You know it’s true:
Chemotherapy drugs have notorious reputation, despite they offer patient hope for survival.
When these medicines enter bloodstream and travel throughout the body, they can cause uncomfortable and sometimes dangerous adverse effects.
One of them is Doxorubicin, dubbed “Red Devil” – and here is a comprehensive view of its short-term and long-term chemo side effects as revealed by medical experts and cancer patients.
Doxorubicin Mechanism of Action: How Does It Work for Cancer Treatment?
Doxorubicin, known as the generic name of Adriamycin or Rubex, is a cytotoxic chemotherapy drug used for various cancer treatment.
According to U.S. National Cancer Institute, Doxorubicin is approved to be used alone or with other drugs to treat breast cancer, Hodgkin lymphoma, ovarian cancer, leukemia, small cell lung cancer, bone sarcomas, bladder cancer, and more.
It is meant to slow or stop growth of cancer cells by blocking an enzyme known as topo isomerase.
For cancer cells to divide and grow abnormally, they need the enzyme. However, it can be avoided by using Doxorubicin to stop such continuous uncontrollable replication and growth of cancerous cells.
Adriamycin / Doxorubicin Dose and Administration for Chemotherapy
While Doxorubicin 2 mg/ml concentrate injectable solution is normally used for infusion –
there are many factors that the doctor will evaluate and determine your exact Doxorubicin dosage and schedule, says Chemocare, such as type of cancer, the patient’s weight / height and general health.
Before the start of chemotherapy, a nurse takes blood sample in order to ascertain if it is okay for you to proceed with the treatment.
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If your blood tests are all right, then the doctor or nurse will prepare your chemo treatment, inform when it will be ready and you will be administered with anti sickness drugs before starting your chemo.
- The first red devil chemo method is through a jab, whereby the nurse inputs a thin tube (also known as cannula) into your vein in arm or hand.
- It can be also be given through a fine tube that goes under the skin of your chest and into a vein close by central line.
- The third Doxorubicin administration method is through a fine tube that is put into a vein in your arm and goes up into a vein located in the chest, or also known as PICC line.
- The nurse can give you doxorubicin as an injection directly into the cannula or line. It can be given as a drip to flush it through and this gives you a set of treatment over time.
- Among the other procedures, this chemo drug can also be administered directly into the bladder in order to treat non-invasive bladder cancer, for example. This is effective as it is directly absorbed into the blood stream and rarely affect other parts of the body.
This video shows a breast cancer was receiving her Adriamycin ‘red devil’ chemotherapy treatment:
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Key Side Effect of Anthracycline Drug: Doxorubicin Cardiotoxicity
As this chemotherapy drug is red in color and very toxic, Doxorubicin has a nickname called ‘red devil’, and cardiac toxicity is one of its most concerned side effects.
Doxorubicin in the anthracycline family may cause cumulative and dose-dependent cardiotoxicity, with such damage may cause the heart to be unable to pump enough blood to supply the cancer patient’s body with essential nutrients and oxygen, that may result in death.
Pamela Hallquist Viale, associate professor from the UCSF Helen Diller Family Comprehensive Cancer Center, elaborates more on cardiotoxicity and chemotherapy in this excellent video:
According to medical studies revealed by the U.S. National Library of Medicine:
- The incidence rate of acute Doxorubicin cardiotoxicity is about 11% during and within the 2 to 3 days of its administration.
- Anthracycline-induced cardiotoxicity is especially relevant to adult survivors who received doxorubicin chemo drug treatment during childhood, with upto 65% of them can have echocardiographic evidence of left ventricular contractile abnormalities.
An example is shown in the video below, whereby A’ Lashay shares the story of how breast cancer treatment with red devil chemotherapy drug caused her mother to suffer from heart failure:
Other Common Doxorubicin ‘Red Devil’ Chemo Drug Side Effects
Just like all medicines, doxorubicin is no exception as it also has side effects. It is important to consult your health care team on how to manage the side effects induced by this chemotherapy drug while going on with your daily activities.
The medication given to control some of the side effects should be followed to the latter according to instructions given by the doctor or pharmacist. After thorough treatment, the short term side effects should start to improve as time goes by.
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While each person’s chemotherapy treatment experience will be different, here are some of the common red devil chemo side effects that may happen – including videos from cancer patients who share their personal experience after receiving Doxorubicin treatment:
1. Mouth Sores and Oral Mucositis
Chemotherapy can damage the healthy cells in mouth, makes it difficult for the mouth to fend off germs and heal, leading to infections and sores.
Another common complication of Doxorubicin chemo is oral mucositis, which causes the mucous membranes lining the digestive tract to break down and form ulcers, sometimes with painful inflammation. According to Medscape, mucositis may start within 5 to 10 days after first chemotherapy and lasts for 1 to 2 weeks.
Diarrhea is another side effect that often occurs while on chemo treatment. It is recommended that you drink at least 2.5 liters of water per day in order to keep you hydrated.
Your nurse may also prescribe a soothing cream that should be applied around the rectum. This is because diarrhea can be sometimes severe leading to sore and even break in case it persists.
Dr Jurgens shares his insights about the Doxorubicin-induced side effects in this brief video:
3. Facial flushing
A sudden feel of warmth characterizes this and your face may become red while the drug is being administered. However this normally lasts for only a few minutes.
4. Risk of Infections
It is important to note that chemotherapy reduces the number of white blood cells that help fight infections. However, this can be addressed by use of antibiotics administered either as tablets or as injections in to your blood stream.
While on doxorubicin, patient is prone to risks of getting infections. Signs of infections include headaches, muscle aching, cough, sore throat, pain while passing urine and feeling cold.
5. Bruising, Bleeding Gums and Nose Bleeding
Occurs due to drop in the number of platelets in the body. With low number of platelets, you are prone to get bruised easily, while you may even experience nose bleeding and bleeding gums. This can also be depicted by lots of tiny red spots in your arms or legs known as petechiae.
The remedy for this is platelet transfusion in order to increase your platelet count in your body. This takes about 30 minutes and the platelets start functioning right away.
6. Nausea and Vomiting
Based on research published in the Canadian Family Physician journal, chemo-induced nausea and vomiting is mainly activated by stimulation of the chemoreceptor trigger zone (CTZ) — an area of the brain that reacts to drugs or chemicals in the blood.
Breast cancer survivor Jaymee shared the side effects she experienced after AC chemotherapy — combination of 2 chemo drugs Adriamycin (doxorubicin) and Cyclophosphamide:
According to Mayo Clinic, chemotherapy destroys healthy cells in addition to the cancerous cells, and causes fatigue when the body tries to repair the chemo-induced damage to healthy cells and tissue.
Additionally, some cancers release proteins called cytokines that may cause fatigue as well.
Related read: 9 Cancer Patients Revealed their FIRST Chemo Treatment Side Effects
8. Pale Looking and Experience Difficulty in Breathing
Red blood cells contain hemoglobin that carries oxygen around the body. If the level of red blood cells is low, then less oxygen is getting to the cells hence cause breathlessness and makes one look pale. It is important to have regular checks to understand the number of red blood cells in your body. If they are extremely low, a transfusion is done in order to avoid breathlessness.
9. Allergic Reaction
Some people may have allergic reactions while on the treatment. The signs include feeling dizzy, shivering and a headache. Other includes swelling of the face, backache, chest pain, abdominal pain and cramping, etc.
In the video below, Stage 4 breast cancer patient Nalie shared the symptoms and side effects she experienced after chemo with doxorubicin:
10. High Uric Acid Levels In Body
Increased levels of uric acid in your body may result to building up of crystals in in body tissue and end up causing inflamed joints. It can however be controlled by drinking many fluids in order to flush out excess uric acid in the body.
11. Weight Loss
Weight loss during chemo treatment are common, when cancer patients eat less due to poor appetite, diarrhea, nausea and vomiting, mouth sores, etc.
Recommended read: What To Eat Before / During / After Cancer Chemotherapy Treatment
12. Hair Loss
It is commonly known that chemo drugs can cause hair loss. This includes eyelashes, eyebrows, underarm, leg and pubic hair.
The loss of hair is gradual and starts within 2-3 weeks from the start of chemotherapy. The hair will however grow back once you are done with the treatment. This may take several months.
In video below, Ewing’s sarcoma cancer patient Jeremy Bolduc shared his experiences with Doxorubicin, and what he found was helpful to battle the red devil chemo drug side effects.
Chemo drugs and pain medicines can result in constipation as a side effect.
Chemotherapy can also result in constipation in other ways – when patients eat less food with fibre due to appetite loss, and low level of physical activity that cause bowels to move less often and stools to become harder and difficult to pass.
14. Hand-Foot Syndrome
The skin starts to peel off. The hands and sole of your feet become sore and red. The condition is referred to as palmar-plantar syndrome.
The resulting effect include tingling, feeling numb, pain and dryness.
In video below, stage 4 ovarian cancer patient Sharon Nance shared the picture of hand-foot syndrome that she experienced as adverse effect after received Doxil (a reformulated version of doxorubicin):
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Besides the possibly fatal Doxorubicin cardiotoxicity that weakens the heart muscle, some of the longer-term red devil chemotherapy side effects include:
15. Contraception Risk
It is important to avoid getting pregnant while on treatment or even father a child. This is because the chemotherapy drugs may affect the child adversely especially in the development of the baby.
The doxorubicin treatment may also lead to interfere with fertility, as it may lower men’s sperm count and reduce sperm’s ability to move, while this chemotherapy drug can also cause damage to a woman’s eggs – according to American Cancer Society.
17. Changes in Periods
Chemotherapy sometimes interferes with the cycle of the ovaries. The periods may cease to occur every month and may eventually stop. It might be temporary to some women while to others it might prolong up to menopause.
18. Secondary Leukemia / Cancer
As mentioned by Dr Jurgens in the video above, secondary leukemia is a rare and serious side effect that can come years after receiving Doxorubicin treatment.
Secondary cancers may develop as a late effect of previous cancer treatments, when chemotherapy damage bone marrow stem cells and increases the risk of acute leukemia or myelodysplasia.