Substrate and weak inhibitor of CYP3A4, but no indications of CYP-inducing capacity. Side effects such as nausea and vomiting may be potentially porphyrinogenic through reduction in caloric intake.

Doxorubicin is an anthracycline antineoplastic antibiotic isolated from a Steptomyces peucetius strain.

Doxorubicin has a wide therapeutic range and is used in the treatment of e.g. breast cancer, lung cancer, sarcoma, maligant lymphoma, and acute leuecamias. Often used in combination with other antineoplasics. Administered as an intravenous infusion. Common adverse reactions of doxorubicin that can be confused with an acute porphyric attack are vomiting and nausea. It may also colour the ruin red. Side effects such as nausea and vomiting may be potentially porphyrinogenic through reduction in caloric intake.

Doxorubicin is meabolised in the liver from quinone to the highly cytotoxic semiquinone by NADPH cytochrome P450 reductase. Listed as an inhibitor and substrate of CYP 3A4 by Rendic (2002). Baumhäkel et al (2001) found that doxorubicinhad only a minor inhibitory effect on human CYP 3A4. Doxorubicin does not activate PXR (Sinz, 2006; Harmsen, 2009). No interactions described pointing to interference with CYP-metabolism of other drugs. Not listed as CYP-inducer.

Used uneventfully by 2 PV women suffering from breast cancer (Thiery-Vuillemin, 2008). Used uneventfully by 1 AIP women suffering from acute myelogenous leukemia (Wehmeier, 1987). Used uneventfully in 16-year old PV girl suffering from acute lymphoblastic leukemia. (Samuels, 1984). Used uneventfully in PV woman suffering from breast cancer (Scarlett, 1995).

Uneventful use reported in 2 patients with acute porphyria.