Adrim Dosage/Direction for Use

Recommended Dose: Adjuvant Breast Cancer: The recommended dose of doxorubicin is 60 mg/m² administered as an intravenous bolus on day 1 of each 21-day treatment cycle, in combination with cyclophosphamide, for a total of four cycles.
Metastatic Disease, Leukemia, or Lymphoma: The recommended dose of doxorubicin when used as a single agent is 60 to 75 mg/m² intravenously every 21 days.
The recommended dose of doxorubicin, when administered in combination with other chemotherapy drugs, is 40 to 75 mg/m² intravenously every 21 to 28 days.
Consider use of the lower doxorubicin dose in the recommended dose range or longer intervals between cycles for heavily pretreated patients, elderly patients, or obese patients.
Cumulative doses above 550 mg/m² are associated with an increased risk of cardiomyopathy.
Dose Modifications: Cardiac Impairment: Discontinue doxorubicin in patients who develop signs or symptoms of cardiomyopathy.
Hepatic Impairment: Doxorubicin hydrochloride is contraindicated in patients with severe hepatic impairment (Child-Pugh Class C or serum bilirubin >5.0 mg/dL).
Decrease the dose of doxorubicin hydrochloride in patients with elevated serum total bilirubin concentrations as follows: (See Table 1.)

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Preparation and Administration: Do not administer IM or subcutaneously.
A direct push injection is not recommended due to the risk of extravasation.
Administration: Visually inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. Discard if the solution is discolored, cloudy, or contains particulate matter.
Administration by Intravenous Injection: Administer doxorubicin hydrochloride as an intravenous injection through a central intravenous line or a secure and free-flowing peripheral venous line containing 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP.
Administer doxorubicin hydrochloride intravenously over 3 to 10 minutes. Decrease the rate of doxorubicin hydrochloride administration if erythematous streaking along the vein proximal to the site of infusion or facial flushing occur.
Administration by Continuous Intravenous Infusion: Preparation for Continuous Intravenous Infusion: Dilute doxorubicin hydrochloride solution in 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP. Protect from light following preparation until completion of infusion.
Infuse only through a central catheter. Decrease the rate of doxorubicin hydrochloride administration if erythematous streaking along the vein proximal to the site of infusion or facial flushing occur.
Protect from light from preparation for infusion until completion of infusion.
Management of Suspected Extravasation: Discontinue doxorubicin hydrochloride for burning or stinging sensation or other evidence indicating perivenous infiltration or extravasation. Manage confirmed or suspected extravasation as follows: Do not remove the needle until attempts are made to aspirate extravasated fluid.
Do not flush the line.
Avoid applying pressure to the site.
Apply ice to the site intermittently for 15 min 4 times a day for 3 days.
If the extravasation is in an extremity, elevate the extremity.
In adults, consider administration of dexrazoxane.