Which drug has notable cardiotoxic potential that necessitates a baseline echocardiogram before use?

• A. Cisplatin
• B. Doxorubicin
• C. Ifosfamide
• D. Cyclophosphamide

Answer: (B)

Doxorubicin has notable cardiotoxic potential that necessitates a baseline echocardiogram before use. This drug, an anthracycline, can cause dose-related, often irreversible damage to heart muscle, leading to systolic heart failure. Because the risk increases with the total lifetime dose and can be subclinical early on, measuring baseline left ventricular function with an echocardiogram helps clinicians monitor changes during treatment and adjust dosing or switch therapy if needed. Establishing the starting ejection fraction provides a reference to detect even small declines later on.

Other drugs in the list have different primary toxicities—cisplatin is mainly nephrotoxic and ototoxic; ifosfamide carries risks like neurotoxicity and hemorrhagic cystitis; cyclophosphamide can cause various toxicities including cardiomyopathy in some regimens—so they do not have the same established requirement for a baseline cardiac function assessment specifically to guard against cardiotoxicity in the way anthracyclines do.