Doxorubicin

The Basics

What is Doxorubicin?

Chemotherapy drug that is a treatment for many different types of cancer.

Brand names for Doxorubicin

Lipodox

How Doxorubicin is classified

Antineoplastic Agents, Antibiotics, Antineoplastic, Antibiotics, Antineoplastic

Doxorubicin During Pregnancy

Doxorubicin pregnancy category

Category DNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Doxorubicin while pregnant

Doxorubicin HCl can cause fetal harm when administered to a pregnant woman. DoxorubicinHCl was teratogenic and embryotoxic in rats and rabbits at doses approximately 0.07 times(based on body surface area) the recommended human dose of 60 mg/m2 . If this drug is usedduring pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patientof the potential hazard to a fetus.Animal DataDoxorubicin HCl was teratogenic and embryotoxic at doses of 0.8 mg/kg/day (about 0.07 timesthe recommended human dose based on body surface area) when administered during the periodof organogenesis in rats. Teratogenicity and embryotoxicity were also seen using discrete periodsof treatment. The most susceptible was the 6- to 9-day gestation period at doses of 1.25mg/kg/day and greater. Characteristic malformations included esophageal and intestinal atresia,tracheo-esophageal fistula, hypoplasia of the urinary bladder, and cardiovascular anomalies.Doxorubicin HCl was embryotoxic (increase in embryofetal deaths) and abortifacient at 0.4mg/kg/day (about 0.07 times the recommended human dose based on body surface area) inrabbits when administered during the period of organogenesis.

Taking Doxorubicin While Breastfeeding

What are recommendations for lactation if you're taking Doxorubicin?

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially anthracyclines such as doxorubicin.[1] It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, the high levels and persistence of doxorubicinol in milk make defining an appropriate abstinence interval difficult. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.

Maternal / infant drug levels

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially anthracyclines such as doxorubicin.[1] It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, the high levels and persistence of doxorubicinol in milk make defining an appropriate abstinence interval difficult. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.

Possible effects of Doxorubicin on milk supply

A study of adolescent males who had received chemotherapy for childhood malignancies found that having received doxorubicin was associated with elevated serum prolactin concentrations.[5]

A woman diagnosed with Hodgkin’s lymphoma during the second trimester of pregnancy received 3 rounds of chemotherapy during the third trimester of pregnancy and resumed chemotherapy 4 weeks postpartum. Milk samples were collected 15 to 30 minutes before and after chemotherapy for 16 weeks after restarting. The regimen consisted of doxorubicin 40 mg, bleomycin 16 units, vinblastine 9.6 mg and dacarbazine 600 mg, all given over a 2-hour period every 2 weeks. The microbial population and metabolic profile of her milk were compared to those of 8 healthy women who were not receiving chemotherapy. The breastmilk microbial population in the patient was markedly different from that of the healthy women, with increases in Acinetobacter sp., Xanthomonadacae and Stenotrophomonas sp. and decreases in Bifidobacterium sp. and Eubacterium sp. Marked differences were also found among numerous chemical components in the breastmilk of the treated woman, most notably DHA and inositol were decreased.[2]

A telephone follow-up study was conducted on 74 women who received cancer chemotherapy at one center during the second or third trimester of pregnancy to determine if they were successful at breastfeeding postpartum. Only 34% of the women were able to exclusively breastfeed their infants, and 66% of the women reported experiencing breastfeeding difficulties. This was in comparison to a 91% breastfeeding success rate in 22 other mothers diagnosed during pregnancy, but not treated with chemotherapy. Other statistically significant correlations included: 1. mothers with breastfeeding difficulties had an average of 5.5 cycles of chemotherapy compared with 3.8 cycles among mothers who had no difficulties; and 2. mothers with breastfeeding difficulties received their first cycle of chemotherapy on average 3.4 weeks earlier in pregnancy. Of the 62 women who received a doxorubicin-containing regimen, 39 had breastfeeding difficulties.[6]

Possible alternatives to Doxorubicin

None listed