Hepatotoxicity doxorubicin

DOXORUBICIN AZATHIOPRINE t risk of myelosuppression and immunosuppression. Deaths have occurred following profound myelosuppression and severe sepsis. Additive myelotoxic effects. Azathioprine is metabolized to 6-mercatopurine in vivo, which results in additive myelosuppres-sion, immunosuppression and hepatotoxicity Avoid co-administration... 

DOXORUBICIN MERCAPTOPURINE t risk of hepatotoxicity due to mercaptopurine Uncertain, possibly due to previous treatment with mercaptopurine Avoid co-administration - except in clinical trials... 

One study postulated that the hepatotoxicity of intravenous mercaptopurine can be increased by doxorubicin. 

For compounds metabolized through multiple pathways, which pathway leads to active (or reactive) metabolites in vivo For example, CPR/P450 of the cardiomyocyte was found not to be essential for the cardiotoxidty of doxorubicin, an anticancer drug, which can be metabolized by multiple enzymes, including CPR and carbonyl reductase, in a study that used a cardiomyocyte-specific Cpr-mW mouse (Fang et al., 2008). On the other hand, hepatic CPR/P450 enzymes were found to be essential for the hepatotoxicity and renal toxicity of acetaminophen, which can be metabolized by both phase I and phase II enzymes (Gu et al., 2005). 

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