Doxorubicin Liposome (Intravenous)

Doxorubicin liposome injection is a chemotherapy drug that can be used in isolation or with other medications to treat some forms of cancer.

Overview

In the US doxorubicin liposome is sold under the brand names Lipodox, Doxil, and Lipodox 50. The drug comes in solution form for intravenous delivery. You will usually receive this drug in hospital, and it will be given to you by a trained medical professional or oncologist.

Doxorubicin liposome is a form of anthracycline chemotherapy medication that is used to treat certain cancers, including ovarian cancer, multiple myeloma (in conjunction with bortezomib), and AIDS-associated Kaposi sarcoma.

The drug works by obstructing an enzyme called topo isomerase 2, which is required by cancer cells in order to divide and proliferate. Doxorubicin is contained in minute spheres known as pegylated liposomes. The spheres ensure that the drug is present in the patient's circulation for longer, meaning that more of the drug reaches the cancerous cells. The overall effect is a slowing of or completed cessation of cancer cell growth.

Conditions treated

  • Ovarian cancer
  • Multiple myeloma
  • Kaposi sarcoma

Type of medicine

  • Anthracycline chemotherapy drug
  • Solution for intravenous delivery

Side effects

Although doxorubicin liposome is very effective in treating certain forms of cancer, it can cause some unwanted side effects. You may not notice any of these effects, but if they do occur, you will need to speak to your GP or treating specialist as medical attention will be required:

  • Weight gain
  • Unusual tiredness or weakness
  • Unusual bruising or bleeding
  • Tingling, numbness, pain, or unusual sensations in the soles of the feet or palms of the hands
  • Tightness of the chest
  • Swelling of the fingers, face, lower legs, or feet
  • Sores on the lips or in the mouth
  • Sore throat
  • Skin rash or itching
  • Shortness of breath
  • Red pinpoint spots on the skin
  • Painful or difficult urination
  • Pain at the injection site
  • Lower back or side pain
  • Loss of strength and energy
  • Jaundice
  • Irregular heartbeat
  • Irregular breathing
  • Headache
  • Fever
  • Facial swelling
  • Extreme fatigue
  • Dilated neck veins
  • Decreased urine output
  • Cough or hoarseness
  • Chills
  • Chest pain
  • Blood in the urine or stools
  • Blistering, redness, peeling, or swelling of the soles of the feet or the palms of the hands
  • Black, tarry stools

Many of the side effects that patients receiving doxorubicin liposome experience go away on their own, without the need for medical attention. Your treatment team may also have some suggestions to help you manage or prevent these side effects. However, you should speak with your doctors if you find the effects particularly difficult to cope with or if they are very persistent:

  • Vomiting
  • Unsteadiness, clumsiness, trembling, or muscle coordination problems
  • Unpleasant or unusual aftertaste
  • Trouble sleeping
  • Swelling of the eye, redness, pain, or swelling of the inner lining of the eyelid
  • Sweating
  • Sore throat
  • Shivering
  • Poor appetite
  • Pain or problems when swallowing or eating
  • Nausea
  • Muscle aches
  • Joint pain
  • Itching
  • Fever
  • Excessive tearing
  • Dry, burning, dry, or itchy eyes
  • Dizziness
  • Diarrhea
  • Creamy curd-like or white patches in throat or mouth
  • Cough
  • Constipation
  • Chills
  • Change in skin color
  • Change in sense of smell
  • Back pain
  • Anxiety
  • Abnormal thinking
  • A general feeling of illness or discomfort

Some people may notice other effects that are not listed here. If you experience any other odd effects, be sure to mention them to your GP or treating specialist.

Dosage

Doxorubicin liposome injection is only given by a trained medical professional, usually in a clinic or hospital.

The treatment is administered via a drip that is placed into your arm. A small cannula is inserted into one of your veins and the drip is then connected to it. In addition to this you may need a central line. A central line is placed into your chest or arm and connects to a large vein, remaining in situ throughout your treatment with doxorubicin liposome.

The infusion usually takes around 30 to 90 minutes each time and is usually given every two to four weeks, depending on the condition you are being treated for. The dose you will be given depends on your medication condition, your weight, and your body's response to the drug. If you notice any pain, reddening, or swelling around the injection site, you must tell your treatment team immediately.

If you get any of the drug on your bare skin, wash the area straight away with soap and water. If any of the medicine gets into your eye, flush it out immediately with clean water and seek medical help straight away.

Be sure to tell caregivers and family members to wear protective gloves for at least a week following your treatment, in order to prevent contact with your bodily fluids and urine.

You must not substitute Doxil® for doxorubicin liposome HCI treatment.

Immediately after receiving doxorubicin liposome, you may feel nauseous and some patients will experience vomiting. If necessary, your GP will prescribe you medication to prevent this.

Interactions

Some drugs should not be used together, as to do so could cause a dangerous interaction or cause side effects. However, in some circumstances your GP may decide that it is in your best interest to use two or more drugs at the same time, even though a minor interaction might take place. Before you begin taking doxorubicin liposome, you must tell your GP or treatment team if you are taking any other medication, especially those listed below.

It is not recommended to take doxorubicin liposome with the following medications. Your doctor may opt to use a different drug or change some of the medication you are already taking:

  • Zidovudine
  • Warfarin
  • Voriconazole
  • Vinflunine
  • Verapamil
  • Valspodar
  • Trastuzumab
  • Topotecan
  • Tocophersolan
  • Tipranavir
  • Ticagrelor
  • Thioridazine
  • Thiopental
  • Terbinafine
  • Telithromycin
  • Telaprevir
  • Stavudine
  • St John's Wort
  • Simeprevir
  • Secobarbital
  • Saquinavir
  • Ritonavir
  • Rifapentine
  • Rifampin
  • Rifabutin
  • Regorafenib
  • Nelfinavir
  • Lopinavir
  • Cobicistat
  • Boceprevir
  • Atazanavir
  • Ranolazine
  • Quinidine
  • Quercetin
  • Posaconazole
  • Piperaquine
  • Phenytoin
  • Phenobarbital
  • Pentobarbital
  • Paroxetine
  • Paclitaxel
  • Oxcarbazepine
  • Nevirapine
  • Nefazodone
  • Nafcillin
  • Morphine Sulfate Liposome
  • Morphine
  • Modafinil
  • Mifepristone
  • Miconazole
  • Methohexital
  • Mercaptopurine
  • Mephobarbital
  • Ketoconazole
  • Itraconazole
  • Indinavir
  • Imatinib
  • Idelalisib
  • Fosphenytoin
  • Fosaprepitant
  • Fosamprenavir
  • Fluvoxamine
  • Fluphenazine
  • Fluoxetine
  • Fluconazole
  • Felodipine
  • Etravirine
  • Erythromycin
  • Enzalutamide
  • Efavirenz
  • Duloxetine
  • Dronedarone
  • Diltiazem
  • Dexrazoxane
  • Dexamethasone
  • Desipramine
  • Delavirdine
  • Darunavir
  • Cyclosporine
  • Cyclophosphamide
  • Crizotinib
  • Conivaptan
  • Clozapine
  • Clobazam
  • Clarithromycin
  • Cisplatin
  • Ciprofloxacin
  • Cinacalcet
  • Chlorpromazine
  • Ceritinib
  • Carvedilol
  • Carbamazepine
  • Captopril
  • Butalbital
  • Butabarbital
  • Bupropion
  • Bosentan
  • Azithromycin
  • Azathioprine
  • Aprobarbital
  • Aprepitant
  • Amprenavir
  • Amobarbital
  • Amitriptyline
  • Amiodarone
  • Abiraterone

Taking the following drugs while you are being treated with doxorubicin liposome could present an increased risk of side effects, although using both medications might be the best option in your case. If you are told to use both drugs together, your doctor may adjust your dose or change the frequency with which you use them.

  • Eltrombopag
  • Sorafenib

It is not recommended to use alcohol or tobacco, or to eat certain food types while you are being treated with some drugs. Your doctor will offer you more advice if this applies to you. It is not recommended to drink grapefruit juice while you are being treated with doxorubicin liposome.

Warnings

Before you decide to undergo treatment with doxorubicin liposome, you should talk to your doctor about the risks versus the benefits of doing so. There are a number considerations that you should take into account, as follows.

You must tell your treating team if you have ever suffered from allergies or unusual reactions to this or any other chemotherapy drug. You should also mention if you have ever had any other allergies to certain foods, preservatives, food dyes, or animal products.

During the course of your treatment with doxorubicin liposome, you must have regular check-ups with your doctor. These appointments are important as they are used to check that the drug is working correctly. You may also need to have blood tests to check for any unwanted side effects.

Pregnancy and breastfeeding

Tell your doctor immediately if you are, or if you think you may be pregnant. Doxorubicin liposome can harm your unborn baby. During the course of your treatment with this drug and for six months thereafter, you must use an effective form of birth control. Men having treatment with doxorubicin liposome should use a condom and notify their doctor if they think their partner is pregnant.

If you are breastfeeding, you should choose an alternative method of feeding your infant until at least six months following the conclusion of your treatment with this medicine. Doxorubicin liposome can pass into breast milk and harm your baby.

This drug can cause infertility in some men and women.

Medical history

Doxorubicin liposome can cause heart problems in some patients. If you suffer any of the following, contact your doctor straight away:

  • Irregular or rapid heartbeat
  • Swelling of lower legs and feet
  • Breathing problems

Some patients may experience an infusion reaction after receiving this medicine. This can be a life-threatening complication that necessitates immediate medication assistance. Symptoms of infusion reaction include:

  • Tightness of the chest
  • Cough
  • Rapid heartbeat
  • Dizzy spells
  • Breathing difficulties
  • Problems with swallowing
  • Swelling of the hands or face
  • Chills
  • Fever
  • Feeling faint or lightheaded while receiving the medication

Doxorubicin liposome can cause hand-foot syndrome. If you experience any of the effects listed below, contact your doctor right away:

  • Reddening or swelling of the palms or soles of the feet
  • Burning or tingling sensation of the palms or soles of the feet
  • Blisters or small sores of the palms or soles of the feet

This medication can reduce the number of white blood cells in your body, causing an increased risk of you contracting an infection. In addition, the platelet count in your blood may also be lower than usual, meaning that your blood clotting capability is reduced. You can take the following precautions when your blood count is low, to avoid contracting infections or suffering bleeding:

  • Try to avoid environments where you are likely to be exposed to people with infections, for example crowded places or your doctor's surgery waiting room.
  • Take extra care when using your toothbrush, toothpicks, or dental floss.
  • Be extra careful when using razors or when handling other sharp objects.
  • Try not to touch the inside of your nose or eyelids unless you have washed your hands.
  • Refrain from playing contact sports or undertaking activities where you could sustain bruising or other injuries.

If you notice some or all of the signs mentioned below, you should contact your GP immediately, as they could all indicate that you have an infection:

  • Fever
  • Chills
  • Hoarseness
  • Cough
  • Painful or difficult urination
  • Pain in the lower back or side

Any of the following signs could mean that you have blood clotting problems, and you should check with your GP immediately:

  • Unusual bleeding
  • Bruising very easily
  • Tarry, black stools
  • Blood in the urine or stools
  • Red pinpoint skin spots

If you have been receiving doxorubicin liposome for over a year, you must tell your treating physician if you notice any sores or ulcers, or if you are feeling any discomfort or pain in your mouth. These could all be signs of oral cancer.

If you discover any pain, swelling, or reddening of the injection site, it could mean that the drug has leaked out and damaged the skin, potentially causing permanent scarring. Under these circumstances, you should tell your doctor immediately.

Your urine may turn orange or red for a day or so following your dose of doxorubicin liposome. This is normal and is not a cause for concern.

Some existing or historical medical condition can affect how doxorubicin liposome works. Tell your doctor if you have a history of any of the medical conditions mentioned below.

Doxorubicin liposome should be used with caution in patients with a history of the following conditions as it can make them worse:

  • Congestive heart failure
  • Blood vessel or heart disease

If you are suffering from any form of infection, you should not be treated with doxorubicin liposome as it could reduce your body's ability to fight off infections.

Doxorubicin liposome should be used with caution in people suffering from liver disease. The drug's effects may be stronger than anticipated because the drug is removed more slowly from the body.

Storage

Doxorubicin liposome is a prescription only chemotherapy drug. It is only given to patients undergoing cancer treatment in a clinic or hospital. You will not be required to store this drug at home.

Summary

Doxorubicin liposome is a form of anthracycline chemotherapy medication, which is used as an effective weapon in the treatment of ovarian cancer, multiple myeloma (in conjunction with bortezomib), and AIDS-associated Kaposi sarcoma. The drug slows the growth of cancer cells and prevents them from spreading.

Cancer drugs by their nature are very strong and may cause interactions when used together with many other medications. Unpleasant side effects may also be experienced during treatment with doxorubicin. For these reasons, you must discuss your medical history in full with your doctor before you begin treatment with this medication. You must also attend regular progress checks, including blood tests, to make sure that your body is responding well to the treatment and to check for any unwanted effects.

This drug presents a danger to the unborn baby. If you are intending to get pregnant you should not use this drug. In addition, male patients should use a barrier form of contraception if their partner is pregnant, to prevent harm to the fetus.

Doxorubicin liposome can reduce the body's ability to fight off infection, so it is important that you avoid contact with people who may have infections while you are being treated with this drug.