Doxorubicin neurotoxicity

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy) vesicant—avoid extravasation use 50% for bilirubin 1.5-3.0 use 25% for bilirubin >3.0 Vincristine—vesicant—avoid extravasation cumulative neurotoxicity—may produce severe constipation maximum 2 mg per administration ... 

Peg Interferon Alfa 2b (PEG-Intron) [Antiviral/ Immunomodulator] WARNING Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disord s. Monitor pts closely Uses Rx Hep C Action Immune modulation Dose 1 mcg/kg/wk SQ 1.5 mcg/kg/wk combined w/ ribavirin Caution [C, X if used w/ ribavirin /-] w/ Hx psychiatric Contra Autoimmune H, decompensated Uvct Dz, hemoglobinopathy Disp Vials 50, 80, 120, 150 mcg/0.5 mL Redipen 50, 80,120,150 mcg/5 mL reconstitute w/ 0.7 mL w/ sterile water SE D ession, insomnia, suicidal behavior, GI upset, neutropenia, thrombocytopenia, alopecia, pruritus Interactions t Myelosuppression W/ antineoplastics t effects OF doxorubicin, theophylline t neurotox W7 vinblastine EMS See Peg Interf on Alfa-2a may cause flu-like Sxs... 

DOCETAXEL DOXORUBICIN t plasma concentrations of docetaxel (t AUC by 50-70%) with t efficacy and also t risk of toxicity, particularly when docetaxel is administered after doxorubicin, compared with administration of docetaxel alone Uncertain possibly due to interference with hepatic microsomal enzymes Monitor closely for T incidence of bone marrow suppression, neurotoxicity, myalgia and fatigue... 

DOXORUBICIN CICLOSPORIN High doses of cidosporin t AUC of doxorubicin by 48% and of a metabolite by 443%. Risk of severe myelosuppression and neurotoxicity Cidosporin inhibits P-gp and selectively inhibits cytochrome P450 isoenzymes, which results in L clearance of doxorubicin Advise patients to report symptoms such as sore throat, fever, bleeding and bruising (i.e. of myelosuppression) and confusion, headache, coma and seizures (i.e. of neurotoxicity). 1 dosage of doxorubicin is often necessaiy... 

L. (2008). Doxorubicin induces biphasic neurotoxicity to rat cortical neurons. Neurotoxicology 29 286-93. 

The vinca alkaloids may have synergistic effects on the nervous system. Amongst 17 patients with metastatic breast cancer given the four-drng combination, vincristine -I- vinblastine -I- doxorubicin + cyclosphosphamide, there was a high incidence of acute neurotoxicity at half the usual therapeutic dose of vincristine and vinblastine (37). 

High-dose ciclosporin increases the serum levels and the myelotoxicity of doxorubicin. An isolated report describes severe neurotoxicity and coma in a patient who had taken ciclosporin and was then subsequently given doxorubicin. Ciclosporin can also increase daunorubicin, epirubicin, idarubicin and mitoxantrone serum levels. 

Acute neurotoxicity and myelotoxicity occurred in a boy with Hodgkin s lymphoma treated with vinblastine, doxorubicin and methotrexate when he was also given itraconazole. The toxicity did not occur when he was given the same chemotherapy without itraconazole. ... 

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