Doxorubicin Ebewe 50mg/25ml Treatment of solid tumors, hematuria and lymphoma cancer

Dosage form Box x 25ml
Specifications Doxorubicin
Ingredient EBewe

Ingredient

Composition information	Content
Doxorubicin	2mg/ml

Uses

Indications

Doxorubicin Ebewe 50mg/25ml drugs are indicated for treatment with solid tumors, hematopoietic cancer and lymphatic systems, including:

Wholesale and lymphocytes, such as Hodgkin lymphoma and Hodgkin non -lymphoma; Neuromuscular tumor; Wilms tumor, head - face - neck, multiple bone marrow.

Doxorubicin has shown anti -alien activity in some animals and are effective in humans but there is no agreement on how doxorubicin and other anthracycline have anti -cancer effects. There are 3 main biochemical mechanisms given: impact on DNA, attaching to cell membranes and activating metabolism through Christmas.

An important cause of treatment failure with doxorubicin and other anthracycline is the development of drug resistance. Overcoming cell resistance with doxorubicin, the use of calcium antagonists such as Verapamil is considered for the main target is cell membranes; Verapamil inhibits slow -channel calcium transport and can increase the cells to increase the absorption of Doxorubicin. Chang et al, 1989 shows that the cellular effect of doxorubicin increases by Verapamil in vitro when used for 3 pancreatic cancer cell lines.

It has also surveyed the role that may be in Doxorubicinol's plasma plasma, the mainstream metabolites of Doxorubicin, but concluded that it is not related to the accumulation of Doxorubicin in the cell. It should be noted that the coordination of doxorubicin and verapamil has shown that it is combined with heavy toxic effects in animals (Sridhar et al, 1992).

Dynamic pharmacokinetics

After using the Doxorubicin intravenous intravenously, there is rapid plasma clearance (t1⁄2 = 10 minutes) and highly attached to tissue. The last waste sale time is about 30 hours. Doxorubicin is partially specialized, mainly into doxorubicinol and a smaller amount into Aglycon, and associated with glucuronide and sulfate. Elimination mainly through bile and fertilizer. About 10% of the dose is eliminated through the kidneys. Doxorubicin attached to plasma proteins is about 50 - 85%. The distribution volume is 800 - 3,500 l/m2.

doxorubicin is not absorbed by oral; The drug does not pass the bloodstream barrier.

In patients with impaired liver function of doxorubicin and metabolites may decrease.

Before taking Doxorubicin Ebewe 50mg/25ml Treatment of solid tumors, hematuria and lymphoma cancer

How to use

doxorubicin can be used intravenously, artery, intravenous infusion for 48 - 96 hours or pump into the bladder. The drug is not allowed to be injected into the spinal cord, intramuscularly, subcutaneously or drink. Absolutely should be avoided from blood vessels because it can cause vascular inflammation and necrosis.

Prolonged drug transmission should only be indicated for special cases.

Aortic injection achieved the high level of medication. Wide necrosis can occur in the tissue spread. Because this injection is dangerous, it is necessary to consider carefully. There should be accurate operation when injected directly (Bolus injection) and/ or injecting in a short time. It is necessary to make sure the needle has entered the right position by testing about 5ml of standard transmission solution (isotonic saline solution) before transmitting medicine. Should clamp the transmission lock above the end of the line of the line, then pump Doxorubicin into the line at the position below the lock to avoid Doxorubicin from the upstream transmission in the infusion cord. Slowly inject the entire amount of Doxorubicin solution into the vein (10-20 minutes). Then unlock the infusion cord to transmit the transmission into the vein to avoid the risk of clogging.

In case of bladder injection, avoid the condition in urine. The reduction of pepper water is approximately 50ml/hour, patients should not drink liquid 12 hours before the treatment procedure is conducted. Patients should change the position lying every 15 minutes while transmitting dripping drugs into the bladder. Usually the transmission time is 1 hour. Next, the patient should urinate.

Before pulling out the drug from the vial and injecting the drug, Doxorubicin should be stored at room temperature. To dilute Doxorubicin solution should use physiological saline.

Should dissolve 50ml doxorubicin with 30-50 ml of physiological saline solution to transmit bladder drip.

If Doxorubicin is exposed to the skin, mucosa, you should wash the contact with water, soap immediately.

Dosage

doxorubicin dose depends on the corresponding treatment cycle, the patient's general condition and the patient's previous treatment. So the following data is just instructions:

Treatment of distance with a dose of 75 mg/m2 body skin every 3 weeks using a single dose or divided into several doses smaller than injected for 2-3 days in a row. The body per day (equivalent to 0.6 mg/kg of body weight) within 3 days or 35 mg/m2 of the body skin (equivalent to 0.8 mg/kg of body weight) within 2 days for the treatment of hematuria system cancer, should not stop the drug less than 10 days. body.

transmitted for a long period of 60 mg/m2 for 48 - 96 hours. Do not exceed 500 - 550 mg/m2 body skin.

The total dose should be reduced to 400 mg/m2 of the body's skin in the following cases: The patient has been irradiated in the medium ventricular area before, used earlier or is taking simultaneously toxic drugs with the heart (such as cyclophosphamid, mitoxantron) or related substances (dualorubicin).

In the case of stomatitis or mucositis, therapy should only continue when the lesions have healed at a decrease to about 50%.

In case of changes in blood formula, with liver and kidney dosage disorders, the dose should be reduced corresponding to the following test results:

The number of white blood cells ≥ 5000/mm3 and the amount of platelets ≥ 150,000/mm3: doxorubicin dose is 100%. Doxorubicin is 50%.

Bilirubin 1.2 - 3 mg/100 ml: Dosage is 50%.

bilirubin> 3 mg/100 ml: Dosage is 25%. Mucosa, heart failure, arrhythmia (within 24 hours) as well as bone marrow inhibitors that peak within 14 days. Treatment recommends is the treatment of mucositis symptoms.

Heart symptoms due to toxicity are largely recovered and temporarily and can lead to non -specific changes on the electrocardiogram (reducing the difference of ST, sinus tachycardia, extras). It may be necessary to prevent infections (just using antibiotics) as well as supplementing the instead of urinary ingredients affected in cases of bone marrow failure.

Chronic poisoning occurs as a special heart disease (left heart failure) especially when accumulating more than 500 mg/m2 of body skin and need symptomatic treatment. It is necessary to perform an echocardiogram, measure the systolic time and nuclear arterial angiography to diagnose myocardial toxicity due to accumulation.

In case of emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when forgetting a dose?

Side Effects

Severe bone marrow failure is usually recovery that may occur after 10-14 days of treatment. The proportion of patients with anemia, thrombocytopenia, leukopenia depends on the dose increased later. The activity of bone marrow failure increases when combined with other anti -cancer drugs (cytostatic) or with radiation, especially if the larger dose is 550 mg/m2 of the body and 400 mg/m2 of the body. Therefore, it is necessary to strictly control the white blood cell formula, red blood cells. With the mentioned doses, leukopenia occurs in the most fleeting and heaviest after 10-14 days. In general, this condition recovers until the 21st day.

As well as other Anthracycline drugs, treatment with doxorubicin can cause heart lesions. The risk of myocardial toxicity increases when the total accumulation dose exceeds 500 mg/m2 of the body in adults and 400 mg/m2 of the body's skin in children. Avoid high levels of drugs that often occur after high -dose intravenous infusion can reduce the toxicity on the heart.

The stage of acute: Most within 24 hours after the beginning of treatment, the first is the electrocardiogram changes that do not depend on the dose such as reducing the length of the St, sinus tachycardia, ventricular tachycardia and ventricular tachycardia. Most of the symptoms on the heart can recover or can be treated with anti -arrhyths. There have been reports of rare cases of patients suffering from life -threatening heart arrhythmia within a few minutes. After the patient has gone over the arrhythmia can be continued.

Late phase: heart poisoning due to drug accumulation and dosage dependent. Late complications are usually congestive heart failure (left heart failure) during treatment or maybe after months or years after treatment has ended (shortness of breath, hands and feet). Anthracyclin caused by anthracyclin combined with a decrease in QRS, prolonging the centrifugal time and reducing the blood of the left ventricle. These manifestations can grow fast and difficult to detect through regular electrocardiograms. Myocardial disease responds well to treatment but may not recover and cause death if not detected early. Difficulty breathing, arms and legs can lead to anthracyclin heart muscle braids. Before treatment with doxorubicin should do electrocardiogram tests, echocardiograms and determine the left ventricular blood emulsion. The heart function must be monitored regularly during and after treatment.

Hair loss has a recovery of about 85% of patients.

Nausea, anorexia, gastric contractions, diarrhea are unwanted side effects but are easy to recover. Gastritis and esophagitis are usually average for 5-10 days and rarely lead to ulcers. Gastrointestinal inflammation lesions (rarely leading to ulcers). The patient's urine is red at the beginning of treatment but returns to normal after 48 hours and has no important symptoms.

Rarely cases of hyperuricemia, kidney disease due to drugs that most occur at the beginning of treatment in patients with leukemia or malignant lymphoma due to rapid destruction of a large number of cells leading to increased serum uric acid.

Allergic reactions: Red rash, itching, urticaria, fever, tremor, danger when anaphylaxis. Rarely cases of patients with nail loss, hyperpigmentation, venous inflammation due to thrombosis, epidermal glass, joint pain, immunodeficiency.

Observed with hyperuricemia in diseases with leukemia and needed treatment with xanthinoxidase inhibitors.

Patients who have been or radioactive treatment may have an increased risk of local reactions in the irradiation area (regression phenomenon) that appears to have healed radiation lesions before using Doxorubicin.

Collaboration for cytarabine can cause colitis to have severe infections. Observed with amenorrhea and sperm when coordinated with other cell pliers.

Radiotherapy combination can cause dermatitis and mucositis on radiation areas. It is also not excluded for secondary tumors caused by drugs.

Unwanted side effects related to drug use: After infusion in small veins or repeated infusion in a vein that can cause sclerosis. If the doxorubicin injection is left out of the medication, it will cause severe local tissue necrosis at the injection site. The risk of thrombosis can be reduced at the injection site when the medical routes of the drug are followed.

Rarely appears along the injecting intravenously (when intravenous injection too fast). Notify the treatment doctor for unwanted effects encountered during treatment.

Notify the physician the unwanted effects when using the drug.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Doxorubicin Ebewe 50mg/25ml contraindications in the following cases:

allergies to an ingredient of the drug. heart). Doxorubicin directly in the bladder if there is cystitis. Caution should be cautious in the case of patients who have or are irradiating the mediastinum, pericardial or post -treatment patients with toxic pills for the heart as well as patients with special clinical conditions due to disease such as anemia, pericarditis and/or myocarditis. There is an increase in the risk of toxicity on the heart when using doxorubicin in these cases.

Be cautious when used

The treatment of drugs in the Anthracycline group is only performed by experienced cancer specialists. Aortic injection is only done by a doctor with specific experience. Essential conditions/medical conditions or medical conditions must be provided for unwanted effects. It is necessary to ensure safe intravenous infusion, otherwise it may occur necrotic and thrombosis. The patient must be closely monitored before, during and after treatment. Monitor hematology parameters: blood formula, granulocytes, red blood cells and platelets. Early treatment of severe bleeding and/or infection also contributes to successful treatment. Checking liver and kidney function such as bilirubin, serum creatinine and dose adjustment are essential.

Hemorrhage urea concentration needs to be treated accordingly for cases of hyper urea. Monitor heart parameters such as electrocardiograms, echocardiography, left ventricular blood emulsion. Early diagnosis and fast treatment is necessary for successful treatment. Control infections: Systemic infections must be controlled before starting treatment. Heart disease before, previously treated with heart poison like anthracycline with high cumulative dose increases the risk of toxicity on the heart. The ratio of benefits/risks must be considered when taking drugs for patients of this group.

Should consult genetic experts if the patient wants to get pregnant after stopping treatment.

The effect of the drug on the ability to drive and operate machinery

doxorubicin can reduce the ability to drive and operate machinery, so it must be cautious if performing these activities while taking the drug.

Use drugs for women during pregnancy and lactation

do not indicate Doxorubicin for pregnant women and for babies. Doxorubicin has manifested fetal toxicity, causing teratogen on experimental animals, not for pregnant women. It is necessary to ensure strict contraception for both male and female patients in the previous time and at least 3 months after therapeutic with doxorubicin. Because doxorubicin is secreted into breast milk, the patient is breastfeeding must be stopped without breastfeeding.

Interactive drug

Interactive drugs occur with all drugs that cause bone marrow inhibitors, toxic pills with heart, poison with the liver. Because doxorubicin can cause increased uric acid levels and therefore may need to be responded by adjusting the dose during combination time to treat gout. Coordinating with cyclosporin can cause neuropathy or coma. Doxorubicin is similar to heparin and alkalin solutions. In general, doxorubicin should not mix with other transmission solutions. Phenobarbital may cause increased doxorubicin clearance. Doxorubicin can reduce the bioavailability of Digoxine (oral).

During the treatment of doxorubicin, do not use active vaccine for patients (patients should avoid contact with people who have just been paralyzed vaccination). Cross resistance occurs with doxorubicin and daunorubicin.

Storage

Store + 2 degrees C + 8 degrees Celsius and avoid light. No frozen.

To be out of reach of children, read the user manual carefully before use.

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