May potentiate the toxicity of other anticancer therapies. Patients w/ history of heart disease, bone-marrow suppression or patients who previously have been treated w/ anthracyclines, or treated w/ radiation in the mediastinum. Patients should recover from the acute toxicities of prior cytotoxic treatment (eg, stomatitis, neutropenia, thrombocytopenia & generalized infections) before beginning treatment. Before or during treatment monitor radiographs of the lungs & chest & ECG; regular monitoring of heart function; daily inspection of the oral cavity & pharynx for mucosal changes; blood tests. Measure liver function prior to start of the treatment. Perform analysis of LVEF using ultrasound or heart scintigraphy. Cardiotoxicity. Assess cardiac function before patients undergo treatment & must be monitored throughout therapy to minimize the risk of incurring severe cardiac impairment. Potential risk factors of cardiotoxicity eg, history of CV disease, previous therapy w/ other anthracyclines or anthracenediones, prior or concomitant radiotherapy to the mediastinal/pericardial area & concomitant use of drugs w/ the ability to suppress cardiac contractility, including cyclophosphamide & 5-fluoruracil. Secondary leukaemia w/ or w/o a preleukaemic phase. Catheter problems (ie, urethral obstruction caused by invasion of intravesical tumour). Serum uric acid may increase. Do not use in the presence in inflammations, ulcerations or diarrhoea. Perivenous misinjection results in local necrosis & thrombophlebitis. Discontinue infusion or inj in case of extravasation & restart in a different blood vessel. Patients who have previously radiotherapy, having radiotherapy concurrently or are planning to have radiotherapy. Not recommended in combination w/ live, attenuated vaccines. Obese patients (>130% ideal body wt). May induce hyperuricaemia. Evaluate blood uric acid levels, K, Ca, phosphate & creatinine after initial treatment. May impart a red colour to the urine. Do not repeat dose in the presence or development of bone marrow depression or buccal ulceration. Men undergoing treatment should use effective contraceptive measures & advised not to father a child during & up to 6 mth after treatment. Patients w/ elevated bilirubin; severe hepatic impairment. May affect ability to drive or operate machinery. Childn & adolescents. Elderly.
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