Precautions and Warnings With Liposomal Doxorubicin

If you have congestive heart failure, liver disease, or are pregnant, tell your healthcare provider before undergoing treatment with liposomal doxorubicin. This drug may not be suitable for everyone, so before starting treatment, be sure you understand the drug's safety precautions and warnings. Liposomal doxorubicin should be avoided by people who are allergic to any of the medicine's ingredients.

What Should I Tell My Healthcare Provider?

Prior to receiving liposomal doxorubicin (Doxil®), tell your healthcare provider if you have:
  • Congestive heart failure (CHF), an irregular heart rhythm (arrhythmia), or other heart problems
  • A history of low levels of white blood cells in the blood (known medically as neutropenia)
  • Any infection
  • Liver disease, including liver failure or cirrhosis
  • Had radiation
  • Any allergies, including to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
Make sure to tell your healthcare provider about all of the medicines you take, including prescription and nonprescription medications, vitamins, and herbal supplements.

Specific Liposomal Doxorubicin Warnings and Precautions

Some precautions and warnings to be aware of prior to using this drug include the following:
  • Liposomal doxorubicin can increase your risk of congestive heart failure (CHF), arrhythmias, or other heart problems. Your healthcare provider should monitor you closely to make sure you are not developing heart problems. Also, due to such problems, there is a lifetime limit to how much liposomal doxorubicin (or other anthracycline medications) you can receive.
  • Infusion reactions (reactions that occur while the drug is being administered) occur in up to 7.1 percent of people given liposomal doxorubicin. Signs and symptoms of an infusion reaction include:
    • Flushing
    • Shortness of breath
    • Facial swelling
    • Headache
    • Chills
    • Chest pain
    • Back pain
    • Tightness in the chest or throat
    • Fever
    • Fast heart rate
    • Blue skin (cyanosis)
    • Fainting
    • Asthma or wheezing
    • Slow or irregular breathing
    • Low blood pressure (hypotension).
For most people, these symptoms gradually improve within a few hours after the infusion is finished. In many cases, the reactions are not serious, although serious allergic reactions are possible.
  • Liposomal doxorubicin can decrease the bone marrow's ability to produce blood cells. This can result in anemia and other serious conditions.
Because your immune system depends on certain blood cells, you may be more susceptible to infections during treatment with liposomal doxorubicin (see Chemotherapy and Infections). You may also be at a higher risk for bleeding (see Blood Clotting Problems and Chemotherapy). You will need regular blood tests to make sure your blood counts are not too low.
  • This medication often causes hand-foot syndrome (HFS), a side effect of some chemotherapy drugs. This causes redness, pain, swelling, and sometimes peeling of the palms of the hands and the soles of the feet. It is more likely to occur after two or three cycles of liposomal doxorubicin, although sometimes it may occur sooner.
For most people, HFS is mild and goes away within a few weeks and, therefore, does not interfere with the chemotherapy schedule. Occasionally, though, HFS may be severe enough to require a reduction in your liposomal doxorubicin dosage or a delay in the chemotherapy schedule.
  • Liposomal doxorubicin may cause radiation recall reactions (a recurrence of radiation reactions that takes place weeks, months, or even years after the radiation has occurred) in people who have had previous radiation treatments.
  • If this medication is not correctly injected into a vein, or if it leaks from a vein, serious damage to your skin and other tissues can occur. Often, surgery is necessary to repair such damage. If you notice burning or stinging while liposomal doxorubicin is injected, be sure to tell your healthcare provider right away.
  • The liver helps clear this drug from the body. Be sure to tell your healthcare provider if you have liver disease, as this may affect how your body handles liposomal doxorubicin.
  • Liposomal doxorubicin often causes nausea and vomiting. Your healthcare provider should consider giving you medications before and after your dose in order to prevent and treat such problems (see Chemotherapy and Nausea).
  • Liposomal doxorubicin can interact with other medications (see Drug Interactions With Liposomal Doxorubicin).
  • Liposomal doxorubicin is considered a pregnancy Category D medication. This means that it is probably not safe for use during pregnancy. Talk to your healthcare provider about the risks and benefits of using this drug when pregnant (see Doxil and Pregnancy).



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