When This Medicine Should Not Be Used:
This medicine is not right for everyone. You should not receive this medicine if you had an allergic reaction to doxorubicin, are pregnant, or have had a recent heart attack.

How to Use This Medicine:
Injectable

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.
• The medicine is usually given once every 21 to 28 days.
• Do not get the medicine on your skin. If it does, wash the area well with soap and water, and tell your caregiver.
• If you feel stinging or burning in your skin where the needle is placed, tell your caregiver right away. Apply ice to the skin for 15 minutes, 4 times each day, to relieve pain or swelling, Do this for 3 days. Tell your doctor if you have blisters, sores, or other skin changes where the needle was placed.
• Drink extra fluids so you will urinate more often and help prevent kidney problems.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• This medicine needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some foods and medicines can affect how doxorubicin works. Tell your doctor if you are also using any of the following:
  
  • St John's wort
  • Mercaptopurine
  • Cyclophosphamide, paclitaxel, , trastuzumab
  • Phenobarbital, phenytoin
  • Verapamil

Warnings While Using This Medicine:

• This medicine may cause birth defects if either partner is using it during conception or pregnancy. Tell your doctor right away if you or your partner becomes pregnant. Use an effective form of birth control during treatment and for 6 months after the last dose of this medicine.
• Tell your doctor if you are breastfeeding, or if you have liver disease, heart disease, or blood or bone marrow problems (myelosuppression). Tell your doctor if you have received other cancer medicine or radiation treatment.
• This medicine may cause the following problems:
  
  • Heart damage, including heart failure (may be permanent)
  • Heart rhythm problem
  • Higher risk of new cancers
  • Skin damage near the injection site
  • Tumor lysis syndrome
• This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children. This medicine may also cause premature menopause.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chest pain
• Fast, pounding, or uneven heartbeat
• Fever, chills, cough, sore throat, and body aches
• Rapid weight gain, swelling in your hands, ankles, or feet, trouble breathing, tiredness
• Severe nausea, mouth sores, diarrhea, or uncontrollable vomiting
• Unusual bleeding, bruising, or weakness

If you notice these less serious side effects, talk with your doctor:

• Changes in menstrual periods
• Hair loss
• Mild nausea, vomiting, diarrhea, mouth sores
• Red urine for 1 to 2 days after treatment

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088