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Doxorubicin Liposome

(dox-uh-roo-buh-sin lye-poe-soam)

Trade/other name(s): Doxil, liposomal doxorubicin

Why would this drug be used?

Doxorubicin liposome is used to treat Kaposi's sarcoma, metastatic ovarian cancer, and multiple myeloma. It is also sometimes used for other types of cancer.

How does this drug work?

Doxorubicin is part of the general group of chemotherapy drugs known as anthracycline antibiotics. It slows or stops the growth of cancer cells.

Doxorubicin liposome is doxorubicin surrounded by a special covering made of fat (liposome). This covering helps the drug stay in the body longer and helps limit the drug’s effects on other parts of the body before it gets inside the cancer cells. This may lessen certain side effects.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever been treated for cancer with daunorubicin, epirubicin, idarubicin, valrubicin, or mitoxantrone (similar types of chemotherapy), or any other drug that may cause heart damage. Your dose of doxorubicin liposome may need to be adjusted.
  • If you have ever had radiation treatment to your chest. This may increase your risk of heart damage with this drug.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug could cause birth defects if a woman is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Doxorubicin liposome may cause problems with the same drugs as doxorubicin, but has not been tested to be sure. The following drugs are known to interact with doxorubicin:

  • Paclitaxel, progesterone, cyclosporine, cytarabine, streptozocin, saquinavir, or blood pressure medicines such as verapamil, diltiazem, and other calcium channel blockers may make the side effects of doxorubicin worse.
  • If doxorubicin is given with cyclophosphamide, it may increase the risk of bleeding in the bladder.
  • Doxorubicin may not work as well if it's given with phenobarbital.
  • Doxorubicin may lower the level of the anti-seizure drug phenytoin in the blood, making it less effective.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with this drug. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • Warfarin (Coumadin)
  • Ticlopidine (Ticlid)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Clopidogrel (Plavix)
  • Any type of heparin injections

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen, and there are many types of non-steroidal anti-inflammatory drugs (NSAID). Ask your pharmacist if you aren't sure what is in the medicines you take, or whether a medicine is an NSAID.

Check with your doctor, nurse, or pharmacist about taking other medicines, vitamins, herbs, and supplements with this drug, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Doxorubicin liposome is injected into a vein, and the dose is given over 1 hour, usually every 3 or 4 weeks depending on which cancer is being treated. If you get chest pain or tightness, back pain, or feel flushed while taking this medicine, tell your nurse right away. Your nurse may need to slow or stop the IV until you feel better. Many people who take doxorubicin liposome experience nausea and/or vomiting, so you will be given anti-nausea medicine to help ease these side effects. Make sure to tell your doctor or nurse if it does not work. Your dose depends upon your size and blood counts and how well your liver is working. Before each treatment, your blood counts should be checked, and if they're low, your treatment will be delayed.

Precautions

This drug can cause infusion reactions in some people while the drug is being given Mild reactions could consist of fever and chills. More serious reactions are less common, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fainting, headache, feeling warm or flushed, fever or chills, hives, itching, cough, shortness of breath, changes in heart rate, pain the back or abdomen, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

Doxorubicin liposome can cause radiation recall, a severe skin reaction in an area previously treated with radiation that occurs when certain chemotherapy drugs are administered after radiation treatment. The skin or tissue damage from prior radiation therapy can turn red and start to itch. If severe, this can progress to blistering and peeling. The reaction may last days or even weeks. Tell your doctor if your skin gets red in areas where radiation was given.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on your test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of doxorubicin liposome, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. Having a low white blood cell count can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your red blood cell count. If this happens, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug may also lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin and other drugs (see the section called “Drug interactions”). Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Talk with your doctor about this.

This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, and/or swelling in the hands or feet. If severe, peeling, blistering, and even open sores on the skin in these areas are also possible. Let your doctor know right away if you notice any of these symptoms.

Doxorubicin liposome causes the urine to turn reddish for 1 to 2 days after each dose is given. This is normal while your body gets rid of the drug, but may stain clothes.

There's a chance doxorubicin liposome can injure your heart muscle if large total doses are given. Your doctor should test your heart function before and during your first treatment so that any damage can be found early. During and after your treatment with the drug, it is still important to let your doctor know right away if you notice shortness of breath, swollen feet or ankles, or irregular heartbeat. These effects can show up months or years after receiving the drug.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, and if it does occur it would likely be years after the drug is used. Rarely, people who got this drug for more than a year, or who got large doses over time, had mouth (oral) cancers that were found both during treatment and up to 6 years after treatment. If you are getting doxorubicin liposome, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Possible side effects

You will probably not have most of the following side effects, but if you have any of these talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Low white blood cell count with increased risk of infection*
  • Anemia (low red blood cell count)*
  • Nausea
  • Vomiting
  • Sores in mouth and throat
  • Swelling, pain, numbness, tingling, or redness of hands and/or feet (hand-foot syndrome)*
  • Fatigue (tiredness) or weakness

Less common

  • Low platelet count with increased risk of bleeding*
  • Loss of appetite
  • Upset stomach
  • Fever
  • Rash
  • Infection
  • Hair loss or thinning
  • Fetal abnormalities if taken while pregnant or if pregnancy occurs while taking this drug
  • Diarrhea
  • Constipation

Rare

  • Severe infusion reaction (flushing, shortness of breath, swelling of the face, chills, back pain, headache, and/or chest tightness during the infusion)*
  • Radiation recall skin changes*
  • Itching
  • Heart damage and congestive heart failure with shortness of breath and swollen feet and ankles, which can happen months or years after treatment*
  • Irregular heartbeat*
  • Leukemia or myelodysplastic syndrome, which may happen years after treatment*
  • Mouth or oral cancer, which can happen during or after treatment*
  • Death due to infusion reactions or allergic reaction, infections, cardiac arrest

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1995.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 11/07/2013
Last Revised: 11/07/2013