Doxorubicin is a type of anthracycline chemotherapy drug used to treat certain types of solid tumors and blood cancers. It has a number of side effects, some more serious than others.
Experts predict more than 2 million people in the United States will receive a new cancer diagnosis in 2025. Many of these individuals will receive chemotherapy (chemo) as part of their treatment.
Doxorubicin is a chemo drug used to treat several types of cancer. You may also hear it called by its nickname, “red devil chemotherapy,” which was coined based on its bright red hue and tendency to cause serious side effects.
This article takes a closer look at doxorubicin, including how it works, what it’s used for, potential side effects, and more.
Like other chemo drugs, doxorubicin interferes with how cells divide. This prevents cancer from growing and spreading.
Doxorubicin is an anthracycline chemo drug. Anthracyclines interfere with enzymes involved in DNA replication, the process by which cells copy their DNA before they divide in two.
The specific enzyme doxorubicin affects is called topoisomerase II. This enzyme normally works to separate and detangle DNA after it has been copied. However, when it cannot perform this function, the cell cannot go on to divide.
A 2023 review notes that, despite being older, anthracyclines like doxorubicin are still some of the most effective cancer drugs. Review authors point out that doxorubicin has been studied in over 2,400 clinical trials.
Doxorubicin can treat a wide variety of cancers, including solid tumors and blood cancers.
According to its prescribing information, doxorubicin is used for the following solid tumors that have metastasized, meaning they have spread from their original site to more distant parts of the body:
Doxorubicin may also be part of your treatment if you have one of the following blood cancers:
Lastly, doxorubicin may be used with other chemo drugs
Doxorubicin may be provided as a liquid solution or as a powder that a healthcare professional mixes with liquid to create a solution.
You receive doxorubicin intravenously (by IV). That means it’s given directly into your bloodstream.
While chemotherapy medications can be given through a catheter placed into your hand or arm, doxorubicin is more likely to be given through a central venous catheter (CVC).
A CVC is a type of catheter that’s placed into a large vein in your chest or arm.
A CVC remains in your body throughout your cancer treatment. This means you don’t have to be repeatedly stuck with a needle each time you go in for chemo. Two common types of CVC are ports and PICC lines.
Doxorubicin can be given as an infusion that lasts 3 to 10 minutes. It may also be given as a continuous IV infusion, which you’ll receive more slowly over a set period via a chemo pump.
Chemo is given in cycles, which include a period of treatment followed by a period of rest so your body can recover. Doxorubicin may be given in 21- or 28-day cycles, meaning you’ll receive it once every 21 or 28 days.
According to the prescribing information for doxorubicin, its most common side effects are:
However, it’s also possible to experience additional side effects while receiving doxorubicin treatment. These may include:
- fatigue
- mouth sores
- reduced appetite
- diarrhea
- skin changes and nail changes
- red, swollen eyes
- pink or red-colored urine up to 48 hours after treatment
Doxorubicin may also cause more serious adverse effects, hence its moniker “red devil.”
Some of these more serious side effects include:
- a severe allergic reaction to doxorubicin called anaphylaxis
- low blood counts, which can lead to anemia, increased infection risk, and easy bruising or bleeding
- extravasation, when doxorubicin leaks into surrounding tissues, which can lead to ulcers and tissue death
- damage to the heart, called cardiotoxicity, which can lead to:
- potentially serious arrhythmias
The cardiotoxicity of doxorubicin is dose-dependent and cumulative. That means that treatment at higher doses, treatment over a long period of time, or both tends to cause more heart damage.
Because of the risk of serious adverse effects, your care team will carefully monitor your health during doxorubicin treatment.
Many oncologists limit doxorubicin to a total amount one can receive in one’s lifetime. This is typically under 550 mg/m2 (milligrams per square meter). The risks of
For example, blood tests like a complete blood count can report the levels of different types of blood cells. Tests like electrocardiogram (EKG) and echocardiography can help a doctor monitor your heart health.
Risk of second cancers
There is also a risk of a second cancer developing after treatment with doxorubicin. Cancers associated with prior treatment with anthracyclines like doxorubicin include:
For example, one 2024 study involved female Hodgkin’s lymphoma survivors who received doxorubicin as part of their treatment. Researchers followed them for a median of 21 years.
At the end of the study, researchers found that study participants treated with doxorubicin had a 1.4-fold higher risk of receiving a breast cancer diagnosis than those who had not received doxorubicin.
If you have reservations about doxorubicin, cannot take it for medical reasons, or your cancer has not responded to it, there may be other chemo options available.
Whether these options are right for you depends on such factors as:
- the specific type of cancer you have
- the stage of the cancer
- the molecular and genetic characteristics of the cancer
- your response to previous treatments
- your age and overall health
Since doxorubicin is typically used for metastatic cancer, it’s also possible that your doctor or oncologist may recommend another type of systemic treatment used for advanced cancers, such as targeted therapy or immunotherapy.
Doxorubicin is an anthracycline chemo drug. It works by interfering with an enzyme involved in DNA replication, preventing cancer cells from dividing.
You may receive doxorubicin for a wide variety of solid tumors and blood cancers. When it’s used for solid tumors, it’s typically used for cancers that have metastasized.
There are several side effects and serious adverse effects associated with doxorubicin, earning it the nickname “red devil.” Because of this, your care team will closely monitor you during treatment.
It’s possible that other chemo or treatment options may be used as alternatives to doxorubicin. Having an open conversation with your doctor can give you a better idea of alternative options and their pros and cons.