Acute overdose with doxorubicin will result in acute cardiac alterations, severe myelosuppression (mainly leucopenia and thrombocytopenia), and gastrointestinal toxic effects (mainly mucositis).
Delayed cardiac failure may occur up to six months after the overdosage. Patients should be observed carefully and should signs of cardiac failure arise, be treated along conventional lines.
Single doses of 250 mg and 500 mg of doxorubicin have proved fatal. Such doses may cause acute myocardial degeneration within 24 hours and severe myelosuppression, the effects of which are greatest between 10 and 15 days after administration.
Toxic blood levels have not been established. Doxorubicin is highly protein bound; however, if haemoperfusion is initiated within minutes of an overdose, a reduction in serum levels can be achieved. Haemodialysis is unlikely to be effective.
There is no specific antidote for doxorubicin. Symptomatic supportive measures should be instituted. Support respiratory and cardiac function. Cardiac monitoring is recommended. Particular attention should be given to prevention and treatment of possible severe haemorrhages or infections secondary to severe, persistent bone marrow depression.
Contact the Poisons Information Centre for advice on the management of an overdose.