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Doxil (Doxorubicin, Adriamycin ®, Rubex ®)  

 

Warning : One of the primary concerns with this medication is if you have an allergy to the substances in it. Before you receive treatment of this drug, you should tell your doctor whether you have ever had an allergic reaction to this medicine or its ingredients.

 

Doxil is a very a potent anti-cancer drug that should be taken with precaution and only if appropriate. In many cases it should not be taken before discussing all of your medical conditions and other types of drugs with your doctor. Other drugs, especially anthracycline-types, can cause side effects and other undesirable results when used at the same time. Also some medical conditions, such as kidney problems, immune system problems, radiation treatments, infections, liver issues, and heart issues can help your doctor decide whether you should take this drug.

This medication can augment the effects of infections, increase bleeding and cause you to bruise more easily. You should try to decrease your risk of getting bruised or cut, and especially washing your hands frequently to avoid infections.

 

Indications:  Doxil is intended for the treatment of certain kinds of cancer, particularly ovarian and breast cancer, as well as AIDS-related Kaposi’s sarcoma, and multiple myeloma. It is similar to other chemotherapy drugs because of the way it works. This medication enters your bloodstream and then gradually slows or even stops the cancer cells from growing.

Doxil  is mostly used in the treatment of the cancers: 

  • cervical cancer
  • endometrial cancer
  • head and neck cancers
  • Prostate cancer
  • liver cancer
  • chronic lymphocytic leukemia
  • non small cell lung cancer
  • p ancreatic cancer
  • esophageal cancer
  • retinoblastoma (a common intraocular cancer of childhood)
  • gestational trophoblastic tumor (a rare form of cancer in women that rises in the uterus or womb)
  • carcinoid tumors (rare tumor that tend to arise in the gastrointestinal tract and in the lungs)
  • hepatoblastoma (a certain type of liver cancer that occurs in children)
  • cancer of the thymus (a small organ in your upper chest, under your breastbone )
  • cancer of the adrenal cortex (the outside layer of the adrenal gland)
  • Ewing’s sarcoma (a type of cancer occurs in the bone or close to the bone, most often in adolescents 

Dosage:  This medication may only be prescribed and administered by a physician or a health care professional. Your physician will determine whether Doxil is appropriate for you. The medication is given by injecting for about thirty to sixty minutes or longer. Your dose is also determined by your doctor according to your body size and mass, your medical conditions, and your individual response to the therapy. If you experience any side effects during or after treatment, notify your physician as soon as possible.

You should be careful to not let the drug directly touch your skin or your eyes. If this happens you should wash your skin with soap and water, or flush your eyes with water for fifteen minutes and then notify medical help as soon as possible. Because this drug is such a potent substance, you should also avoid touching your urine or other body fluids for five days after receiving this drug. You or your caregiver should wear gloves during this time and make sure all equipment is disposed of properly.

 

Overdose:  Overdose enhances the toxic effects of Doxil. Very high doses of Doxil can cause heart problems and severe aplastic anemia (bone marrow does not produce enough new cells)  in the space of 10 to 14 days. In fact, heart failure can occur even 6 months after an overdose. If you experience abnormal effects during or after the treatment, report them immediately to your doctor. Treatment of Doxil overdose includes supportive measures and possibly blood transfusions. You can also be recommended to stay in hospital for a couple days.  

Contraindications : Doxil  is not recommended in patients suffering from heart disease associated with myocardial failure, chronic liver or kidney disease. Women who are pregnant or breast-feeding should not be treated with Doxil. 

Interactions : There are several drug interactions that should be avoided when using this medication. Keep a list of all of your medications and show them to your doctor before beginning Doxil therapy.

 

Doxil is highly not recommended with cyclophosphamide (also called 6-mercaptopurine, 6-MP or Purinethol)  ; it increases the cardiotoxic effects of Doxil and the risk of hemorrhagic cystitis (inflammation and bleeding inside the bladder  ). When Doxil is administered with mercaptopurine, there is an increased risk of liver problems. It is also preferable not to associate Doxil with cyclosporin and live attenuated vaccines.  

Side effects :  Doxil attacks not only cancer cells but healthy cells; this often leads to the development of adverse effects in most patients. Most common Doxil side effects include: 

  • fatigue
  • nausea and vomitting.......................................
  • mouth sores
  • hair loss
  • abdominal pain
  • difficulty swallowing  
  • eye watering
  • nail discoloration
  • skin discoloration/irritation
  • swelling, pain, redness, or peeling of skin on the palms and soles of the feet
  • Low blood counts 

Although rare, Doxil may trigger secondary leukemias and severe heart problems in some patients


Heart problems : Doxil can damage the heart muscle and lead to: 

  • chest pain and tightness   
  • abnormal heart rhythm  
  • Sudden reddening of the face, neck, or upper chest 

If you experience these symptoms, see your doctor immediately. Cardiac and haematological (blood and blood-producing organs) monitoring is necessary during the treatment. In some cases, your doctor can conduct a complete blood count and electrocardiogram before each injection. Surveillance should be increased in cases of liver problem and radiotherapy. 

In the majority of women,  Doxil may cause temporary absence of menstruation (amenorrhea). For women approaching menopause,  Doxil may cause complete absence of menstruation. The drug may also lead to discoloration of urine and formation of blood clot within a vein (venous thrombosis).