The amelioration of anthracycline-induced cardiotoxicity by numerous organic chemicals is discussed. These include ion regulators, receptor site antagonists, and inhibitors of mediator release, energy regulators, enzyme inhibitors, membrane stabilizers, anthracycline uptake inhibitors, and inactivators, antioxidants and chelating materials, and various miscellaneous substances.Of these the bis(2,6-dioxopiperazine)s remain as the potentially most useful drugs.Recently published reviews (7,2) describe the various organic chemicals that serve to ameliorate acute and chronic anthracycline-induced toxicities at the cellular, animal, and clinical levels. In this review drugs are categorized according to the rationale proposed for their protective activity. Whereas major efforts have been directed towards decreasing myocardial concentrations of anthracyclines and their metabolites and the development of less cardiotoxic anthracyclines, this summary focuses upon the concurrent administration of substances that block anthracyclineinduced toxicities.As discussed in other chapters, anthracycline antitumor activity may be attributable to multiple mechanisms (1-3) such as (a) intercalation into DNA, (b) formation of ternary complexes with DNA topoisomerase n, and (c) radical-induced DNA strand breakage. The latter may involve anthracycline semiquinone radical-induced hydroxyl radical (HO*) formation, anthracycline semiquinone radical-induced superoxide anion radical (0 2 T )generation, and/or anthracycline-ferric ion complex catalyzed Fenton reactions (J).Anthracycline-induced cardiotoxicity also is a function of multiple mechanistic possibilities (1). Acute effects such as hypotension are inhibited by antagonists of neurotransmitters (4,5). Subacute toxicity is rare, is unrelated to cumulative anthracycline dose, and manifests itself within 4 weeks as pericarditis-myocarditis with pericardial effusion and ventricular dysfunction (6). Nucleolar segregation also