독소루비신

항종양제 - 안트라사이클린계

**독소루비신(Doxorubicin)**은 소동물 수의 종양학에서 가장 널리 사용되는 안트라사이클린계 항종양제 중 하나입니다. 밝은 붉은색과 강력한 부작용으로 인해 종종 "붉은 악마(Red Devil)"라고 불리며, 단일 약물 또는 다제 병용 화학요법 프로토콜에 사용됩니다. * **광범위한 효능**: 개와 고양이의 **림프종, 암종, 백혈병 및 육종**을 포함한 다양한 악성 종양에 매우 효과적입니다. * **기원**: 원래 *Streptomyces peucetius*에서 분리되었습니다. * **임상 요점**: 항균 특성을 가지고 있지만, 강력한 세포 독성으로 인해 항감염제로의 사용은 완전히 배제됩니다. 심각한 **발포제(vesicant)**이므로, 치명적인 혈관 외 유출 손상을 방지하기 위해 완벽한 정맥 경로를 확보하는 데 극도의 주의를 기울여야 합니다.

작용 기전: 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.

동물 종별 용량

Dogs

Antineoplastic · 30 mg/m2 IV every 2-3 weeks · IV · every 2-3 weeks · Depending on the protocol used. Maximum cumulative dose = 240 mg/m2.
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 · Administer over a minimum of 10 minutes into side port of freely running 0.9% NaCl.

Cats

Antineoplastic · 20-30 mg/m2 IV every 2-4 weeks · IV · every 2-4 weeks · Depending on the protocol used. Maximum cumulative dose is usually 240 mg/m2.
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 · Nephrotoxicity is a major risk in cats, especially at cumulative dosages >100 mg/m2.

Ferrets

Antineoplastic · 30 mg/m2 IV every 3 weeks · IV · every 3 weeks · Depending on the protocol used.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

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

이상반응

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)

약물 상호작용

Antineoplastic agents, other · May potentiate the toxic effects of doxorubicin
Calcium-channel blockers · Potentially could increase risk for cardiotoxicity associated with doxorubicin
Carbamazepine · Decreased carbamazepine levels
Cisplatin · Increased risk of toxicity for both agents; carefully weigh risks versus benefits
Cyclophosphamide · May increase doxorubicin blood levels (AUC); doxorubicin may potentiate and prolong hematologic toxicity; coma and seizures have been reported in human patients · major
Cyclosporine · Can increase doxorubicin and doxorubicinol (active metabolite) levels
Glucosamine · May reduce doxorubicin effectiveness; use together not recommended in humans
Phenytoin · Doxorubicin may decrease phenytoin levels
Phenobarbital · May increase elimination and reduce blood levels of doxorubicin
Streptozocin · May inhibit doxorubicin metabolism
Verapamil · May increase doxorubicin levels
Warfarin · Increased risk for bleeding
Zidovudine · Increased risk for neutropenia

모니터링

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)

과용량

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.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.