Anthracyclines (daunorubicin, doxorubicin, idarubicin and mitoxantrone)

Anthracyclines are chemotherapy medicines used to treat certain types of cancer and leukaemia. This page from Great Ormond Street Hospital (GOSH) explains what anthracyclines are, how they are given and some of the possible side effects. Each person reacts differently to medicines, so your child will not necessarily suffer from every side effect mentioned. If you have any questions or concerns, please speak to your doctor, nurse or pharmacist.

Each drug is given as an infusion into a vein (intravenously or IV), through a cannula, central venous catheter or implantable port.

What are the side effects?

Nausea and vomiting

Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is very bad or continues for more than a few days.

Discoloured urine

Daunorubicin, doxorubicin and idarubicin may make your child’s urine turn an orange or red colour for a day or two after the drug is given. Mitoxantrone can make the urine turn blue or green. This is due to the colour of the medicines. It is temporary and has no lasting effects.

Bone marrow suppression

There will be a temporary reduction in how well your child’s bone marrow works. This means they may become anaemic (reduced red blood cells), bruise or bleed more easily than usual, and have a higher risk of infection.

Your child’s blood counts will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising, bleeding or any signs of infection, especially a high temperature.

Mouth sores and ulcers

You will be given advice about appropriate mouth care including a copy of our leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.

Changes in heart function

These medicines may affect the muscle of your child’s heart and how well it works. Before having any of these medicines, your child will have a test called an echocardiogram (ECHO). This will also be used to monitor the heart during the course of treatment and at long-term follow up clinics. The total amount of these drugs will be carefully calculated to minimise the risk of heart damage.

Red flush or ache along vein

If these medicines are given into a vein using a cannula, a red flush may appear along the path of the vein. This is temporary and will fade over time. This is not the same as the medicines leaking out of the vein (extravasation) – see below.

Changes in nails

Your child’s nails may become darker. Your child’s nail growth will return to normal in the future.

Inflammatory skin reaction

Sometimes these medicines may cause your child’s skin to become red and sore in the areas that have already been treated with radiotherapy.

Interactions with other medicines

Some medicines can react with anthracyclines, altering how well they work. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.


If these medicines leak into the tissues underneath your child’s skin, they can damage the tissue in this area. This is called extravasation.

  • If given through a cannula and your child complains of stinging and burning around the cannula, please tell your doctor or nurse immediately.
  • If given through a central venous catheter or implantable port and your child complains of pain around their chest or neck, please tell your doctor or nurse immediately.
Compiled by:
The Pharmacy department in collaboration with the Child and Family Information Group
Last review date:
September 2019