Doxil (Doxorubicin, Hcl Liposome Injection)  

Brand name: Adriamycin ®, Rubex ®, Doxil®  

Generic name:Doxorubicin  

Other names: Hydroxydaunomycin, Hydroxydoxorubicin and Liposomal doxorubicin 

Therapeutic Class:  anthracycline antiobiotic 

Manufacturer / Distributor:  Pfizer 

Availability:  Doxil is available by prescription only  

Dosage form: Doxil is given through a vein by intravenous injection 

Indications: Doxil is used to treat a variety of cancers such as:  

• cervical cancer 
• endometrial cancer 
• head and neck cancers 
• Prostate cancer  
• liver cancer  
• ovarian cancer  
• 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)
• non small cell lung cancer 
• multiple myeloma (a form of blood cancer) 
• pancreatic cancer(cancer of the pancreas)
• esophageal cancer (cancer of the esophagus) 
• retinoblastoma (a common intraocular cancer of childhood)
• 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)  
• chronic lymphocytic leukemia (a type of cancer of the blood and lymph system) 
• Ewing’s sarcoma (a type of cancer occurs in the bone or close to the bone, most often in adolescents)
• Autoimmune deficiency syndrome (AIDS)–associated Kaposi's sarcoma (a type of cancer of the skin and mucous membranes that is more common in patients with AIDS).  

Note : Some doctors may prescribe Doxil for other medical conditions not mentioned in this article; talk to your health care provider or pharmacist for more information. 

Dosage: Doxil is administered only in hospital by specialists in oncology or by competent nurses who have experience in giving chemotherapy drugs. The drug can cause serious adverse reactions; special monitoring is required throughout the therapy. Doxil is given intravenously through a vein over 3-10 minutes. In exceptional cases, the medication can be taken by continuous infusion over a period of 48-96 hrs.   

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.  

Mechanism of action (MOA): Doxil acts by inhibiting the synthesis of DNA and RNA; thereby preventing the uncontrolled multiplication of cancer cells.  

Contraindications : Doxil is contraindicated or should be used with precaution in patients with 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: 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: low red blood cell count, low white blood cell count, low blood platelet count.  

Although rare, it can happen that Doxil triggers secondary leukemias and severe heart problems. 

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).