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It is not the total number of times you have had adriamycin, but rather the total dose. The life time dose of adriamycin is 450 mg per meter square of body surface area ( calculated based on weight and height ). Usually, the dose of adriamycin given with cytoxan ( AC ) is either 50 or 60 mg per meter squared so after 4 doses, you would be nowhere near your lifetime max.
There used to be some concern that using zinecard with adriamycin to protect the heart might have reduced its efficacy but that was a few years back. I don't know what the recent thinking is. I know it is not used alot. I do know that if adriamycin is given slowly as opposed to a quick IV push, it is thought to be less toxic.
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