Caution with other carditoxic drugs such as fluorocil, cyclophosphamide, cisplatin, taxanes

Cardioactive  such as propranolol , calcium channel blockers

Drugs affecting liver function

Potentiated by cimetidine

Live vaccines, heparin,inflammatory recall reaction, possibly with radiation therapy

Primary breast cancer

Myelosuppression ( leucopenia, neutropenia, anaemia ) thrombocytopenia
Secondary AML

GI upset.ucosis, alopecia, lethargy, amenorrhea, bleeding, infection, conjuntivitis/ keratitis
Ulcer, depression, photosentivity, thrombophlebitis

Altered LFTs
Red colored urine discolration

Skin, nail, hyperpigmentation, cardiotoxicity, altered ECG, hyperuricamia, azospermia,
Tumor lysis syndrome, shock, fever

Baseline neutrophil count < 1500 cells/m2
Severe myocardial insufficiency, recent MI, severe arrhthmias

Previous treatment with anhracycline ( max cumulative dose )
Severe hepatic  dysfunction, severe stomatitis
Generalised infection

Special precautions-
Cardiovascular disease
Prior to concomittant  radiotherapy to mediastinal pericardial area.
Previous anthracycline therapy
Renal or hepatic impairment
Hypertensive cardiomyopathy
Bone marrow infiltration
Monitor CBCs, platelet , cardiac , renal, uric acid and hepatic function before and during each treatment
Avoid extravasation
Elderly ( esp. female above 70 years )

Primary breast cancer

Adults- by iv infusion over 15-20 minutes to be repeated in 3-4 week cycles
Total dose may be gven on Day 1 of each cycle or divided equally and given
Days  1 and 8 of each cycle  initially 100- 120mg/m2

Bone marrow dysfunction- consider low starting dose 75 -90  mg/m2

Renal or hepatic impairment ,doseadjustments

Children- not recommended

Contraindicated for use during pregnancy and lactation
Observe caution if required to be used