Ovarian cancer AIDS-related Kaposi’s sarcoma Multiple myeloma
Doxil is a type of chemotherapy in which the chemotherapy particles are covered in a fatty (liposomal) coating. This causes the medication to be broken down more slowly once it enters the body, allowing the chemotherapy to be more effective in reaching the cancerous tumor.
Once in the tumor, Doxil affects the DNA inside the cancer cells by interfering with their ability to grow. This prevents the cancer from being able to replicate.
What Is Doxil Used For?
Doxil is used to treat multiple cancers, including:
Brand Name(s): Doxil
Drug Availability: Prescription
Administration Route: Intravenous
Therapeutic Classification: Anthracycline
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Doxorubicin
Dosage Form(s): Solution
Ovarian cancer: Doxil is approved for use in people who have already tried another type of chemotherapy known as platinum chemotherapy. AIDS-related Kaposi’s sarcoma: Doxil can be used after someone has already received a regimen of chemotherapy with multiple combined medications. Doxil can also be used if a person can’t tolerate a certain combination chemotherapy regimen. Multiple myeloma: Doxil is combined with a medication called Velcade (bortezomib). It is used when at least one previous therapy has been given and the person has not yet had Velcade.
How to Take Doxil
Doxil is given through IV infusion in a medical center by specially trained infusion healthcare providers. Due to the potential for an infusion reaction, you may need frequent monitoring, especially during the first infusion (when a reaction is most likely to occur).
How long the infusion takes depends upon the dose you are receiving. It may not take as long to give to you if you have previously received it, as long as you didn’t have an infusion reaction.
A Doxil infusion is typically given once every three or four weeks, depending upon your type of cancer.
Off-Label Uses
Healthcare providers may prescribe Doxil for off-label uses, meaning for conditions not specifically indicated by the Food and Drug Administration (FDA).
The most common off-label use for Doxil is for metastatic breast cancer.
There is not any specific indication for its use, though studies have suggested that it may be more effective in those who have not had another anthracycline medication before. The study also found that the more chemotherapy someone has had, the less likely it would be to work as well.
What Are the Side Effects of Doxil?
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
The most common effects associated with Doxil are:
Fatigue and weakness Fever Poor appetite Nausea and vomiting Mouth sores Rash Leukopenia (low white blood cell count) Anemia (low red blood cell count) Thrombocytopenia (low platelet count) Hand-foot syndrome, or palmar-plantar erythrodysesthesia (pain, swelling, or redness to hands and feet)
Severe Side Effects
Call your healthcare provider immediately if you are experiencing severe side effects. If you think your symptoms are life-threatening or if you’re having a medical emergency, call 911. Serious side effects and their symptoms can include the following.
Heart Problems
Weakening of the heart muscle can be a severe side effect of Doxil. Due to this risk, Doxil has a maximum lifetime dose, as the side effect is cumulative. An echocardiogram will likely be done to evaluate the strength of the heart before starting Doxil. Symptoms of a weakened heart muscle include:
Shortness of breathChest painSwelling to the lower extremities
Infusion Reactions
An infusion reaction can have the following symptoms:
Hot flashesSwelling to the faceTightness of the throat and chest or shortness of breathFlu-like symptoms like fever or chillsChest painSkin reactions such as rash or itchinessFast heart rate
In some cases, the infusion reaction can be severe enough to cause someone to stop breathing. If a reaction occurs, the infusion is stopped immediately, and medications to resolve the reaction are given.
Long-Term Side Effects
Weakening of the heart muscle is the biggest long-term risk associated with Doxil use. This is a cumulative side effect, and may not be present immediately after Doxil is given. This side effect may present months or even years after using the medication.
Dosage: How Much Doxil Should I Take?
The exact dose of Doxil given depends upon many factors, which can include the height and weight of the person receiving it, as well as the type of cancer being treated.
If you experience a serious side effect, you or your provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Doxil usually is administered once every three to four weeks. Following its administration, your urine, tears, and sweat might be reddish-orange. This is a normal effect of the drug and should disappear as the drug is eliminated from your body.
Modifications
Your dose of Doxil may be changed in certain cases.
For example, if you have preexisting liver disease, the starting dose of Doxil may need to be decreased. For those who are experiencing significant side effects, Doxil may be held off for a period of time to allow for recovery, and then resumed at a reduced rate.
Missed Dose
Try not to miss your appointments for Doxil infusions. Talk to your oncologist (cancer specialist) if you must miss an infusion appointment.
Overdose: What Happens If I Take Too Much Doxil?
This medication is made by specially trained pharmacists and given by nurses who are trained to administer chemotherapy, so there is a low risk of overdose. However, if an overdose does occur, it can cause blood counts to drop significantly. An overdose can also cause severe mouth sores.
An overdose of Doxil typically needs to be managed in a hospital setting.
Precautions
What Are Reasons I Shouldn’t Take Doxil?
Doxil should not be used while pregnant or breastfeeding, as it can cause harm to the fetus or infant.
If someone collapses or isn’t breathing after taking Doxil, call 911 immediately.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control while you are receiving this medicine and for 6 months after treatment to keep from getting pregnant. If you think you or your partner have become pregnant, tell your doctor right away.
Talk with your doctor before using this medicine if you plan to have children. Some men and women who use this medicine have become infertile (unable to have children).
Check with your doctor right away if you have chest pain or discomfort, a fast or irregular heartbeat, swelling of the feet and lower legs, or troubled breathing. These could be symptoms of a serious heart problem.
This medicine may cause an infusion reaction, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have chest tightness, a cough, dizziness, a fast heartbeat, trouble breathing, trouble swallowing, swelling in your face or hands, a fever or chills, or lightheadedness or faintness while you are receiving this medicine.
This medicine may cause hand-foot syndrome. Check with your doctor right away if you have tingling or burning, redness, swelling, blistering, or small sores on the palms of your hands or soles of your feet.
Doxorubicin liposome can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination. Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done. Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime. Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters. Avoid contact sports or other situations where bruising or injury can occur.
If you continue to receive this medicine for a full year, tell your doctor right away if you have any discomfort, pain, sores or ulcers in your mouth. These could be symptoms of oral cancer.
Tell your doctor right away if you notice redness, pain, or swelling at the injection site after you receive this medicine. If doxorubicin liposome accidentally leaks out of the vein where it is injected, it may damage the skin and cause scars.
This medicine may cause your urine color to be red or orange for 1 or 2 days after you receive the injection. This is normal.
It should also not be used in people who have had a severe reaction to another anthracycline or who are allergic to any of the ingredients in Doxil.
What Other Medications Interact With Doxil?
While being given through the IV, Doxil should not be mixed with any other IV medications.
There are no formal studies on other medication interactions with Doxil.
What Medications Are Similar?
There are other anthracycline medications available, but they are not used along with Doxil. Doxil is the only anthracycline in a liposomal fatty coating.
Other anthracyclines include:
Lipodox (doxorubicin)Cerubidine (daunorubicin)Ellence (epirubicin)Idamycin (idarubicin)
Anthracyclines can be used to treat several types of cancers, including:
Leukemia Breast cancer Lymphoma Sarcoma
How Can I Stay Healthy While Taking Doxil?
Living with cancer can come with a lot of fear and uncertainty, especially when starting a new treatment. Chemotherapy often comes with side effects that can be scary or overwhelming. However, it is important to remember that there are ways to manage these side effects. For example, not eating before your treatment might help relieve nausea and vomiting. Being open with your healthcare team can help them better manage your treatment.
Nausea and vomitingFeeling tired and fatiguedMouth sores and sores on the hands and feetInfusion reactionsHeart muscle weakness
When getting Doxil, it is important to keep all follow-up and infusion appointments with the cancer care team. Let them know of any side effects. Never hesitate to connect with them, as they will know you well and can help you manage side effects before they become severe. Caregivers should also take precautions (such as wearing gloves) to prevent contact with urine or other body fluids for at least five days after treatment.
