Doxorubicin Hcl

Drug overview for DOXORUBICIN HCL (doxorubicin hcl):

Generic name: DOXORUBICIN HCL (dox-oh-REW-beh-sin)
Drug class: Anthracycline Antibiotics
Therapeutic class: Antineoplastics

Doxorubicin is an anthracycline glycoside antineoplastic antibiotic produced by Streptomyces peucetius var. caesius.

Since doxorubicin does not cross the blood-brain barrier or achieve a measurable concentration in CSF, there is a possibility of metastases to the brain and meninges from potentially metastatic tumors.

DRUG IMAGES

DOXORUBICIN 10 MG/5 ML VIAL
DOXORUBICIN 50 MG/25 ML VIAL
DOXORUBICIN 20 MG/10 ML VIAL

The following indications for DOXORUBICIN HCL (doxorubicin hcl) have been approved by the FDA:

Indications:
Acute lymphoid leukemia
Acute myeloid leukemia
Burkitt's lymphoma
Carcinoma of breast
Diffuse large B-cell lymphoma
Follicular lymphoma
Hodgkin's lymphoma
Invasive bladder cancer
Locally advanced breast carcinoma
Malignant neoplasm of lung
Malignant neoplasm of the ovary
Metastatic breast carcinoma
Metastatic gastric cancer
Neuroblastoma
Non-Hodgkin's lymphoma
Osteosarcoma of bone
Small cell lung carcinoma
Soft or connective tissue sarcoma
Thyroid carcinoma
Wilms' tumor

Professional Synonyms:
Acute granulocytic leukemia
Acute leukemic myelosis
Acute lymphatic leukemia
Acute lymphocytic leukemia
Acute lymphogenous leukemia
Acute myelocytic leukemia
Acute myelogenic leukemia
Acute myelogenous leukemia
Acute non-lymphoblastic leukemia
Acute non-lymphocytic leukemia
Advanced breast carcinoma
Anemia lymphatica
Breast carcinoma
Burkitt's tumor
Embryoma of kidney
Embryonal adenomyosarcoma
Embryonal adenosarcoma
Embryonal carcinosarcoma
Embryonal nephroma
Follicular B-cell lymphoma
Follicular B-cell non-Hodgkin's lymphoma
Hodgkin's disease
Invasive malignancy of bladder
Lymphoblastic leukemia
Malignant epithelial neoplasm of thyroid
Malignant epithelial tumor of thyroid
Malignant neoplasm of ovary
Malignant tumor of lung
Malignant tumor of the ovary
Mesoblastic nephroma
Metastatic breast cancer
Metastatic malignancy of breast
Metastatic malignant neoplasm of breast
Metastatic malignant tumor of breast
Metastatic malignant tumor of stomach
Myelosarcoma
Nephroblastoma
Neuroblastoma sympathicum
Non-Hodgkin's type lymphoma
Oat cell carcinoma of the lung
Osteogenic sarcoma
Ovarian cancer
Ovarian malignancy
Renal carcinosarcoma
Small cell lung cancer
Sympathicoblastoma
Sympathicogonioma

The following dosing information is available for DOXORUBICIN HCL (doxorubicin hcl):

Dosing
Administration
Dosing Information
Generic

To obtain optimum therapeutic results with minimum adverse effects, dosage of doxorubicin hydrochloride must be based on the clinical, cardiac, hepatic, renal, and hematologic response and tolerance of the patient and on other chemotherapy or irradiation being used. Dosage reduction may be necessary in patients who have received extensive prior radiation therapy or in those whose bone marrow has been infiltrated with malignant cells, since severe myelosuppression is likely to occur. Clinicians should consult published protocols for the dosage of doxorubicin hydrochloride and other chemotherapeutic agents and the method and sequence of administration.

Dosage of doxorubicin hydrochloride is based indirectly on body weight; if the patient has abnormal fluid retention, the patient's ideal weight is used to calculate body surface area.

Accidental substitution of liposomal doxorubicin for conventional doxorubicin hydrochloride injection has resulted in severe adverse effects. Liposomal doxorubicin hydrochloride should not be substituted for conventional doxorubicin hydrochloride, and the drugs are not equivalent on a mg per mg basis.

The total cumulative dose of doxorubicin hydrochloride should not exceed 550 mg/m2 because of the risk of potentially irreversible cardiotoxicity, but higher cumulative doses may be tolerated when dexrazoxane (Zinecard(R)) is used concomitantly as a cardioprotectant. (See Cautions: Cardiac Effects.) If previous or concomitant therapy includes the use of other potentially cardiotoxic agents, such as cyclophosphamide, or irradiation of the cardiac region, total doxorubicin hydrochloride dosage should not exceed 400 mg/m2. The total dosage of doxorubicin hydrochloride should include any previous or concomitant therapy with other anthracycline agents or related compounds.

In adults with impairment of hepatic function, conventional or liposomal doxorubicin dosage must be reduced. Patients with serum bilirubin concentrations of 1.2-3 mg/dL should receive 50% of the usual dose of doxorubicin hydrochloride and those with serum bilirubin concentrations exceeding 3 mg/dL should receive 25% of the usual dose.

No enhanced Administration information available for this drug.

No dosing information available.

No generic dosing information available.

The following drug interaction information is available for DOXORUBICIN HCL (doxorubicin hcl):

Contraindicated
Severe
Moderate

There are 4 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction	Drug Names
Efalizumab; Natalizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Natalizumab,(1-3) efalizumab,(4) immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of natalizumab(1-3) or efalizumab(4) with immunosuppressives or immunomodulators may result in an increased risk of infections, including progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV). PREDISPOSING FACTORS: Previous JCV infection, longer duration of natalizumab treatment - especially if greater than 2 years, and prior or concomitant treatment with immunosuppressant medication are all independent risk factors which increase the risk for PML.(1,5) The FDA has estimated PML incidence stratified by risk factors: If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment less than 25 months, incidence <1/1,000. If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment less than 25 months, incidence 2/1,000 If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 4/1,000 If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 11/1,000. PATIENT MANAGEMENT: The US manufacturer of natalizumab states patients with Crohn's disease should not receive concurrent immunosuppressants, with the exception of limited overlap of corticosteroids, due to the increased risk for PML. For new natalizumab patients currently receiving chronic oral corticosteroids for Crohn's Disease, begin corticosteroid taper when therapeutic response to natalizumab has occurred. If corticosteroids cannot be discontinued within six months of starting natalizumab, discontinue natalizumab.(3) The US manufacturer of natalizumab states that natalizumab should not ordinarily be used in multiple sclerosis patients receiving immunosuppressants or immunomodulators due to the increased risk for PML. Immunosuppressives include, but are not limited to azathioprine, cyclophosphamide, cyclosporine, mercaptopurine, methotrexate, mitoxantrone, mycophenolate, and corticosteroids.(3,6) The UK manufacturer of natalizumab states that concurrent use with immunosuppressives or antineoplastic agents is contraindicated.(1) The Canadian manufacturer of natalizumab states that natalizumab should not be used with immunosuppressive or immunomodulatory agents.(2) The US manufacturer of certolizumab states that concurrent therapy with natalizumab is not recommended.(7) DISCUSSION: Progressive multifocal leukoencephalopathy has been reported in patients receiving concurrent natalizumab were recently or concomitantly taking immunomodulators or immunosuppressants.(1-5,8,9) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(10)	TYSABRI
Live Vaccines; Live BCG/Selected Immunosuppressive Agents SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: A variety of disease modifying agents suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(1) CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(2) PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency. PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1) Patients who receive anti-B cell therapies should not receive live vaccines for at least 6 months after such therapies due to a prolonged duration of immunosuppression. An exception is the Zoster vaccine, which can be given at least 1 month after receipt of anti-B cell therapies.(1) The US manufacturer of abatacept states live vaccines should not be given during or for up to 3 months after discontinuation of abatacept.(2) The US manufacturer of live BCG for intravesicular treatment of bladder cancer states use is contraindicated in immunosuppressed patients.(3) The US manufacturer of daclizumab states live vaccines are not recommended during and for up to 4 months after discontinuation of treatment.(4) The US manufacturer of guselkumab states that live vaccines should be avoided during treatment with guselkumab.(5) The US manufacturer of inebilizumab-cdon states that live vaccines are not recommended during treatment and after discontinuation until B-cell repletion. Administer all live vaccinations at least 4 weeks prior to initiation of inebilizumab-cdon.(6) The US manufacturer of ocrelizumab states that live vaccines are not recommended during treatment and until B-cell repletion occurs after discontinuation of therapy. Administer all live vaccines at least 4 weeks prior to initiation of ocrelizumab.(7) The US manufacturer of ozanimod states that live vaccines should be avoided during and for up to 3 months after discontinuation of ozanimod.(8) The US manufacturer of siponimod states that live vaccines are not recommended during treatment and for up to 4 weeks after discontinuation of treatment.(9) The US manufacturer of ustekinumab states BCG vaccines should not be given in the year prior to, during, or the year after ustekinumab therapy.(10) The US manufacturer of satralizumab-mwge states that live vaccines are not recommended during treatment and should be administered at least four weeks prior to initiation of satralizumab-mwge.(11) The US manufacturer of ublituximab-xiiy states that live vaccines are not recommended during treatment and until B-cell recovery. Live vaccines should be administered at least 4 weeks prior to initiation of ublituximab-xiiy.(12) The US manufacturer of etrasimod states that live vaccines should be avoided during and for 5 weeks after treatment. Live vaccines should be administered at least 4 weeks prior to initiation of etrasimod.(13) The US manufacturer of emapalumab-lzsg states that live vaccines should not be administered to patients receiving emapalumab-lzsg and for at least 4 weeks after the last dose of emapalumab-lzsg. The safety of immunization with live vaccines during or following emapalumab-lzsg therapy has not been studied.(14) DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1)	ACAM2000 (NATIONAL STOCKPILE), ADENOVIRUS TYPE 4, ADENOVIRUS TYPE 4 AND TYPE 7, ADENOVIRUS TYPE 7, BCG (TICE STRAIN), BCG VACCINE (TICE STRAIN), DENGVAXIA, ERVEBO (NATIONAL STOCKPILE), FLUMIST TRIVALENT 2024-2025, IXCHIQ, M-M-R II VACCINE, PRIORIX, PROQUAD, ROTARIX, ROTATEQ, STAMARIL, VARIVAX VACCINE, VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE, VIVOTIF, YF-VAX
Talimogene laherparepvec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Talimogene laherparepvec is a live, attenuated herpes simplex virus.(1) CLINICAL EFFECTS: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Talimogene laherparepvec is contraindicated in immunosuppressed patients.(1) The magnitude of immunocompromise and associated risks due to immunosuppressant drugs should be determined by a physician. DISCUSSION: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1)	IMLYGIC
Nadofaragene Firadenovec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Nadofaragene firadenovec may contain low levels of replication-competent adenovirus.(1) CLINICAL EFFECTS: Concurrent use of nadofaragene firadenovec in patients receiving immunosuppressive therapy may cause disseminated adenovirus infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Individuals who are immunosuppressed or immune-deficient should not receive nadofaragene firadenovec.(1) DISCUSSION: Nadofaragene firadenovec is a non-replicating adenoviral vector-based gene therapy but may contain low levels of replication-competent adenovirus. Immunocompromised persons, including those receiving immunosuppressant therapy, may be at risk for disseminated adenovirus infection.(1)	ADSTILADRIN

There are 22 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Stavudine; Zidovudine/Doxorubicin SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Doxorubicin may inhibit the phosphorylation of stavudine(1,2) and zidovudine(3) to their active forms. Prolonged use of zidovudine may result in the resistance of tumor cells to doxorubicin.(4) CLINICAL EFFECTS: The concurrent use of doxorubicin may result in decreased levels and effectiveness of stavudine(1) and zidovudine.(3) Prolonged use of zidovudine may result in decreased effectiveness of doxorubicin.(4) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of stavudine states that concurrent use of doxorubicin should be approached with caution.(2) The US manufacturer of zidovudine states that the concomitant use of zidovudine and doxorubicin should be avoided.(5) DISCUSSION: An in vitro study showed that doxorubicin inhibits the intracellular phosphorylation of stavudine to its active form at clinically relevant concentrations.(1) An in vitro study showed that doxorubicin inhibits the intracellular phosphorylation of zidovudine to its active form.(3) Another in vitro study found that long-term exposure to zidovudine decreased cell sensitivity to doxorubicin.(4)	LAMIVUDINE-ZIDOVUDINE, RETROVIR, ZIDOVUDINE
Deferiprone/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis may increase the frequency or risk for severe toxicity.(1) CLINICAL EFFECTS: Concurrent use of deferiprone and myelosuppressive agents may result in severe neutropenia or agranulocytosis, which may be fatal. PREDISPOSING FACTORS: Agranulocytosis may be less common in patients receiving deferiprone for thalassemia, and more common in patients treated for other systemic iron overload conditions (e.g. myelodysplastic syndromes, sickle cell disease).(2,3) Inadequate monitoring appears to increase the risk for severe outcomes. Manufacturer post market surveillance found that in all fatal cases of agranulocytosis reported between 1999 and 2005, data on weekly white blood count (WBC) monitoring was missing. In three fatal cases, deferiprone was continued for two to seven days after the detection of neutropenia or agranulocytosis.(2) PATIENT MANAGEMENT: If possible, discontinue one of the drugs associated with risk for neutropenia or agranulocytosis. If alternative therapy is not available, documentation and adherence to the deferiprone monitoring protocol is essential. Baseline absolute neutrophil count (ANC) must be at least 1,500/uL prior to starting deferiprone. Monitor ANC weekly during therapy. If infection develops, interrupt deferiprone therapy and monitor ANC more frequently. If ANC is less than 1,500/uL but greater than 500/uL, discontinue deferiprone and any other drugs possibly associated with neutropenia. Initiate ANC and platelet counts daily until recovery (i.e. ANC at least 1,500/uL). If ANC is less than 500/uL, discontinue deferiprone, evaluate patient and hospitalize if appropriate. Do not resume deferiprone unless potential benefits outweigh potential risks.(1) DISCUSSION: Drugs linked to this monograph have an FDA Boxed Warning for risk of neutropenia, agranulocytosis, or pancytopenia, or have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(1-25) In pooled clinical studies submitted to the FDA, 6.1% of deferiprone patients met criteria for neutropenia and 1.7% of patients developed agranulocytosis.(1) The time to onset of agranulocytosis was highly variable with a range of 65 days to 9.2 years (median, 161 days).(3)	DEFERIPRONE, DEFERIPRONE (3 TIMES A DAY), FERRIPROX, FERRIPROX (2 TIMES A DAY), FERRIPROX (3 TIMES A DAY)
Anthracyclines/Trastuzumab SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Trastuzumab and anthracyclines are independently associated with a risk for cardiotoxicities such as heart failure and cardiomyopathy. Prescribing information for each agent includes an FDA Boxed Warning describing these risks. Concurrent or sequential use of an anthracycline and trastuzumab further increases the risk for cardiotoxicity.(1-8) CLINICAL EFFECTS: Cardiotoxicity may manifest as asymptomatic or symptomatic left ventricular dysfunction (LVD), arrhythmias, hypertension, heart failure or cardiomyopathy.(1,2) Early signs of LVD are often asymptomatic; diagnosis may be delayed in the absence routine measurement of left ventricular ejection fraction (LVEF).(3) Cardiac dysfunction from this combination may be irreversible. PREDISPOSING FACTORS: The elderly, patients with a history of prior anthracycline or mediastinal radiation therapy, with underlying cardiac disease, or with elevated cardiac biomarkers (e.g. troponin, BNP) during or after therapy appear to be at higher risk for cardiotoxicity.(1,3,8) PATIENT MANAGEMENT: If possible, avoid anthracycline-based therapy for up to 7 months after stopping trastuzumab. (1,9) When both trastuzumab and an anthracycline are included in a chemotherapeutic regimen close monitoring is needed to minimize the risk for permanent heart damage. Monitoring recommendations from the manufacturer of trastuzumab(1): - Prior to treatment conduct thorough cardiac assessment, including history, physical examination, and determination of left ventricular ejection fraction (LVEF). - Measure LVEF every 3 months during trastuzumab therapy. - Withhold trastuzumab dose at least 4 weeks for reduction of LVEF >= 16% from pre-treatment values, or if LVEF is below institutional limits of normal and LVEF is reduced >= 10% from pre-treatment baseline values. Trastuzumab may be resumed if LVEF improves to above threshold hold parameters within 4 to 8 weeks and the absolute decrease from baseline is <= 15%. If a dose is held for left ventricular dysfunction repeat LVEF measurements at 4 week intervals. - Discontinue trastuzumab for persistent LVEF decline for > 8 weeks, or if dose has been held on more than 3 occasions for cardiomyopathy. - Repeat LVEF evaluation upon trastuzumab completion and then every 6 months for a minimum of 2 years after treatment. American Heart Association(AHA)/American College of Cardiology(ACC) and European Society of Medical Oncology(ESMO) treatment guidelines recommend use of ACE Inhibitors or ARBs and beta blockers in asymptomatic patients with reduced LVEF. Patients who develop overt heart failure should receive standard heart failure therapies.(3,4) DISCUSSION: While treatment with both anthracyclines and trastuzumab may be optimal cancer treatment, there is growing awareness of an increased risk for heart failure or cardiomyopathy in this population. To decrease risk for symptomatic heart failure consider cardiology consultation, particularly in patients with predisposing risk factors, to assure appropriate assessment and preventative treatment. A retrospective study of oncology patients treated with an anthracycline and/or trastuzumab examined treatments provided for symptomatic or asymptomatic decreases in LVEF. All 88 patients received at least one pre and one post chemotherapy echocardiogram. Thirty-five patients (40%) had decreased LVEF after receiving chemotherapy; 26 patients were asymptomatic while 9 were symptomatic. All 9 symptomatic patients received recommended beta blocker therapy and 6 also received an ACEI or ARB. Only 9 of 26 asymptomatic patients received recommended beta blockers; 8 of 26 received recommended ACEI/ARB therapy. Based upon chart review, none of the asymptomatic patients had contraindications to either therapy. This treatment rate for decreased LVEF is significantly lower than the 98% background treatment compliance rate at this institution.(5) A large retrospective cohort study examined heart failure risk after anthracycline and /or trastuzumab therapy. The cohort included 12,500 women diagnosed with invasive breast cancer; 442 women received trastuzumab and an anthracycline. The cumulative incidence of heart failure or cardiomyopathy on the combination was 6.2 % at one year, increasing to 20.1 % at five years with a hazard ratio(HR) of 7.19 (CI = 5.00 to 10.35) for anthracycline plus trastuzumab compared with no chemotherapy.(6) A large epidemiologic study evaluated Medicare data to determine the risk for heart failure or cardiomyopathy in 45,537 older women (mean age 76.2 years) diagnosed with early stage breast cancer. Over a 3 year period the cumulative incidence of heart failure or cardiomyopathy in women who received no chemotherapy, an anthracycline, trastuzumab, or anthracycline and trastuzumab therapy was 18.1%, 20.2%, 32.1% and 41.9% respectively.(8)	ENHERTU, HERCEPTIN, HERCEPTIN HYLECTA, HERCESSI, HERZUMA, KADCYLA, KANJINTI, OGIVRI, ONTRUZANT, PHESGO, TRAZIMERA
Tofacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of tofacitinib and azathioprine, other biologic disease-modifying antirheumatic drugs (DMARDs), or potent immunosuppressants may result in additive or synergistic effects on the immune system.(1) CLINICAL EFFECTS: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants use may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Tofacitinib should not be used concurrently with azathioprine, other biologic DMARDs, or cyclosporine.(1) Patient should be monitored for decreases in lymphocytes and neutrophils. Therapy should be adjusted based on the indication. - For all indications: If absolute neutrophil count (ANC) or lymphocyte count is less than 500 cells/mm3, discontinue tofacitinib. - For rheumatoid arthritis or psoriatic arthritis and absolute neutrophil count (ANC) 500 to 1000 cells/mm3: interrupt dosing. When ANC is greater than 1000 cells/mm3, resume Xeljanz 5 mg twice daily or Xeljanz XR 11 mg once daily. - For ulcerative colitis and ANC 500 to 1000 cells/mm3: -If taking Xeljanz 10 mg twice daily, decrease to 5 mg twice daily. When ANC is greater than 1000 cells/mm3, increase to 10 mg twice daily based on clinical response. -If taking Xeljanz 5 mg twice daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 5 mg twice daily. -If taking Xeljanz XR 22 mg once daily, decrease to 11 mg once daily. When ANC is greater than 1000 cells/mm3, increase to 22 mg once daily based on clinical response. -If taking Xeljanz XR 11 mg once daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 11 mg once daily. - For polyarticular course juvenile idiopathic arthritis (pcJIA) and ANC 500 to 1000 cells/mm3: interrupt dosing until ANC is greater than 1000 cells/mm3.(1) DISCUSSION: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants may increase the risk of infection.(1)	TOFACITINIB CITRATE, XELJANZ, XELJANZ XR
Clozapine/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Clozapine and other myelosuppressive agents may be associated with neutropenia or agranulocytosis.(2) CLINICAL EFFECTS: Moderate neutropenia, even if due to combination therapy, may require abrupt discontinuation of clozapine resulting in decompensation of the patient's psychiatric disorder (e.g. schizophrenia). The disease treated by the myelosuppressive agent may be compromised if myelosuppression requires dose reduction, delay, or discontinuation of the myelosuppressive agent. Undetected severe neutropenia or agranulocytosis may be fatal. PREDISPOSING FACTORS: Low white blood counts prior to initiation of the myelosuppressive agent may increase risk for clinically significant neutropenia. PATIENT MANAGEMENT: If a patient stabilized on clozapine therapy requires treatment with a myelosuppressive agent, the clozapine prescriber should consult with prescriber of the myelosuppressive agent (e.g. oncologist) to discuss treatment and monitoring options.(2) More frequent ANC monitoring or treatment alternatives secondary to neutropenic episodes may need to be considered. Clozapine is only available through a restricted distribution system which requires documentation of the absolute neutrophil count (ANC) prior to dispensing.(1-2) For most clozapine patients, clozapine treatment must be interrupted for a suspected clozapine-induced ANC < 1000 cells/microliter. For patients with benign ethnic neutropenia (BEN), treatment must be interrupted for suspected clozapine-induced neutropenia < 500 cells/microliter.(2) DISCUSSION: Clozapine is only available through a restricted distribution system which requires documentation of the ANC prior to dispensing.(1) Agents linked to this interaction generally have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(3-26)	CLOZAPINE, CLOZAPINE ODT, CLOZARIL, VERSACLOZ
Selected Multiple Sclerosis Agents/Immunosuppressants; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ocrelizumab or ofatumumab in combination with immunosuppressives and immune-modulators all suppress the immune system.(1,2) CLINICAL EFFECTS: Concurrent use of ocrelizumab or ofatumumab with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1,2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ocrelizumab US prescribing information states: - Ocrelizumab and other immune-modulating or immunosuppressive therapies, (including immunosuppressant doses of corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with ocrelizumab. When switching from drugs with prolonged immune effects, such as daclizumab, fingolimod, natalizumab, teriflunomide, or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating ocrelizumab.(1) The ofatumumab US prescribing information states: - Ofatumumab and other immunosuppressive therapies (including systemic corticosteroids) may have the potential for increased immunosuppressive effects and increase the risk of infection. When switching between therapies, the duration and mechanism of action of each therapy should be considered due to the potential for additive immunosuppressive effects. Ofatumumab for MS therapy has not been studied in combination with other MS agents that suppress the immune system.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1,2) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(3)	KESIMPTA PEN, OCREVUS, OCREVUS ZUNOVO
Upadacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Upadacitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of upadacitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of upadacitinib states that concurrent use of upadacitinib with immunosuppressives or immunomodulators is not recommended. DISCUSSION: Serious infections have been reported in patients receiving upadacitinib. Reported infections included pneumonia, cellulitis, tuberculosis, multidermatomal herpes zoster, oral/esophageal candidiasis, cryptococcosis. Reports of viral reactivation, including herpes virus reactivation and hepatitis B reactivation, were reported in clinical studies with upadacitinib.(1)	RINVOQ, RINVOQ LQ
Inebilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inebilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of inebilizumab with immunosuppressive or immunomodulating agents may result in myelosuppression including neutropenia resulting in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of inebilizumab states that the concurrent use of inebilizumab with immunosuppressive agents, including systemic corticosteroids, may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Inebilizumab has not been studied in combination with other immunosuppressants. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents. The most common infections reported by inebilizumab treated patients in the randomized and open-label clinical trial periods included urinary tract infections (20%), nasopharyngitis (13%), upper respiratory tract infections (8%), and influenza (7%). Although there been no cases of Hepatitis B virus reactivation or progressive multifocal leukoencephalopathy reported in patients taking inebilizumab, these infections have been observed in patients taking other B-cell-depleting antibodies.(1)	UPLIZNA
Baricitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of baricitinib with other biologic disease-modifying antirheumatic drugs (DMARDs) or potent immunosuppressants such as azathioprine or cyclosporine may result in additive or synergistic effects on the immune system. CLINICAL EFFECTS: Concurrent use of baricitinib with other biologic DMARDs or potent immunosuppressants such as azathioprine or cyclosporine may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of baricitinib states that concurrent use of baricitinib with biologic DMARDs or potent immunosuppressants is not recommended.(1) DISCUSSION: Most patients who developed serious infections while being treated with baricitinib were on concomitant immunosuppressants like methotrexate and corticosteroids. The combination of baricitinib with other biologic DMARDs has not been studied.(1)	OLUMIANT
Doxorubicin/Strong CYP3A4 Inhibitors SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Agents that inhibit the CYP3A4 isoenzyme may inhibit the metabolism of doxorubicin.(1) CLINICAL EFFECTS: Concurrent use of strong CYP3A4 inhibitors may increase levels of and effects from doxorubicin, including cardiomyopathy, myelosuppression, or hepatic impairment.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid the use of strong CYP3A4 inhibitors in patients undergoing therapy with doxorubicin.(1) Consider alternatives with no or minimal enzyme inhibition. DISCUSSION: Doxorubicin is a substrate of CYP3A4.(1) Strong inhibitors of CYP3A4 include: adagrasib, boceprevir, ceritinib, clarithromycin, cobicistat, idelalisib, indinavir, itraconazole, josamycin, ketoconazole, lonafarnib, lopinavir, mibefradil, mifepristone, nefazodone, nelfinavir, nirmatrelvir/ritonavir, paritaprevir, posaconazole, ribociclib, saquinavir, telaprevir, telithromycin, tipranavir, troleandomycin, tucatinib, or voriconazole.(2,3)	APTIVUS, CLARITHROMYCIN, CLARITHROMYCIN ER, EVOTAZ, GENVOYA, ITRACONAZOLE, ITRACONAZOLE MICRONIZED, KALETRA, KETOCONAZOLE, KISQALI, KORLYM, KRAZATI, LANSOPRAZOL-AMOXICIL-CLARITHRO, LOPINAVIR-RITONAVIR, MIFEPREX, MIFEPRISTONE, NEFAZODONE HCL, NOXAFIL, OMECLAMOX-PAK, PAXLOVID, POSACONAZOLE, PREZCOBIX, RECORLEV, SPORANOX, STRIBILD, SYMTUZA, TOLSURA, TUKYSA, TYBOST, VFEND, VFEND IV, VIRACEPT, VOQUEZNA TRIPLE PAK, VORICONAZOLE, ZOKINVY, ZYDELIG, ZYKADIA
Leflunomide; Teriflunomide/Selected Immunosuppressants SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of leflunomide or teriflunomide and potent immunosuppressants may result in additive or synergistic effects on the immune system.(1,2) Leflunomide is a prodrug and is converted to its active metabolite teriflunomide.(1) CLINICAL EFFECTS: Concurrent use of leflunomide or teriflunomide with immunosuppressants may result in an increased risk of serious infections, including opportunistic infections, especially Pneumocystis jiroveci pneumonia, tuberculosis (including extra-pulmonary tuberculosis), and aspergillosis. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If leflunomide or teriflunomide is used concurrently with immunosuppressive agents, chronic CBC monitoring should be performed more frequently, every month instead of every 6 to 8 weeks. If bone marrow suppression or a serious infection occurs, leflunomide or teriflunomide should be stopped and rapid drug elimination procedure should be performed.(1,2) DISCUSSION: Pancytopenia, agranulocytosis and thrombocytopenia have been reported in patients receiving leflunomide or teriflunomide alone, but most frequently in patients taking concurrent immunosuppressants.(1,2) Severe and potentially fatal infections, including sepsis, have been reported in patients receiving leflunomide or teriflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Tuberculosis has also been reported.(1,2)	ARAVA, AUBAGIO, LEFLUNICLO, LEFLUNOMIDE, TERIFLUNOMIDE
Ponesimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ponesimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ponesimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ponesimod US prescribing information states ponesimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ponesimod after alemtuzumab is not recommended. However, ponesimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1)	PONVORY
Sodium Iodide I 131/Myelosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1) DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1)	HICON, SODIUM IODIDE I-131
Fingolimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fingolimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-3) CLINICAL EFFECTS: Concurrent use of fingolimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-3) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for fingolimod regarding this interaction differ between regulatory approving agencies. The fingolimod US prescribing information states: - Antineoplastic, immune-modulating, or immunosuppressive therapies, (including corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with fingolimod. When switching from drugs with prolonged immune effects, such as natalizumab, teriflunomide or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating fingolimod.(1) The fingolimod Canadian prescribing information states: - Concurrent use with immunosuppressive or immunomodulatory agents is contraindicated due to the risk of additive immune system effects. However, co-administration of a short course of corticosteroids (up to 5 days) did not increase the overall rate of infection in patients participating Phase III clinical trials.(2) The fingolimod UK specific product characteristics states: - Fingolimod is contraindicated in patients currently receiving immunosuppressive therapies or those immunocompromised by prior therapies. When switching patients from another disease modifying therapy to Gilenya, the half-life and mode of action of the other therapy must be considered in order to avoid an additive immune effect whilst at the same time minimizing the risk of disease activation.(3) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-3)	FINGOLIMOD, GILENYA, TASCENSO ODT
Ozanimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ozanimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ozanimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ozanimod US prescribing information state this information regarding this interaction: -Ozanimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ozanimod after alemtuzumab is not recommended. However, ozanimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1)	ZEPOSIA
Siponimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Siponimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of siponimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The siponimod US prescribing information state this information regarding this interaction: -Siponimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with siponimod after alemtuzumab is not recommended. However, siponimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1)	MAYZENT
Cladribine/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Cladribine in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-2) CLINICAL EFFECTS: Concurrent use of cladribine with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for cladribine regarding this interaction differ between regulatory approving agencies. The cladribine US prescribing information states: -Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended. Acute short-term therapy with corticosteroids can be administered. In patients who have previously been treated with immunomodulatory or immunosuppressive drugs, consider potential additive effect, the mode of action, and duration of effect of the other drugs prior to initiation of cladribine.(1) The cladribine Canadian prescribing information states: -Use of cladribine in immunocompromised patients is contraindicated because of a risk of additive effects on the immune system. Acute short-term therapy with corticosteroids can be administered during cladribine treatment.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-2)	CLADRIBINE, MAVENCLAD
Doxorubicin/P-glycoprotein (P-gp) Inhibitors SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: P-glycoprotein (P-gp) inhibition may increase doxorubicin cellular concentration, as well as decrease biliary or renal elimination.(1) CLINICAL EFFECTS: Increased cellular or systemic levels of doxorubicin may result in doxorubicin toxicity, including cardiomyopathy, myelosuppression, or hepatic impairment.(1) PREDISPOSING FACTORS: The interaction magnitude may be greater in patients with impaired renal or hepatic function. PATIENT MANAGEMENT: Avoid the concurrent use of P-gp inhibitors in patients undergoing therapy with doxorubicin.(1) Consider alternatives with no or minimal inhibition. If concurrent therapy is warranted, monitor the patient closely for signs and symptoms of doxorubicin toxicity. DISCUSSION: Doxorubicin is a substrate of P-gp.(1) Clinical studies have identified and evaluated the concurrent use of doxorubicin and P-gp inhibitors as a target to overcome P-gp mediated multidrug resistance.(2,3) P-gp inhibitors linked to this monograph include: amiodarone, asciminib, asunaprevir, azithromycin, belumosudil, capmatinib, cimetidine, cyclosporine, daclatasvir, danicopan, daridorexant, diltiazem, diosmin, dronedarone, eliglustat, erythromycin, flibanserin, fluvoxamine, fostamatinib, ginkgo, ginseng, glecaprevir/pibrentasvir, hydroquinidine, istradefylline, ivacaftor, lapatinib, ledipasvir, mavorixafor, neratinib, osimertinib, paroxetine, pirtobrutinib, propafenone, quercetin, quinidine, quinine, ranolazine, sarecycline, schisandra, selpercatinib, simeprevir, sofosbuvir/velpatasvir/voxilaprevir, sotorasib, tepotinib, tezacaftor, valbenazine, vemurafenib, verapamil, vimseltinib, and voclosporin.(4,5)	ADDYI, ALYFTREK, AMIODARONE HCL, AMIODARONE HCL-D5W, ASPRUZYO SPRINKLE, AZITHROMYCIN, CARDIZEM, CARDIZEM CD, CARDIZEM LA, CARTIA XT, CERDELGA, CIMETIDINE, CYCLOSPORINE, CYCLOSPORINE MODIFIED, DILT-XR, DILTIAZEM 12HR ER, DILTIAZEM 24HR ER, DILTIAZEM 24HR ER (CD), DILTIAZEM 24HR ER (LA), DILTIAZEM 24HR ER (XR), DILTIAZEM HCL, DILTIAZEM HCL-0.7% NACL, DILTIAZEM HCL-0.9% NACL, DILTIAZEM HCL-NACL, DILTIAZEM-D5W, E.E.S. 200, E.E.S. 400, EPCLUSA, ERY-TAB, ERYPED 200, ERYPED 400, ERYTHROCIN LACTOBIONATE, ERYTHROCIN STEARATE, ERYTHROMYCIN, ERYTHROMYCIN ESTOLATE, ERYTHROMYCIN ETHYLSUCCINATE, ERYTHROMYCIN LACTOBIONATE, FLIBANSERIN, FLUVOXAMINE MALEATE, FLUVOXAMINE MALEATE ER, GENGRAF, HARVONI, INGREZZA, INGREZZA INITIATION PK(TARDIV), INGREZZA SPRINKLE, JAYPIRCA, KALYDECO, LAPATINIB, LEDIPASVIR-SOFOSBUVIR, LUMAKRAS, LUPKYNIS, MATZIM LA, MAVYRET, MULTAQ, NEORAL, NERLYNX, NEXTERONE, NOURIANZ, NUEDEXTA, PACERONE, PAROXETINE CR, PAROXETINE ER, PAROXETINE HCL, PAROXETINE MESYLATE, PAXIL, PAXIL CR, PROPAFENONE HCL, PROPAFENONE HCL ER, QUALAQUIN, QUINIDINE GLUCONATE, QUINIDINE SULFATE, QUININE HCL, QUININE SULFATE, QUVIVIQ, RANOLAZINE ER, RETEVMO, REZUROCK, ROMVIMZA, SANDIMMUNE, SCEMBLIX, SEYSARA, SOFOSBUVIR-VELPATASVIR, SYMDEKO, TABRECTA, TAGRISSO, TAVALISSE, TEPMETKO, TIADYLT ER, TIAZAC, TRANDOLAPRIL-VERAPAMIL ER, TRIKAFTA, TYKERB, VERAPAMIL ER, VERAPAMIL ER PM, VERAPAMIL HCL, VERAPAMIL SR, VOSEVI, VOYDEYA, XOLREMDI, ZELBORAF, ZITHROMAX, ZITHROMAX TRI-PAK
Ritlecitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ritlecitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of ritlecitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ritlecitinib states that concurrent use of ritlecitinib with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants is not recommended.(1) DISCUSSION: Serious infections have been reported in patients receiving ritlecitinib. Reported infections included appendicitis, COVID-19 infection (including pneumonia), and sepsis. Reports of viral reactivation, including herpes virus reactivation was reported in clinical studies with ritlecitinib.(1)	LITFULO
Doxorubicin/Strong CYP3A4 Inducers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Strong inducers of CYP3A4 may induce the metabolism of doxorubicin.(1) CLINICAL EFFECTS: Concurrent or recent use of a strong inducer of CYP3A4 may result in decreased levels and effectiveness of doxorubicin.(1) PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks. PATIENT MANAGEMENT: Avoid concurrent use of strong inducers of CYP3A4 with doxorubicin.(1) Consider the use of agents with no or minimal induction potential if possible. Monitor patients for decreased response to therapy. DISCUSSION: Doxorubicin is metabolized by CYP3A4 and strong inducers of this isoenzyme are expected to decrease levels of doxorubicin.(1) Strong inducers of CYP3A4 include: apalutamide, barbiturates, carbamazepine, encorafenib, enzalutamide, fosphenytoin, ivosidenib, lumacaftor, mitotane, phenobarbital, phenytoin, primidone, rifampin, rifapentine, and St. John's wort.(2,3)	ASA-BUTALB-CAFFEINE-CODEINE, ASCOMP WITH CODEINE, BRAFTOVI, BUTALB-ACETAMINOPH-CAFF-CODEIN, BUTALBITAL, BUTALBITAL-ACETAMINOPHEN, BUTALBITAL-ACETAMINOPHEN-CAFFE, BUTALBITAL-ASPIRIN-CAFFEINE, CARBAMAZEPINE, CARBAMAZEPINE ER, CARBATROL, CEREBYX, DILANTIN, DILANTIN-125, DONNATAL, EPITOL, EQUETRO, ERLEADA, FIORICET, FIORICET WITH CODEINE, FOSPHENYTOIN SODIUM, LYSODREN, MITOTANE, MYSOLINE, ORKAMBI, PENTOBARBITAL SODIUM, PHENOBARBITAL, PHENOBARBITAL SODIUM, PHENOBARBITAL-BELLADONNA, PHENOBARBITAL-HYOSC-ATROP-SCOP, PHENOHYTRO, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED, PRIFTIN, PRIMIDONE, RIFADIN, RIFAMPIN, SEZABY, TEGRETOL, TEGRETOL XR, TENCON, TIBSOVO, XTANDI
Etrasimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Etrasimod causes reversible sequestration of lymphocytes in lymphoid tissues, resulting in a mean 55% decrease in peripheral blood lymphocyte count at 52 weeks.(1) Other immunosuppressives and immune-modulators also suppress the immune system. CLINICAL EFFECTS: Concurrent use of etrasimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious and fatal infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications increases the risk of adverse effects. PATIENT MANAGEMENT: The etrasimod US prescribing information states etrasimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Concomitant administration of these therapies with etrasimod should be avoided because of the risk of additive immune effects during therapy and in the weeks following administration. Etrasimod's effect on peripheral lymphocytes may persist for up to 5 weeks after discontinuation.(1) When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with other sphingosine-1 phosphate receptor modulators.(1)	VELSIPITY
Ropeginterferon alfa-2b/Slt Immunosuppress; Immunomodulator SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ropeginterferon alfa-2b and immunosuppressives both suppress the immune system. CLINICAL EFFECTS: Concurrent use of ropeginterferon alfa-2b with immunosuppressives may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concurrent use of myelosuppressive agents.(1-2) If concurrent use cannot be avoided, monitor for effects of excessive immunosuppression. DISCUSSION: In clinical trials, 20% of patients experienced leukopenia. Interferon alfa products may cause fatal or life-threatening infections.(1-2)	BESREMI

There are 7 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Digoxin, Oral/Antineoplastics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Decreased gastrointestinal digoxin absorption. CLINICAL EFFECTS: The pharmacologic effects of digoxin may be decreased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor serum digoxin concentrations and observe the patient for a decrease in pharmacologic activity. Adjust the dose of digoxin accordingly. Substituting digitoxin or digoxin capsules for digoxin tablets may circumvent this interaction. DISCUSSION: There are a number of factors affecting the outcome of this interaction. The effects of antineoplastic therapy on the gastrointestinal absorption of digoxin have only been studied with certain chemotherapeutic agents or regimens (e.g., bleomycin, carmustine, cyclophosphamide, cytarabine, doxorubicin, methotrexate, procarbazine, vincristine). The interaction appears to occur with the administration of oral digoxin tablets as opposed to digoxin capsules. The gastrointestinal absorption of digitoxin does not seem to be altered by antineoplastic therapy.	DIGITEK, DIGOXIN, LANOXIN
Doxorubicin/Paclitaxel SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Paclitaxel and Cremophor, a vehicle of paclitaxel, may interfere with the pharmacokinetics of doxorubicin, which may cause an increase in the exposure of doxorubicin and its metabolites.(2)(3) CLINICAL EFFECTS: Concurrent use of doxorubicin and paclitaxel may increase the doxorubicin exposure. This may increase the risk of doxorubicin associated adverse effects.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor patients receiving concurrent therapy for signs of cardiotoxicity, heart failure, or other adverse effects associated with doxorubicin.(1) Avoid coadministration within a short interval.(2) DISCUSSION: An open-label drug interaction study, as part of two parallel clinical phase I trials, studied 19 oncology patients receiving doxorubicin combined with either paclitaxel or docetaxel. When administered with paclitaxel the mean increase in doxorubicin area-under-curve(AUC) was 80% (p=0.002, 95%CI: 23%-136%) and the mean doxorubicin clearance was decreased by 71% (p=0/013, 95%CI: 8%-133%).(1) In a study of 28 female breast cancer patients receiving concurrent administration of doxorubicin and paclitaxel, the mean AUC0-24 ratio was 1.59 (p <0.0001) when doxorubicin was administered 30 minutes before paclitaxel versus 24 hours before paclitaxel. Even when paclitaxel was given 24 hours after doxorubicin, there was a rebound 240% increase in the plasma concentration of doxorubicinol.(2) Cremophor, a vehicle of paclitaxel, has been demonstrated to inhibit p-glycoprotein (P-gp) in a noncompetitive manner.(3) Paclitaxel is a substrate of P-gp and therefore metabolism may be inhibited if Cremophor is co-administered.(2)	ABRAXANE, PACLITAXEL, PACLITAXEL PROTEIN-BOUND
Ustekinumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ustekinumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ustekinumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ustekinumab recommends caution because the concurrent use of ustekinumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Ustekinumab has not been studied in combination with other immunosuppressants in psoriasis studies. In psoriatic arthritis studies, concomitant methotrexate use did not appear to influence the safety or efficacy of ustekinumab. In Crohn's disease and ulcerative colitis studies, concomitant use of immunosuppressants or corticosteroids did not appear to influence the safety or efficacy of ustekinumab. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by ustekinumab treated patients in the clinical trial periods included nasopharyngitis(8%) and upper respiratory tract infection(5%). Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving ustekinumab. Cases of interstitial pneumonia, eosinophilic pneumonia, and cryptogenic organizing pneumonia resulting in respiratory failure or prolonged hospitalization have been reported in patients receiving ustekinumab.(1)	OTULFI, PYZCHIVA, SELARSDI, STELARA, STEQEYMA, USTEKINUMAB, USTEKINUMAB-AEKN, USTEKINUMAB-TTWE, WEZLANA, YESINTEK
COVID-19 Vaccines/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Immunosuppressants and immunomodulators may prevent the immune system from properly responding to the COVID-19 vaccine.(1,2) CLINICAL EFFECTS: Administration of a COVID-19 vaccine with immunosuppressants or immunomodulators may interfere with vaccine-induced immune response and impair the efficacy of the vaccine. However, patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: In an effort to optimize COVID-19 vaccine response, the American College of Rheumatology (ACR) published conditional recommendations for administration of COVID-19 vaccines with immunosuppressants and immunomodulators.(1) The CDC also provides clinical considerations for COVID-19 vaccination in patients on immunosuppressants.(2) The CDC states that all immunocompromised patients over 6 months of age should receive at least 1 dose of COVID-19 vaccine if eligible. See the CDC's Interim Clinical Considerations for Use of COVID-19 Vaccines for specific recommendations based on age, vaccination history, and vaccine manufacturer.(2) The ACR states that in general, immunosuppressants and immunomodulators should be held for 1-2 weeks after each vaccine dose. See below for specific recommendations for certain agents.(1) The CDC advises planning for vaccination at least 2 weeks before starting or resuming immunosuppressive therapy.(2) Patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted.(1,2) B-cell depleting agents, including rituximab: The ACR recommends consulting with the rheumatologist to determine optimal timing of COVID-19 vaccination. Measuring CD19 B cells may be considered to determine need for a booster vaccine dose. If B cell levels are not measured, a supplemental vaccine dose 2-4 weeks before the next scheduled dose of rituximab is recommended.(1) The CDC states that the utility of B-cell quantification to guide clinical care is not known and is not recommended. Patients who receive B-cell depleting therapy should receive COVID-19 vaccines about 4 weeks before the next scheduled dose. For patients who received 1 or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies that were administered over a limited period (e.g., as part of a treatment regimen for certain malignancies), revaccination may be considered. The suggested interval to start revaccination is about 6 months after completion of the B-cell-depleting therapy.(2) Abatacept: - Subcutaneous abatacept should be withheld for 1-2 weeks after each vaccine dose, as disease activity allows. - For intravenous abatacept, time administration so that vaccination will occur 1 week before the next abatacept infusion.(1) Cyclophosphamide: When feasible, administer cyclophosphamide one week after each COVID-19 vaccine dose.(1) Recipients of hematopoietic cell transplant or CAR-T-cell therapy who received one or more doses of COVID-19 vaccine prior to or during treatment should undergo revaccination following the current CDC recommendations for unvaccinated patients. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy.(2) TNF-alpha inhibitors and cytokine inhibitors: The ACR was not able to reach consensus on whether to modify dosing or timing of these agents with COVID-19 vaccination.(1) The CDC includes these agents in their general recommendation to hold therapy for at least 2 weeks following vaccination.(2) DISCUSSION: The ACR convened a COVID-19 Vaccine Guidance Task Force to provide guidance on optimal use of COVID-19 vaccines in rheumatology patients. These recommendations are based on limited clinical evidence of COVID-19 vaccines in patients without rheumatic and musculoskeletal disorders and evidence of other vaccines in this patient population.(1) The ACR recommendation for rituximab is based on studies of humoral immunity following receipt of other vaccines. These studies have uncertain generalizability to vaccination against COVID-19, as it is unknown if efficacy is attributable to induction of host T cells versus B cell (antibody-based) immunity.(1) The ACR recommendation for mycophenolate is based on preexisting data of mycophenolate on non-COVID-19 vaccine immunogenicity. Emerging data suggests that mycophenolate may impair SARS-CoV-2 vaccine response in rheumatic and musculoskeletal disease and transplant patients.(1) The ACR recommendation for methotrexate is based on data from influenza vaccines and pneumococcal vaccines with methotrexate.(1) The ACR recommendation for JAK inhibitors is based on concerns related to the effects of JAK inhibitors on interferon signaling that may result in a diminished vaccine response.(1) The ACR recommendation for subcutaneous abatacept is based on several studies suggesting a negative effect of abatacept on vaccine immunogenicity. The first vaccine dose primes naive T cells, naive T cell priming is inhibited by CTLA-4, and abatacept is a CTLA-4Ig construct. CTLA-4 should not inhibit boosts of already primed T cells at the time of the second vaccine dose.(1)	COMIRNATY 2024-2025, MODERNA COVID 24-25(6M-11Y)EUA, NOVAVAX COVID 2024-2025 (EUA), PFIZER COVID 2024-25(5-11Y)EUA, PFIZER COVID 2024-25(6M-4Y)EUA, SPIKEVAX 2024-2025
Sarilumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Sarilumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sarilumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sarilumab recommends caution because the concurrent use of sarilumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Sarilumab was studied as monotherapy and in combination with methotrexate or conventional disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis studies. Sarilumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by sarilumab treated patients in the clinical trial periods included pneumonia and cellulitis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving sarilumab. Cases of tuberculosis, candidiasis, and pneumocystis with sarilumab have been reported.(1)	KEVZARA
Ublituximab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ublituximab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ublituximab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The US manufacturer of ublituximab recommends caution because the concurrent use of ublituximab with immunomodulating or immunosuppressive agents, including immunosuppressant doses of corticosteroids, may increase the risk of infection.(1) If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents. When switching from agents with immune effects, the half-life and mechanism of action of these drugs must be taken into consideration in order to prevent additive immunosuppressive effects.(1) DISCUSSION: The most common infections reported by ublituximab-treated patients in the clinical trial periods included upper respiratory tract infections and urinary tract infections. Serious, including life-threatening or fatal, bacterial and viral infections were observed in patients receiving ublituximab.(1) Serious and/or fatal bacterial, fungal, and new or reactivated viral infections have been associated with other anti-CD20 B-cell depleting therapies. There were no cases of progressive multifocal leukoencephalopathy (PML) reported during the clinical trials; however, there have been reports of PML during or following completion of other anti-CD20 B-cell depleting therapies.(1)	BRIUMVI
Tocilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Tocilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of tocilizumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of tocilizumab recommends caution because the concurrent use of tocilizumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Tocilizumab was studied as monotherapy and in combination with methotrexate, non-biologic DMARDs or corticosteroids, depending on the indication. Tocilizumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by tocilizumab treated patients in the clinical trial periods included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis and bacterial arthritis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving tocilizumab. Cases of tuberculosis, cryptococcus, aspergillosis, candidiasis, and pneumocystosis have been reported.(1)	ACTEMRA, ACTEMRA ACTPEN, TOFIDENCE, TYENNE, TYENNE AUTOINJECTOR

The following contraindication information is available for DOXORUBICIN HCL (doxorubicin hcl):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

No enhanced Contraindications information available for this drug.

There are 5 contraindications. Absolute contraindication.

Contraindication List
30 day risk period post-myocardial infarction
Cardiomyopathy
Child-pugh class C hepatic impairment
Heart failure
Lactation

There are 12 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Anemia
Atrioventricular block
Bundle branch block
Cardiac arrhythmia
Child-pugh class B hepatic impairment
Hyperbilirubinemia
Myocarditis
Neutropenic disorder
Palmar-plantar erythrodysesthesia
Pregnancy
Severe infection
Thrombocytopenic disorder

There are 1 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Asymptomatic left ventricular dysfunction

The following adverse reaction information is available for DOXORUBICIN HCL (doxorubicin hcl):

Overview
Severe
Less Severe

Adverse reaction overview.

No enhanced Common Adverse Effects information available for this drug.

There are 39 severe adverse reactions.

More Frequent	Less Frequent
Esophagitis Infection Leukopenia Neutropenic disorder	Cardiomyopathy Chronic heart failure Gastrointestinal ulcer Injection site sequelae Phlebosclerosis Postirradiation erythema Tissue necrosis

Rare/Very Rare
Abnormal ECG Anaphylaxis Bradycardia Cardiotoxicity Colitis Colonic necrosis Coma Dehydration Dyspnea Extravasation injury Increased alanine transaminase Increased aspartate transaminase Left ventricular failure Myelodysplastic syndrome Myocarditis Palmar-plantar erythrodysesthesia Pericarditis Peripheral motor neuropathy Radiation recall syndrome Secondary acute myeloid leukemia Seizure disorder Severe bone marrow depression Sinus tachycardia Thrombocytopenic disorder Thromboembolic disorder Tumor lysis syndrome Ventricular premature beats Ventricular tachycardia

Rare/Very Rare

Abnormal ECG
Anaphylaxis
Bradycardia
Cardiotoxicity
Colitis
Colonic necrosis
Coma
Dehydration
Dyspnea
Extravasation injury
Increased alanine transaminase
Increased aspartate transaminase
Left ventricular failure
Myelodysplastic syndrome
Myocarditis
Palmar-plantar erythrodysesthesia
Pericarditis
Peripheral motor neuropathy
Radiation recall syndrome
Secondary acute myeloid leukemia
Seizure disorder
Severe bone marrow depression
Sinus tachycardia
Thrombocytopenic disorder
Thromboembolic disorder
Tumor lysis syndrome
Ventricular premature beats
Ventricular tachycardia

There are 27 less severe adverse reactions.

More Frequent	Less Frequent
Alopecia Nausea Stomatitis Urine discoloration Vomiting	Diarrhea Skin photosensitivity

Rare/Very Rare
Acute abdominal pain Anorexia Chills Conjunctivitis Drug-induced hot flash Dyschromia Eye tearing Fever General weakness Hyperpigmentation of oral mucosa Keratitis Malaise Nail discoloration Peripheral sensory neuropathy Pruritus of skin Skin pigmentation enhancement Skin rash Thrombophlebitis Urticaria Weight gain

The following precautions are available for DOXORUBICIN HCL (doxorubicin hcl):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

Doxorubicin can cause fetal toxicity when administered to pregnant women, but potential benefits from use of the drug may be acceptable in certain conditions despite the possible risks to the fetus. The drug is embryotoxic and teratogenic in rats and embryotoxic and abortifacient in rabbits, and trace amounts of drug have been found in mouse fetuses and in one aborted human fetus following administration of conventional (nonencapsulated) doxorubicin. Liposomal doxorubicin is embryotoxic at doses of 1 mg/kg daily (about one-eighth the 50 mg/m2 human dose on a mg/m2 basis) in rats and is embryotoxic and abortifacient at doses of 0.5

mg/kg daily (about one-eighth the 50 mg/m2 human dose on a mg/m2 basis) in rabbits. Embryotoxicity consisted of increased embryo-fetal deaths and reduced live litter sizes. There are no adequate and well-controlled studies to date using conventional or liposomal doxorubicin in pregnant women.

Doxorubicin should be used during pregnancy only in life-threatening situations or for disease for which safer drugs cannot be used or are ineffective. When conventional or liposomal doxorubicin is used during pregnancy, or if the patient becomes pregnant while receiving the drug, the patient should be apprised of the potential hazard to the fetus. If a patient becomes pregnant during the first few months following liposomal doxorubicin therapy, the prolonged elimination half-life of the drug must be taken into account. Women of childbearing potential should be advised to avoid becoming pregnant during doxorubicin therapy.

Conventional (nonencapsulated) doxorubicin is distributed into milk. It is not known whether liposomal doxorubicin is distributed into milk. Because of the potential for serious adverse reactions to doxorubicin in nursing infants, nursing should be discontinued during doxorubicin therapy. Liposomal doxorubicin is contraindicated in nursing women.

No enhanced Geriatric Use information available for this drug.

The following icd codes are available for DOXORUBICIN HCL (doxorubicin hcl)'s list of indications:

Acute lymphoid leukemia
C91.0	Acute lymphoblastic leukemia [ALl]
C91.00	Acute lymphoblastic leukemia not having achieved remission
C91.02	Acute lymphoblastic leukemia, in relapse
Acute myeloid leukemia
C92.0	Acute myeloblastic leukemia
C92.00	Acute myeloblastic leukemia, not having achieved remission
C92.02	Acute myeloblastic leukemia, in relapse
C92.4	Acute promyelocytic leukemia
C92.40	Acute promyelocytic leukemia, not having achieved remission
C92.42	Acute promyelocytic leukemia, in relapse
C92.5	Acute myelomonocytic leukemia
C92.50	Acute myelomonocytic leukemia, not having achieved remission
C92.52	Acute myelomonocytic leukemia, in relapse
C92.6	Acute myeloid leukemia with 11q23-abnormality
C92.60	Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62	Acute myeloid leukemia with 11q23-abnormality in relapse
C93.0	Acute monoblastic/monocytic leukemia
C93.00	Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02	Acute monoblastic/monocytic leukemia, in relapse
C94.4	Acute panmyelosis with myelofibrosis
C94.40	Acute panmyelosis with myelofibrosis not having achieved remission
C94.42	Acute panmyelosis with myelofibrosis, in relapse
Burkitt's lymphoma
C83.7	Burkitt lymphoma
C83.70	Burkitt lymphoma, unspecified site
C83.71	Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72	Burkitt lymphoma, intrathoracic lymph nodes
C83.73	Burkitt lymphoma, intra-abdominal lymph nodes
C83.74	Burkitt lymphoma, lymph nodes of axilla and upper limb
C83.75	Burkitt lymphoma, lymph nodes of inguinal region and lower limb
C83.76	Burkitt lymphoma, intrapelvic lymph nodes
C83.77	Burkitt lymphoma, spleen
C83.78	Burkitt lymphoma, lymph nodes of multiple sites
C83.79	Burkitt lymphoma, extranodal and solid organ sites
Carcinoma of breast
C50	Malignant neoplasm of breast
C50.1	Malignant neoplasm of central portion of breast
C50.11	Malignant neoplasm of central portion of breast, female
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.119	Malignant neoplasm of central portion of unspecified female breast
C50.12	Malignant neoplasm of central portion of breast, male
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.129	Malignant neoplasm of central portion of unspecified male breast
C50.2	Malignant neoplasm of upper-inner quadrant of breast
C50.21	Malignant neoplasm of upper-inner quadrant of breast, female
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.219	Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.22	Malignant neoplasm of upper-inner quadrant of breast, male
C50.221	Malignant neoplasm of upper-inner quadrant of right male breast
C50.222	Malignant neoplasm of upper-inner quadrant of left male breast
C50.229	Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.3	Malignant neoplasm of lower-inner quadrant of breast
C50.31	Malignant neoplasm of lower-inner quadrant of breast, female
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.319	Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.32	Malignant neoplasm of lower-inner quadrant of breast, male
C50.321	Malignant neoplasm of lower-inner quadrant of right male breast
C50.322	Malignant neoplasm of lower-inner quadrant of left male breast
C50.329	Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.4	Malignant neoplasm of upper-outer quadrant of breast
C50.41	Malignant neoplasm of upper-outer quadrant of breast, female
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast
C50.419	Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.42	Malignant neoplasm of upper-outer quadrant of breast, male
C50.421	Malignant neoplasm of upper-outer quadrant of right male breast
C50.422	Malignant neoplasm of upper-outer quadrant of left male breast
C50.429	Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.5	Malignant neoplasm of lower-outer quadrant of breast
C50.51	Malignant neoplasm of lower-outer quadrant of breast, female
C50.511	Malignant neoplasm of lower-outer quadrant of right female breast
C50.512	Malignant neoplasm of lower-outer quadrant of left female breast
C50.519	Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.52	Malignant neoplasm of lower-outer quadrant of breast, male
C50.521	Malignant neoplasm of lower-outer quadrant of right male breast
C50.522	Malignant neoplasm of lower-outer quadrant of left male breast
C50.529	Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.6	Malignant neoplasm of axillary tail of breast
C50.61	Malignant neoplasm of axillary tail of breast, female
C50.611	Malignant neoplasm of axillary tail of right female breast
C50.612	Malignant neoplasm of axillary tail of left female breast
C50.619	Malignant neoplasm of axillary tail of unspecified female breast
C50.62	Malignant neoplasm of axillary tail of breast, male
C50.621	Malignant neoplasm of axillary tail of right male breast
C50.622	Malignant neoplasm of axillary tail of left male breast
C50.629	Malignant neoplasm of axillary tail of unspecified male breast
C50.8	Malignant neoplasm of overlapping sites of breast
C50.81	Malignant neoplasm of overlapping sites of breast, female
C50.811	Malignant neoplasm of overlapping sites of right female breast
C50.812	Malignant neoplasm of overlapping sites of left female breast
C50.819	Malignant neoplasm of overlapping sites of unspecified female breast
C50.82	Malignant neoplasm of overlapping sites of breast, male
C50.821	Malignant neoplasm of overlapping sites of right male breast
C50.822	Malignant neoplasm of overlapping sites of left male breast
C50.829	Malignant neoplasm of overlapping sites of unspecified male breast
C50.9	Malignant neoplasm of breast of unspecified site
C50.91	Malignant neoplasm of breast of unspecified site, female
C50.911	Malignant neoplasm of unspecified site of right female breast
C50.912	Malignant neoplasm of unspecified site of left female breast
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
C50.92	Malignant neoplasm of breast of unspecified site, male
C50.921	Malignant neoplasm of unspecified site of right male breast
C50.922	Malignant neoplasm of unspecified site of left male breast
C50.929	Malignant neoplasm of unspecified site of unspecified male breast
Diffuse large b-cell lymphoma
C83.3	Diffuse large b-cell lymphoma
C83.30	Diffuse large b-cell lymphoma, unspecified site
C83.31	Diffuse large b-cell lymphoma, lymph nodes of head, face, and neck
C83.32	Diffuse large b-cell lymphoma, intrathoracic lymph nodes
C83.33	Diffuse large b-cell lymphoma, intra-abdominal lymph nodes
C83.34	Diffuse large b-cell lymphoma, lymph nodes of axilla and upper limb
C83.35	Diffuse large b-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36	Diffuse large b-cell lymphoma, intrapelvic lymph nodes
C83.37	Diffuse large b-cell lymphoma, spleen
C83.38	Diffuse large b-cell lymphoma, lymph nodes of multiple sites
C83.39	Diffuse large b-cell lymphoma, extranodal and solid organ sites
C83.398	Diffuse large b-cell lymphoma of other extranodal and solid organ sites
Follicular lymphoma
C82	Follicular lymphoma
C82.0	Follicular lymphoma grade I
C82.00	Follicular lymphoma grade i, unspecified site
C82.01	Follicular lymphoma grade i, lymph nodes of head, face, and neck
C82.02	Follicular lymphoma grade i, intrathoracic lymph nodes
C82.03	Follicular lymphoma grade i, intra-abdominal lymph nodes
C82.04	Follicular lymphoma grade i, lymph nodes of axilla and upper limb
C82.05	Follicular lymphoma grade i, lymph nodes of inguinal region and lower limb
C82.06	Follicular lymphoma grade i, intrapelvic lymph nodes
C82.07	Follicular lymphoma grade i, spleen
C82.08	Follicular lymphoma grade i, lymph nodes of multiple sites
C82.09	Follicular lymphoma grade i, extranodal and solid organ sites
C82.1	Follicular lymphoma grade II
C82.10	Follicular lymphoma grade Ii, unspecified site
C82.11	Follicular lymphoma grade Ii, lymph nodes of head, face, and neck
C82.12	Follicular lymphoma grade Ii, intrathoracic lymph nodes
C82.13	Follicular lymphoma grade Ii, intra-abdominal lymph nodes
C82.14	Follicular lymphoma grade Ii, lymph nodes of axilla and upper limb
C82.15	Follicular lymphoma grade Ii, lymph nodes of inguinal region and lower limb
C82.16	Follicular lymphoma grade Ii, intrapelvic lymph nodes
C82.17	Follicular lymphoma grade Ii, spleen
C82.18	Follicular lymphoma grade Ii, lymph nodes of multiple sites
C82.19	Follicular lymphoma grade Ii, extranodal and solid organ sites
C82.2	Follicular lymphoma grade IIi, unspecified
C82.20	Follicular lymphoma grade IIi, unspecified, unspecified site
C82.21	Follicular lymphoma grade IIi, unspecified, lymph nodes of head, face, and neck
C82.22	Follicular lymphoma grade IIi, unspecified, intrathoracic lymph nodes
C82.23	Follicular lymphoma grade IIi, unspecified, intra-abdominal lymph nodes
C82.24	Follicular lymphoma grade IIi, unspecified, lymph nodes of axilla and upper limb
C82.25	Follicular lymphoma grade IIi, unspecified, lymph nodes of inguinal region and lower limb
C82.26	Follicular lymphoma grade IIi, unspecified, intrapelvic lymph nodes
C82.27	Follicular lymphoma grade IIi, unspecified, spleen
C82.28	Follicular lymphoma grade IIi, unspecified, lymph nodes of multiple sites
C82.29	Follicular lymphoma grade IIi, unspecified, extranodal and solid organ sites
C82.3	Follicular lymphoma grade IIia
C82.30	Follicular lymphoma grade IIia, unspecified site
C82.31	Follicular lymphoma grade IIia, lymph nodes of head, face, and neck
C82.32	Follicular lymphoma grade IIia, intrathoracic lymph nodes
C82.33	Follicular lymphoma grade IIia, intra-abdominal lymph nodes
C82.34	Follicular lymphoma grade IIia, lymph nodes of axilla and upper limb
C82.35	Follicular lymphoma grade IIia, lymph nodes of inguinal region and lower limb
C82.36	Follicular lymphoma grade IIia, intrapelvic lymph nodes
C82.37	Follicular lymphoma grade IIia, spleen
C82.38	Follicular lymphoma grade IIia, lymph nodes of multiple sites
C82.39	Follicular lymphoma grade IIia, extranodal and solid organ sites
C82.4	Follicular lymphoma grade IIib
C82.40	Follicular lymphoma grade IIib, unspecified site
C82.41	Follicular lymphoma grade IIib, lymph nodes of head, face, and neck
C82.42	Follicular lymphoma grade IIib, intrathoracic lymph nodes
C82.43	Follicular lymphoma grade IIib, intra-abdominal lymph nodes
C82.44	Follicular lymphoma grade IIib, lymph nodes of axilla and upper limb
C82.45	Follicular lymphoma grade IIib, lymph nodes of inguinal region and lower limb
C82.46	Follicular lymphoma grade IIib, intrapelvic lymph nodes
C82.47	Follicular lymphoma grade IIib, spleen
C82.48	Follicular lymphoma grade IIib, lymph nodes of multiple sites
C82.49	Follicular lymphoma grade IIib, extranodal and solid organ sites
C82.5	Diffuse follicle center lymphoma
C82.50	Diffuse follicle center lymphoma, unspecified site
C82.51	Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52	Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53	Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54	Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55	Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56	Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57	Diffuse follicle center lymphoma, spleen
C82.58	Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59	Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.6	Cutaneous follicle center lymphoma
C82.60	Cutaneous follicle center lymphoma, unspecified site
C82.61	Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62	Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63	Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64	Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65	Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66	Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67	Cutaneous follicle center lymphoma, spleen
C82.68	Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69	Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.8	Other types of follicular lymphoma
C82.80	Other types of follicular lymphoma, unspecified site
C82.81	Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82	Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83	Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84	Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85	Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86	Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87	Other types of follicular lymphoma, spleen
C82.88	Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89	Other types of follicular lymphoma, extranodal and solid organ sites
C82.9	Follicular lymphoma, unspecified
C82.90	Follicular lymphoma, unspecified, unspecified site
C82.91	Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92	Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93	Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94	Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95	Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96	Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97	Follicular lymphoma, unspecified, spleen
C82.98	Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99	Follicular lymphoma, unspecified, extranodal and solid organ sites
Hodgkin's lymphoma
C81	Hodgkin lymphoma
C81.0	Nodular lymphocyte predominant hodgkin lymphoma
C81.00	Nodular lymphocyte predominant hodgkin lymphoma, unspecified site
C81.01	Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of head, face, and neck
C81.02	Nodular lymphocyte predominant hodgkin lymphoma, intrathoracic lymph nodes
C81.03	Nodular lymphocyte predominant hodgkin lymphoma, intra-abdominal lymph nodes
C81.04	Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.05	Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.06	Nodular lymphocyte predominant hodgkin lymphoma, intrapelvic lymph nodes
C81.07	Nodular lymphocyte predominant hodgkin lymphoma, spleen
C81.08	Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of multiple sites
C81.09	Nodular lymphocyte predominant hodgkin lymphoma, extranodal and solid organ sites
C81.1	Nodular sclerosis hodgkin lymphoma
C81.10	Nodular sclerosis hodgkin lymphoma, unspecified site
C81.11	Nodular sclerosis hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12	Nodular sclerosis hodgkin lymphoma, intrathoracic lymph nodes
C81.13	Nodular sclerosis hodgkin lymphoma, intra-abdominal lymph nodes
C81.14	Nodular sclerosis hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.15	Nodular sclerosis hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.16	Nodular sclerosis hodgkin lymphoma, intrapelvic lymph nodes
C81.17	Nodular sclerosis hodgkin lymphoma, spleen
C81.18	Nodular sclerosis hodgkin lymphoma, lymph nodes of multiple sites
C81.19	Nodular sclerosis hodgkin lymphoma, extranodal and solid organ sites
C81.2	Mixed cellularity hodgkin lymphoma
C81.20	Mixed cellularity hodgkin lymphoma, unspecified site
C81.21	Mixed cellularity hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22	Mixed cellularity hodgkin lymphoma, intrathoracic lymph nodes
C81.23	Mixed cellularity hodgkin lymphoma, intra-abdominal lymph nodes
C81.24	Mixed cellularity hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.25	Mixed cellularity hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.26	Mixed cellularity hodgkin lymphoma, intrapelvic lymph nodes
C81.27	Mixed cellularity hodgkin lymphoma, spleen
C81.28	Mixed cellularity hodgkin lymphoma, lymph nodes of multiple sites
C81.29	Mixed cellularity hodgkin lymphoma, extranodal and solid organ sites
C81.3	Lymphocyte depleted hodgkin lymphoma
C81.30	Lymphocyte depleted hodgkin lymphoma, unspecified site
C81.31	Lymphocyte depleted hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32	Lymphocyte depleted hodgkin lymphoma, intrathoracic lymph nodes
C81.33	Lymphocyte depleted hodgkin lymphoma, intra-abdominal lymph nodes
C81.34	Lymphocyte depleted hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.35	Lymphocyte depleted hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.36	Lymphocyte depleted hodgkin lymphoma, intrapelvic lymph nodes
C81.37	Lymphocyte depleted hodgkin lymphoma, spleen
C81.38	Lymphocyte depleted hodgkin lymphoma, lymph nodes of multiple sites
C81.39	Lymphocyte depleted hodgkin lymphoma, extranodal and solid organ sites
C81.4	Lymphocyte-rich hodgkin lymphoma
C81.40	Lymphocyte-rich hodgkin lymphoma, unspecified site
C81.41	Lymphocyte-rich hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42	Lymphocyte-rich hodgkin lymphoma, intrathoracic lymph nodes
C81.43	Lymphocyte-rich hodgkin lymphoma, intra-abdominal lymph nodes
C81.44	Lymphocyte-rich hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.45	Lymphocyte-rich hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.46	Lymphocyte-rich hodgkin lymphoma, intrapelvic lymph nodes
C81.47	Lymphocyte-rich hodgkin lymphoma, spleen
C81.48	Lymphocyte-rich hodgkin lymphoma, lymph nodes of multiple sites
C81.49	Lymphocyte-rich hodgkin lymphoma, extranodal and solid organ sites
C81.7	Other hodgkin lymphoma
C81.70	Other hodgkin lymphoma, unspecified site
C81.71	Other hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72	Other hodgkin lymphoma, intrathoracic lymph nodes
C81.73	Other hodgkin lymphoma, intra-abdominal lymph nodes
C81.74	Other hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75	Other hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76	Other hodgkin lymphoma, intrapelvic lymph nodes
C81.77	Other hodgkin lymphoma, spleen
C81.78	Other hodgkin lymphoma, lymph nodes of multiple sites
C81.79	Other hodgkin lymphoma, extranodal and solid organ sites
C81.9	Hodgkin lymphoma, unspecified
C81.90	Hodgkin lymphoma, unspecified, unspecified site
C81.91	Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C81.92	Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C81.93	Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C81.94	Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
C81.95	Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C81.96	Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
C81.97	Hodgkin lymphoma, unspecified, spleen
C81.98	Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C81.99	Hodgkin lymphoma, unspecified, extranodal and solid organ sites
Invasive bladder cancer
C67	Malignant neoplasm of bladder
C67.0	Malignant neoplasm of trigone of bladder
C67.1	Malignant neoplasm of dome of bladder
C67.2	Malignant neoplasm of lateral wall of bladder
C67.3	Malignant neoplasm of anterior wall of bladder
C67.4	Malignant neoplasm of posterior wall of bladder
C67.5	Malignant neoplasm of bladder neck
C67.6	Malignant neoplasm of ureteric orifice
C67.7	Malignant neoplasm of urachus
C67.8	Malignant neoplasm of overlapping sites of bladder
C67.9	Malignant neoplasm of bladder, unspecified
Locally advanced breast carcinoma
C50	Malignant neoplasm of breast
C50.1	Malignant neoplasm of central portion of breast
C50.11	Malignant neoplasm of central portion of breast, female
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.119	Malignant neoplasm of central portion of unspecified female breast
C50.12	Malignant neoplasm of central portion of breast, male
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.129	Malignant neoplasm of central portion of unspecified male breast
C50.2	Malignant neoplasm of upper-inner quadrant of breast
C50.21	Malignant neoplasm of upper-inner quadrant of breast, female
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.219	Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.22	Malignant neoplasm of upper-inner quadrant of breast, male
C50.221	Malignant neoplasm of upper-inner quadrant of right male breast
C50.222	Malignant neoplasm of upper-inner quadrant of left male breast
C50.229	Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.3	Malignant neoplasm of lower-inner quadrant of breast
C50.31	Malignant neoplasm of lower-inner quadrant of breast, female
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.319	Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.32	Malignant neoplasm of lower-inner quadrant of breast, male
C50.321	Malignant neoplasm of lower-inner quadrant of right male breast
C50.322	Malignant neoplasm of lower-inner quadrant of left male breast
C50.329	Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.4	Malignant neoplasm of upper-outer quadrant of breast
C50.41	Malignant neoplasm of upper-outer quadrant of breast, female
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast
C50.419	Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.42	Malignant neoplasm of upper-outer quadrant of breast, male
C50.421	Malignant neoplasm of upper-outer quadrant of right male breast
C50.422	Malignant neoplasm of upper-outer quadrant of left male breast
C50.429	Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.5	Malignant neoplasm of lower-outer quadrant of breast
C50.51	Malignant neoplasm of lower-outer quadrant of breast, female
C50.511	Malignant neoplasm of lower-outer quadrant of right female breast
C50.512	Malignant neoplasm of lower-outer quadrant of left female breast
C50.519	Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.52	Malignant neoplasm of lower-outer quadrant of breast, male
C50.521	Malignant neoplasm of lower-outer quadrant of right male breast
C50.522	Malignant neoplasm of lower-outer quadrant of left male breast
C50.529	Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.6	Malignant neoplasm of axillary tail of breast
C50.61	Malignant neoplasm of axillary tail of breast, female
C50.611	Malignant neoplasm of axillary tail of right female breast
C50.612	Malignant neoplasm of axillary tail of left female breast
C50.619	Malignant neoplasm of axillary tail of unspecified female breast
C50.62	Malignant neoplasm of axillary tail of breast, male
C50.621	Malignant neoplasm of axillary tail of right male breast
C50.622	Malignant neoplasm of axillary tail of left male breast
C50.629	Malignant neoplasm of axillary tail of unspecified male breast
C50.8	Malignant neoplasm of overlapping sites of breast
C50.81	Malignant neoplasm of overlapping sites of breast, female
C50.811	Malignant neoplasm of overlapping sites of right female breast
C50.812	Malignant neoplasm of overlapping sites of left female breast
C50.819	Malignant neoplasm of overlapping sites of unspecified female breast
C50.82	Malignant neoplasm of overlapping sites of breast, male
C50.821	Malignant neoplasm of overlapping sites of right male breast
C50.822	Malignant neoplasm of overlapping sites of left male breast
C50.829	Malignant neoplasm of overlapping sites of unspecified male breast
C50.9	Malignant neoplasm of breast of unspecified site
C50.91	Malignant neoplasm of breast of unspecified site, female
C50.911	Malignant neoplasm of unspecified site of right female breast
C50.912	Malignant neoplasm of unspecified site of left female breast
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
C50.92	Malignant neoplasm of breast of unspecified site, male
C50.921	Malignant neoplasm of unspecified site of right male breast
C50.922	Malignant neoplasm of unspecified site of left male breast
C50.929	Malignant neoplasm of unspecified site of unspecified male breast
Malignant neoplasm of lung
C34	Malignant neoplasm of bronchus and lung
C34.0	Malignant neoplasm of main bronchus
C34.00	Malignant neoplasm of unspecified main bronchus
C34.01	Malignant neoplasm of right main bronchus
C34.02	Malignant neoplasm of left main bronchus
C34.1	Malignant neoplasm of upper lobe, bronchus or lung
C34.10	Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11	Malignant neoplasm of upper lobe, right bronchus or lung
C34.12	Malignant neoplasm of upper lobe, left bronchus or lung
C34.2	Malignant neoplasm of middle lobe, bronchus or lung
C34.3	Malignant neoplasm of lower lobe, bronchus or lung
C34.30	Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31	Malignant neoplasm of lower lobe, right bronchus or lung
C34.32	Malignant neoplasm of lower lobe, left bronchus or lung
C34.8	Malignant neoplasm of overlapping sites of bronchus and lung
C34.80	Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81	Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82	Malignant neoplasm of overlapping sites of left bronchus and lung
C34.9	Malignant neoplasm of unspecified part of bronchus or lung
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91	Malignant neoplasm of unspecified part of right bronchus or lung
C34.92	Malignant neoplasm of unspecified part of left bronchus or lung
C39.9	Malignant neoplasm of lower respiratory tract, part unspecified
Malignant neoplasm of the ovary
C56	Malignant neoplasm of ovary
C56.1	Malignant neoplasm of right ovary
C56.2	Malignant neoplasm of left ovary
C56.3	Malignant neoplasm of bilateral ovaries
C56.9	Malignant neoplasm of unspecified ovary
Metastatic breast carcinoma
C50	Malignant neoplasm of breast
C50.1	Malignant neoplasm of central portion of breast
C50.11	Malignant neoplasm of central portion of breast, female
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.119	Malignant neoplasm of central portion of unspecified female breast
C50.12	Malignant neoplasm of central portion of breast, male
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.129	Malignant neoplasm of central portion of unspecified male breast
C50.2	Malignant neoplasm of upper-inner quadrant of breast
C50.21	Malignant neoplasm of upper-inner quadrant of breast, female
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.219	Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.22	Malignant neoplasm of upper-inner quadrant of breast, male
C50.221	Malignant neoplasm of upper-inner quadrant of right male breast
C50.222	Malignant neoplasm of upper-inner quadrant of left male breast
C50.229	Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.3	Malignant neoplasm of lower-inner quadrant of breast
C50.31	Malignant neoplasm of lower-inner quadrant of breast, female
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.319	Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.32	Malignant neoplasm of lower-inner quadrant of breast, male
C50.321	Malignant neoplasm of lower-inner quadrant of right male breast
C50.322	Malignant neoplasm of lower-inner quadrant of left male breast
C50.329	Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.4	Malignant neoplasm of upper-outer quadrant of breast
C50.41	Malignant neoplasm of upper-outer quadrant of breast, female
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast
C50.419	Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.42	Malignant neoplasm of upper-outer quadrant of breast, male
C50.421	Malignant neoplasm of upper-outer quadrant of right male breast
C50.422	Malignant neoplasm of upper-outer quadrant of left male breast
C50.429	Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.5	Malignant neoplasm of lower-outer quadrant of breast
C50.51	Malignant neoplasm of lower-outer quadrant of breast, female
C50.511	Malignant neoplasm of lower-outer quadrant of right female breast
C50.512	Malignant neoplasm of lower-outer quadrant of left female breast
C50.519	Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.52	Malignant neoplasm of lower-outer quadrant of breast, male
C50.521	Malignant neoplasm of lower-outer quadrant of right male breast
C50.522	Malignant neoplasm of lower-outer quadrant of left male breast
C50.529	Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.6	Malignant neoplasm of axillary tail of breast
C50.61	Malignant neoplasm of axillary tail of breast, female
C50.611	Malignant neoplasm of axillary tail of right female breast
C50.612	Malignant neoplasm of axillary tail of left female breast
C50.619	Malignant neoplasm of axillary tail of unspecified female breast
C50.62	Malignant neoplasm of axillary tail of breast, male
C50.621	Malignant neoplasm of axillary tail of right male breast
C50.622	Malignant neoplasm of axillary tail of left male breast
C50.629	Malignant neoplasm of axillary tail of unspecified male breast
C50.8	Malignant neoplasm of overlapping sites of breast
C50.81	Malignant neoplasm of overlapping sites of breast, female
C50.811	Malignant neoplasm of overlapping sites of right female breast
C50.812	Malignant neoplasm of overlapping sites of left female breast
C50.819	Malignant neoplasm of overlapping sites of unspecified female breast
C50.82	Malignant neoplasm of overlapping sites of breast, male
C50.821	Malignant neoplasm of overlapping sites of right male breast
C50.822	Malignant neoplasm of overlapping sites of left male breast
C50.829	Malignant neoplasm of overlapping sites of unspecified male breast
C50.9	Malignant neoplasm of breast of unspecified site
C50.91	Malignant neoplasm of breast of unspecified site, female
C50.911	Malignant neoplasm of unspecified site of right female breast
C50.912	Malignant neoplasm of unspecified site of left female breast
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
C50.92	Malignant neoplasm of breast of unspecified site, male
C50.921	Malignant neoplasm of unspecified site of right male breast
C50.922	Malignant neoplasm of unspecified site of left male breast
C50.929	Malignant neoplasm of unspecified site of unspecified male breast
Metastatic gastric cancer
C16	Malignant neoplasm of stomach
C16.0	Malignant neoplasm of cardia
C16.1	Malignant neoplasm of fundus of stomach
C16.2	Malignant neoplasm of body of stomach
C16.3	Malignant neoplasm of pyloric antrum
C16.4	Malignant neoplasm of pylorus
C16.5	Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6	Malignant neoplasm of greater curvature of stomach, unspecified
C16.8	Malignant neoplasm of overlapping sites of stomach
C16.9	Malignant neoplasm of stomach, unspecified
Neuroblastoma
C30.0	Malignant neoplasm of nasal cavity
C47.9	Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
C74.9	Malignant neoplasm of unspecified part of adrenal gland
C74.90	Malignant neoplasm of unspecified part of unspecified adrenal gland
C74.91	Malignant neoplasm of unspecified part of right adrenal gland
C74.92	Malignant neoplasm of unspecified part of left adrenal gland
Non-hodgkin's lymphoma
C82	Follicular lymphoma
C82.0	Follicular lymphoma grade I
C82.00	Follicular lymphoma grade i, unspecified site
C82.01	Follicular lymphoma grade i, lymph nodes of head, face, and neck
C82.02	Follicular lymphoma grade i, intrathoracic lymph nodes
C82.03	Follicular lymphoma grade i, intra-abdominal lymph nodes
C82.04	Follicular lymphoma grade i, lymph nodes of axilla and upper limb
C82.05	Follicular lymphoma grade i, lymph nodes of inguinal region and lower limb
C82.06	Follicular lymphoma grade i, intrapelvic lymph nodes
C82.07	Follicular lymphoma grade i, spleen
C82.08	Follicular lymphoma grade i, lymph nodes of multiple sites
C82.09	Follicular lymphoma grade i, extranodal and solid organ sites
C82.1	Follicular lymphoma grade II
C82.10	Follicular lymphoma grade Ii, unspecified site
C82.11	Follicular lymphoma grade Ii, lymph nodes of head, face, and neck
C82.12	Follicular lymphoma grade Ii, intrathoracic lymph nodes
C82.13	Follicular lymphoma grade Ii, intra-abdominal lymph nodes
C82.14	Follicular lymphoma grade Ii, lymph nodes of axilla and upper limb
C82.15	Follicular lymphoma grade Ii, lymph nodes of inguinal region and lower limb
C82.16	Follicular lymphoma grade Ii, intrapelvic lymph nodes
C82.17	Follicular lymphoma grade Ii, spleen
C82.18	Follicular lymphoma grade Ii, lymph nodes of multiple sites
C82.19	Follicular lymphoma grade Ii, extranodal and solid organ sites
C82.2	Follicular lymphoma grade IIi, unspecified
C82.20	Follicular lymphoma grade IIi, unspecified, unspecified site
C82.21	Follicular lymphoma grade IIi, unspecified, lymph nodes of head, face, and neck
C82.22	Follicular lymphoma grade IIi, unspecified, intrathoracic lymph nodes
C82.23	Follicular lymphoma grade IIi, unspecified, intra-abdominal lymph nodes
C82.24	Follicular lymphoma grade IIi, unspecified, lymph nodes of axilla and upper limb
C82.25	Follicular lymphoma grade IIi, unspecified, lymph nodes of inguinal region and lower limb
C82.26	Follicular lymphoma grade IIi, unspecified, intrapelvic lymph nodes
C82.27	Follicular lymphoma grade IIi, unspecified, spleen
C82.28	Follicular lymphoma grade IIi, unspecified, lymph nodes of multiple sites
C82.29	Follicular lymphoma grade IIi, unspecified, extranodal and solid organ sites
C82.3	Follicular lymphoma grade IIia
C82.30	Follicular lymphoma grade IIia, unspecified site
C82.31	Follicular lymphoma grade IIia, lymph nodes of head, face, and neck
C82.32	Follicular lymphoma grade IIia, intrathoracic lymph nodes
C82.33	Follicular lymphoma grade IIia, intra-abdominal lymph nodes
C82.34	Follicular lymphoma grade IIia, lymph nodes of axilla and upper limb
C82.35	Follicular lymphoma grade IIia, lymph nodes of inguinal region and lower limb
C82.36	Follicular lymphoma grade IIia, intrapelvic lymph nodes
C82.37	Follicular lymphoma grade IIia, spleen
C82.38	Follicular lymphoma grade IIia, lymph nodes of multiple sites
C82.39	Follicular lymphoma grade IIia, extranodal and solid organ sites
C82.4	Follicular lymphoma grade IIib
C82.40	Follicular lymphoma grade IIib, unspecified site
C82.41	Follicular lymphoma grade IIib, lymph nodes of head, face, and neck
C82.42	Follicular lymphoma grade IIib, intrathoracic lymph nodes
C82.43	Follicular lymphoma grade IIib, intra-abdominal lymph nodes
C82.44	Follicular lymphoma grade IIib, lymph nodes of axilla and upper limb
C82.45	Follicular lymphoma grade IIib, lymph nodes of inguinal region and lower limb
C82.46	Follicular lymphoma grade IIib, intrapelvic lymph nodes
C82.47	Follicular lymphoma grade IIib, spleen
C82.48	Follicular lymphoma grade IIib, lymph nodes of multiple sites
C82.49	Follicular lymphoma grade IIib, extranodal and solid organ sites
C82.5	Diffuse follicle center lymphoma
C82.50	Diffuse follicle center lymphoma, unspecified site
C82.51	Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52	Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53	Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54	Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55	Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56	Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57	Diffuse follicle center lymphoma, spleen
C82.58	Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59	Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.6	Cutaneous follicle center lymphoma
C82.60	Cutaneous follicle center lymphoma, unspecified site
C82.61	Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62	Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63	Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64	Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65	Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66	Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67	Cutaneous follicle center lymphoma, spleen
C82.68	Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69	Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.8	Other types of follicular lymphoma
C82.80	Other types of follicular lymphoma, unspecified site
C82.81	Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82	Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83	Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84	Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85	Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86	Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87	Other types of follicular lymphoma, spleen
C82.88	Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89	Other types of follicular lymphoma, extranodal and solid organ sites
C82.9	Follicular lymphoma, unspecified
C82.90	Follicular lymphoma, unspecified, unspecified site
C82.91	Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92	Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93	Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94	Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95	Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96	Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97	Follicular lymphoma, unspecified, spleen
C82.98	Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99	Follicular lymphoma, unspecified, extranodal and solid organ sites
C83	Non-follicular lymphoma
C83.0	Small cell b-cell lymphoma
C83.00	Small cell b-cell lymphoma, unspecified site
C83.01	Small cell b-cell lymphoma, lymph nodes of head, face, and neck
C83.02	Small cell b-cell lymphoma, intrathoracic lymph nodes
C83.03	Small cell b-cell lymphoma, intra-abdominal lymph nodes
C83.04	Small cell b-cell lymphoma, lymph nodes of axilla and upper limb
C83.05	Small cell b-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06	Small cell b-cell lymphoma, intrapelvic lymph nodes
C83.07	Small cell b-cell lymphoma, spleen
C83.08	Small cell b-cell lymphoma, lymph nodes of multiple sites
C83.09	Small cell b-cell lymphoma, extranodal and solid organ sites
C83.1	Mantle cell lymphoma
C83.10	Mantle cell lymphoma, unspecified site
C83.11	Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.12	Mantle cell lymphoma, intrathoracic lymph nodes
C83.13	Mantle cell lymphoma, intra-abdominal lymph nodes
C83.14	Mantle cell lymphoma, lymph nodes of axilla and upper limb
C83.15	Mantle cell lymphoma, lymph nodes of inguinal region and lower limb
C83.16	Mantle cell lymphoma, intrapelvic lymph nodes
C83.17	Mantle cell lymphoma, spleen
C83.18	Mantle cell lymphoma, lymph nodes of multiple sites
C83.19	Mantle cell lymphoma, extranodal and solid organ sites
C83.3	Diffuse large b-cell lymphoma
C83.30	Diffuse large b-cell lymphoma, unspecified site
C83.31	Diffuse large b-cell lymphoma, lymph nodes of head, face, and neck
C83.32	Diffuse large b-cell lymphoma, intrathoracic lymph nodes
C83.33	Diffuse large b-cell lymphoma, intra-abdominal lymph nodes
C83.34	Diffuse large b-cell lymphoma, lymph nodes of axilla and upper limb
C83.35	Diffuse large b-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36	Diffuse large b-cell lymphoma, intrapelvic lymph nodes
C83.37	Diffuse large b-cell lymphoma, spleen
C83.38	Diffuse large b-cell lymphoma, lymph nodes of multiple sites
C83.39	Diffuse large b-cell lymphoma, extranodal and solid organ sites
C83.5	Lymphoblastic (diffuse) lymphoma
C83.50	Lymphoblastic (diffuse) lymphoma, unspecified site
C83.51	Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52	Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53	Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.54	Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb
C83.55	Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb
C83.56	Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes
C83.57	Lymphoblastic (diffuse) lymphoma, spleen
C83.58	Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites
C83.59	Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.7	Burkitt lymphoma
C83.70	Burkitt lymphoma, unspecified site
C83.71	Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72	Burkitt lymphoma, intrathoracic lymph nodes
C83.73	Burkitt lymphoma, intra-abdominal lymph nodes
C83.74	Burkitt lymphoma, lymph nodes of axilla and upper limb
C83.75	Burkitt lymphoma, lymph nodes of inguinal region and lower limb
C83.76	Burkitt lymphoma, intrapelvic lymph nodes
C83.77	Burkitt lymphoma, spleen
C83.78	Burkitt lymphoma, lymph nodes of multiple sites
C83.79	Burkitt lymphoma, extranodal and solid organ sites
C83.8	Other non-follicular lymphoma
C83.80	Other non-follicular lymphoma, unspecified site
C83.81	Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82	Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83	Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84	Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85	Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86	Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87	Other non-follicular lymphoma, spleen
C83.88	Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89	Other non-follicular lymphoma, extranodal and solid organ sites
C83.9	Non-follicular (diffuse) lymphoma, unspecified
C83.90	Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C83.91	Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck
C83.92	Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes
C83.93	Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes
C83.94	Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb
C83.95	Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C83.96	Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes
C83.97	Non-follicular (diffuse) lymphoma, unspecified, spleen
C83.98	Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites
C83.99	Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84	Mature t/Nk-cell lymphomas
C84.0	Mycosis fungoides
C84.00	Mycosis fungoides, unspecified site
C84.01	Mycosis fungoides, lymph nodes of head, face, and neck
C84.02	Mycosis fungoides, intrathoracic lymph nodes
C84.03	Mycosis fungoides, intra-abdominal lymph nodes
C84.04	Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05	Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06	Mycosis fungoides, intrapelvic lymph nodes
C84.07	Mycosis fungoides, spleen
C84.08	Mycosis fungoides, lymph nodes of multiple sites
C84.09	Mycosis fungoides, extranodal and solid organ sites
C84.1	Sezary disease
C84.10	Sezary disease, unspecified site
C84.11	Sezary disease, lymph nodes of head, face, and neck
C84.12	Sezary disease, intrathoracic lymph nodes
C84.13	Sezary disease, intra-abdominal lymph nodes
C84.14	Sezary disease, lymph nodes of axilla and upper limb
C84.15	Sezary disease, lymph nodes of inguinal region and lower limb
C84.16	Sezary disease, intrapelvic lymph nodes
C84.17	Sezary disease, spleen
C84.18	Sezary disease, lymph nodes of multiple sites
C84.19	Sezary disease, extranodal and solid organ sites
C84.4	Peripheral t-cell lymphoma, not elsewhere classified
C84.40	Peripheral t-cell lymphoma, not elsewhere classified, unspecified site
C84.41	Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42	Peripheral t-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43	Peripheral t-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44	Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45	Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46	Peripheral t-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47	Peripheral t-cell lymphoma, not elsewhere classified, spleen
C84.48	Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49	Peripheral t-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.6	Anaplastic large cell lymphoma, ALk-positive
C84.60	Anaplastic large cell lymphoma, ALk-positive, unspecified site
C84.61	Anaplastic large cell lymphoma, ALk-positive, lymph nodes of head, face, and neck
C84.62	Anaplastic large cell lymphoma, ALk-positive, intrathoracic lymph nodes
C84.63	Anaplastic large cell lymphoma, ALk-positive, intra-abdominal lymph nodes
C84.64	Anaplastic large cell lymphoma, ALk-positive, lymph nodes of axilla and upper limb
C84.65	Anaplastic large cell lymphoma, ALk-positive, lymph nodes of inguinal region and lower limb
C84.66	Anaplastic large cell lymphoma, ALk-positive, intrapelvic lymph nodes
C84.67	Anaplastic large cell lymphoma, ALk-positive, spleen
C84.68	Anaplastic large cell lymphoma, ALk-positive, lymph nodes of multiple sites
C84.69	Anaplastic large cell lymphoma, ALk-positive, extranodal and solid organ sites
C84.7	Anaplastic large cell lymphoma, ALk-negative
C84.70	Anaplastic large cell lymphoma, ALk-negative, unspecified site
C84.71	Anaplastic large cell lymphoma, ALk-negative, lymph nodes of head, face, and neck
C84.72	Anaplastic large cell lymphoma, ALk-negative, intrathoracic lymph nodes
C84.73	Anaplastic large cell lymphoma, ALk-negative, intra-abdominal lymph nodes
C84.74	Anaplastic large cell lymphoma, ALk-negative, lymph nodes of axilla and upper limb
C84.75	Anaplastic large cell lymphoma, ALk-negative, lymph nodes of inguinal region and lower limb
C84.76	Anaplastic large cell lymphoma, ALk-negative, intrapelvic lymph nodes
C84.77	Anaplastic large cell lymphoma, ALk-negative, spleen
C84.78	Anaplastic large cell lymphoma, ALk-negative, lymph nodes of multiple sites
C84.79	Anaplastic large cell lymphoma, ALk-negative, extranodal and solid organ sites
C84.7A	Anaplastic large cell lymphoma, ALk-negative, breast
C84.9	Mature t/Nk-cell lymphomas, unspecified
C84.90	Mature t/Nk-cell lymphomas, unspecified, unspecified site
C84.91	Mature t/Nk-cell lymphomas, unspecified, lymph nodes of head, face, and neck
C84.92	Mature t/Nk-cell lymphomas, unspecified, intrathoracic lymph nodes
C84.93	Mature t/Nk-cell lymphomas, unspecified, intra-abdominal lymph nodes
C84.94	Mature t/Nk-cell lymphomas, unspecified, lymph nodes of axilla and upper limb
C84.95	Mature t/Nk-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb
C84.96	Mature t/Nk-cell lymphomas, unspecified, intrapelvic lymph nodes
C84.97	Mature t/Nk-cell lymphomas, unspecified, spleen
C84.98	Mature t/Nk-cell lymphomas, unspecified, lymph nodes of multiple sites
C84.99	Mature t/Nk-cell lymphomas, unspecified, extranodal and solid organ sites
C84.A	Cutaneous t-cell lymphoma, unspecified
C84.A0	Cutaneous t-cell lymphoma, unspecified, unspecified site
C84.A1	Cutaneous t-cell lymphoma, unspecified lymph nodes of head, face, and neck
C84.A2	Cutaneous t-cell lymphoma, unspecified, intrathoracic lymph nodes
C84.A3	Cutaneous t-cell lymphoma, unspecified, intra-abdominal lymph nodes
C84.A4	Cutaneous t-cell lymphoma, unspecified, lymph nodes of axilla and upper limb
C84.A5	Cutaneous t-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C84.A6	Cutaneous t-cell lymphoma, unspecified, intrapelvic lymph nodes
C84.A7	Cutaneous t-cell lymphoma, unspecified, spleen
C84.A8	Cutaneous t-cell lymphoma, unspecified, lymph nodes of multiple sites
C84.A9	Cutaneous t-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z	Other mature t/Nk-cell lymphomas
C84.Z0	Other mature t/Nk-cell lymphomas, unspecified site
C84.Z1	Other mature t/Nk-cell lymphomas, lymph nodes of head, face, and neck
C84.Z2	Other mature t/Nk-cell lymphomas, intrathoracic lymph nodes
C84.Z3	Other mature t/Nk-cell lymphomas, intra-abdominal lymph nodes
C84.Z4	Other mature t/Nk-cell lymphomas, lymph nodes of axilla and upper limb
C84.Z5	Other mature t/Nk-cell lymphomas, lymph nodes of inguinal region and lower limb
C84.Z6	Other mature t/Nk-cell lymphomas, intrapelvic lymph nodes
C84.Z7	Other mature t/Nk-cell lymphomas, spleen
C84.Z8	Other mature t/Nk-cell lymphomas, lymph nodes of multiple sites
C84.Z9	Other mature t/Nk-cell lymphomas, extranodal and solid organ sites
C85	Other specified and unspecified types of non-hodgkin lymphoma
C85.1	Unspecified b-cell lymphoma
C85.10	Unspecified b-cell lymphoma, unspecified site
C85.11	Unspecified b-cell lymphoma, lymph nodes of head, face, and neck
C85.12	Unspecified b-cell lymphoma, intrathoracic lymph nodes
C85.13	Unspecified b-cell lymphoma, intra-abdominal lymph nodes
C85.14	Unspecified b-cell lymphoma, lymph nodes of axilla and upper limb
C85.15	Unspecified b-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.16	Unspecified b-cell lymphoma, intrapelvic lymph nodes
C85.17	Unspecified b-cell lymphoma, spleen
C85.18	Unspecified b-cell lymphoma, lymph nodes of multiple sites
C85.19	Unspecified b-cell lymphoma, extranodal and solid organ sites
C85.2	Mediastinal (thymic) large b-cell lymphoma
C85.20	Mediastinal (thymic) large b-cell lymphoma, unspecified site
C85.21	Mediastinal (thymic) large b-cell lymphoma, lymph nodes of head, face, and neck
C85.22	Mediastinal (thymic) large b-cell lymphoma, intrathoracic lymph nodes
C85.23	Mediastinal (thymic) large b-cell lymphoma, intra-abdominal lymph nodes
C85.24	Mediastinal (thymic) large b-cell lymphoma, lymph nodes of axilla and upper limb
C85.25	Mediastinal (thymic) large b-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.26	Mediastinal (thymic) large b-cell lymphoma, intrapelvic lymph nodes
C85.27	Mediastinal (thymic) large b-cell lymphoma, spleen
C85.28	Mediastinal (thymic) large b-cell lymphoma, lymph nodes of multiple sites
C85.29	Mediastinal (thymic) large b-cell lymphoma, extranodal and solid organ sites
C85.8	Other specified types of non-hodgkin lymphoma
C85.80	Other specified types of non-hodgkin lymphoma, unspecified site
C85.81	Other specified types of non-hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82	Other specified types of non-hodgkin lymphoma, intrathoracic lymph nodes
C85.83	Other specified types of non-hodgkin lymphoma, intra-abdominal lymph nodes
C85.84	Other specified types of non-hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85	Other specified types of non-hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86	Other specified types of non-hodgkin lymphoma, intrapelvic lymph nodes
C85.87	Other specified types of non-hodgkin lymphoma, spleen
C85.88	Other specified types of non-hodgkin lymphoma, lymph nodes of multiple sites
C85.89	Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites
C85.9	Non-hodgkin lymphoma, unspecified
C85.90	Non-hodgkin lymphoma, unspecified, unspecified site
C85.91	Non-hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C85.92	Non-hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C85.93	Non-hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C85.94	Non-hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
C85.95	Non-hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C85.96	Non-hodgkin lymphoma, unspecified, intrapelvic lymph nodes
C85.97	Non-hodgkin lymphoma, unspecified, spleen
C85.98	Non-hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C85.99	Non-hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86	Other specified types of t/Nk-cell lymphoma
C86.0	Extranodal Nk/t-cell lymphoma, nasal type
C86.1	Hepatosplenic t-cell lymphoma
C86.2	Enteropathy-type (intestinal) t-cell lymphoma
C86.3	Subcutaneous panniculitis-like t-cell lymphoma
C86.4	Blastic Nk-cell lymphoma
C86.5	Angioimmunoblastic t-cell lymphoma
C86.6	Primary cutaneous Cd30-positive t-cell proliferations
C88.0	Waldenstrom macroglobulinemia
C88.4	Extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue [MALt-lymphoma]
C91.5	Adult t-cell lymphoma/leukemia (HTLv-1-associated)
C91.50	Adult t-cell lymphoma/leukemia (HTLv-1-associated) not having achieved remission
Osteosarcoma of bone
C40	Malignant neoplasm of bone and articular cartilage of limbs
C40.0	Malignant neoplasm of scapula and long bones of upper limb
C40.00	Malignant neoplasm of scapula and long bones of unspecified upper limb
C40.01	Malignant neoplasm of scapula and long bones of right upper limb
C40.02	Malignant neoplasm of scapula and long bones of left upper limb
C40.1	Malignant neoplasm of short bones of upper limb
C40.10	Malignant neoplasm of short bones of unspecified upper limb
C40.11	Malignant neoplasm of short bones of right upper limb
C40.12	Malignant neoplasm of short bones of left upper limb
C40.2	Malignant neoplasm of long bones of lower limb
C40.20	Malignant neoplasm of long bones of unspecified lower limb
C40.21	Malignant neoplasm of long bones of right lower limb
C40.22	Malignant neoplasm of long bones of left lower limb
C40.3	Malignant neoplasm of short bones of lower limb
C40.30	Malignant neoplasm of short bones of unspecified lower limb
C40.31	Malignant neoplasm of short bones of right lower limb
C40.32	Malignant neoplasm of short bones of left lower limb
C40.8	Malignant neoplasm of overlapping sites of bone and articular cartilage of limb
C40.80	Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb
C40.81	Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb
C40.82	Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb
C40.9	Malignant neoplasm of unspecified bones and articular cartilage of limb
C40.90	Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb
C40.91	Malignant neoplasm of unspecified bones and articular cartilage of right limb
C40.92	Malignant neoplasm of unspecified bones and articular cartilage of left limb
C41	Malignant neoplasm of bone and articular cartilage of other and unspecified sites
C41.0	Malignant neoplasm of bones of skull and face
C41.1	Malignant neoplasm of mandible
C41.2	Malignant neoplasm of vertebral column
C41.3	Malignant neoplasm of ribs, sternum and clavicle
C41.4	Malignant neoplasm of pelvic bones, sacrum and coccyx
C41.9	Malignant neoplasm of bone and articular cartilage, unspecified
Small cell lung carcinoma
C34	Malignant neoplasm of bronchus and lung
C34.0	Malignant neoplasm of main bronchus
C34.00	Malignant neoplasm of unspecified main bronchus
C34.01	Malignant neoplasm of right main bronchus
C34.02	Malignant neoplasm of left main bronchus
C34.1	Malignant neoplasm of upper lobe, bronchus or lung
C34.10	Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11	Malignant neoplasm of upper lobe, right bronchus or lung
C34.12	Malignant neoplasm of upper lobe, left bronchus or lung
C34.2	Malignant neoplasm of middle lobe, bronchus or lung
C34.3	Malignant neoplasm of lower lobe, bronchus or lung
C34.30	Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31	Malignant neoplasm of lower lobe, right bronchus or lung
C34.32	Malignant neoplasm of lower lobe, left bronchus or lung
C34.8	Malignant neoplasm of overlapping sites of bronchus and lung
C34.80	Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81	Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82	Malignant neoplasm of overlapping sites of left bronchus and lung
C34.9	Malignant neoplasm of unspecified part of bronchus or lung
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91	Malignant neoplasm of unspecified part of right bronchus or lung
C34.92	Malignant neoplasm of unspecified part of left bronchus or lung
Soft or connective tissue sarcoma
C49	Malignant neoplasm of other connective and soft tissue
C49.0	Malignant neoplasm of connective and soft tissue of head, face and neck
C49.1	Malignant neoplasm of connective and soft tissue of upper limb, including shoulder
C49.10	Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder
C49.11	Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12	Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.2	Malignant neoplasm of connective and soft tissue of lower limb, including hip
C49.20	Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip
C49.21	Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22	Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3	Malignant neoplasm of connective and soft tissue of thorax
C49.4	Malignant neoplasm of connective and soft tissue of abdomen
C49.5	Malignant neoplasm of connective and soft tissue of pelvis
C49.6	Malignant neoplasm of connective and soft tissue of trunk, unspecified
C49.8	Malignant neoplasm of overlapping sites of connective and soft tissue
C49.9	Malignant neoplasm of connective and soft tissue, unspecified
Thyroid carcinoma
C73	Malignant neoplasm of thyroid gland
Wilms' tumor
C64	Malignant neoplasm of kidney, except renal pelvis
C64.1	Malignant neoplasm of right kidney, except renal pelvis
C64.2	Malignant neoplasm of left kidney, except renal pelvis
C64.9	Malignant neoplasm of unspecified kidney, except renal pelvis