las heces. Se pueden encontrar residuos del fármaco en la orina de un perro tratado hasta por 21 días y en las heces durante varios días. Use guantes al limpiar accidentes y lávese bien las manos.
- Contacto físico: No permita que su mascota lama la piel humana, especialmente las caras de niños o personas inmunocomprometidas, mientras estén recibiendo quimioterapia activamente.
- Efectos secundarios esperados: La pérdida leve de apetito y los vómitos ocasionales son comunes de 2 a 5 días después de la terapia.
- Cuándo llamar al veterinario: Contacte a su veterinario inmediatamente si su mascota muestra signos de depresión profunda, letargo extremo, sangrado anormal, hematomas o diarrea con sangre.
- Pérdida de pelo: Algunas mascotas (especialmente ciertas razas de perros con pelo de crecimiento continuo como Poodles o Terriers) pueden experimentar pérdida o adelgazamiento del pelo.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.