Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Clinical tool

Cumulative Anthracycline Dose and Doxorubicin Equivalents

Add up doxorubicin, epirubicin, daunorubicin, idarubicin and mitoxantrone for cardiac risk

Updated: 27 October 20261 min read3 references

Enter the cumulative dose of each anthracycline (mg/m²); the sum is converted to doxorubicin equivalents for cardiac risk.

This calculator needs JavaScript; the formula and its interpretation are in the text of this page.

An aid for clinicians; it does not replace clinical judgement, local protocols or the drug label. Double-check every result before prescribing.

Equivalence ratios

Anthracycline equivalence to doxorubicin for late cardiomyopathy [1]
DrugRatio
Doxorubicin1
Daunorubicin0.6
Epirubicin0.8
Idarubicin5
Mitoxantrone10

Direct data for idarubicin are limited; the traditional ratio is used.

Who is at high risk?

The ASCO guideline considers these patients at high risk of heart failure [2]: doxorubicin 250 mg/m² or more (or epirubicin 600 mg/m² or more); radiotherapy of 30 Gy or more with the heart in the field; a lower anthracycline dose combined with lower-dose radiotherapy (below 30 Gy) with the heart in the field; and a lower anthracycline dose (or trastuzumab) together with any of: two or more risk factors (smoking, hypertension, diabetes, dyslipidaemia, obesity), age 60 or older, or compromised cardiac function (ejection fraction 50–55%, previous myocardial infarction, moderate or worse valvular disease) [2].

The 2022 ESC cardio-oncology guideline recommends a baseline echocardiogram and troponin or NT-proBNP before anthracyclines, with closer monitoring in high-risk groups [3].

Common questions

What is the maximum cumulative dose of doxorubicin?

The drug label describes a sharply higher risk of heart failure above about 550 mg/m² (and lower with chest radiotherapy or other cardiotoxic drugs), but risk starts at much lower doses and the ASCO high-risk threshold is 250 mg/m² [2].

When is dexrazoxane used?

In patients who have received a high cumulative dose and will benefit from more anthracycline, dexrazoxane and longer infusions reduce cardiac risk [2, 3].

Related cancer types

Breast cancerLeukaemiaLymphoma

Treatment regimens (physicians)

AC followed by paclitaxel (dose-dense and weekly)TC regimen (docetaxel and cyclophosphamide): dose and scheduleTCHP regimen: dose and schedule in HER2-positive breast cancerWeekly paclitaxel with trastuzumab (APT regimen)KEYNOTE-522 regimen: pembrolizumab and chemotherapy in triple-negative breast cancerTrastuzumab emtansine (T-DM1, Kadcyla): dose and scheduleTrastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringAdjuvant capecitabine after neoadjuvant treatment (CREATE-X)Sacituzumab govitecan (Trodelvy)Pembrolizumab with chemotherapy in metastatic triple-negative breast cancer (KEYNOTE-355)R-CHOP regimen: dose, schedule and practical pointsPola-R-CHP in DLBCL

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References

3 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset CardiotoxicityFeijen EAM, Leisenring WM, Stratton KL, et al · JAMA Oncol · 2019;5:864-871
    DOIPubMed Back to text
  2. 2
    Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice GuidelineArmenian SH, Lacchetti C, Barac A, et al · J Clin Oncol · 2017;35:893-911
    DOIPubMed Back to text: 1 2 3 4
  3. 3
    2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)Lyon AR, López-Fernández T, Couch LS, et al · Eur Heart J · 2022;43:4229-4361
    Study cardDOIPubMed Back to text: 1 2

This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/tools/anthracycline-cumulative-dose/

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