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Lifetime cumulative dose thresholds for cardiotoxicity from anthracyclines and related agents in adults

Lifetime cumulative dose thresholds for cardiotoxicity from anthracyclines and related agents in adults
Drug Cumulative lifetime limit (mg/m2)
Daunorubicin[1] 400 to 550
Doxorubicin[2] 400
Epirubicin[3] 900
Idarubicin*[4,5] 150
Mitoxantrone[6] 140
Anthracycline cardiotoxicity is dose-dependent. If the cumulative lifetime dose exceeds the thresholds above, the risk of cardiotoxicity increases substantially.
* For idarubicin, there is no consensus on threshold cumulative dose. Some guidelines suggest 150 mg/m2, but others disagree. Refer to UpToDate content on anthracycline cardiotoxicity for further details.
References:
  1. Daunorubicin hydrochloride injection, solution. US National Library of Medicine: DailyMed. Revised February 9, 2021. Hisun Pharmaceuticals USA, Inc. Available online at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9705fa12-499e-41a3-8fb4-f6df0858b851 (Accessed on October 24, 2022).
  2. Doxorubicin hydrochloride. US Food and Drug Administration (FDA) approved product information. Revised October, 2013. Pfizer. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/050467s073lbl.pdf (Accessed on July 20, 2022).
  3. Epirubicin. US Food and Drug Administration (FDA) approved product information. Revised July, 2019. Pfizer. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/050778s024s025lbl.pdf (Accessed on July 20, 2022).
  4. Idarubicin hydrochloride - Drug Summary. Prescribers' digital reference. Available at: https://www.pdr.net/drug-summary/Idamycin-PFS-idarubicin-hydrochloride-1018 (Accessed on July 20, 2022).
  5. IDArubicin - Provider Monograph. Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43861 (Accessed on July 20, 2022).
  6. Mitoxantrone for injection. US Food and Drug Administration (FDA) approved product information. Revised May, 2010. EMD Serono. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/019297s033s034lbl.pdf (Accessed on July 20, 2022).
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