Version May 2024
Doxorubicin (liposomal) can cause myocardial damage, including acute left ventricular failure. The risk of cardiomyopathy was 11% when the cumulative anthracycline dose was between 450 and 550 mg/m2. Assess left ventricular cardiac function prior to initiation of doxorubicin (liposomal) and during and after treatment.
Serious, life-threatening, and fatal infusion-related reactions can occur with doxorubicin (liposomal). Acute infusion-related reactions occurred in 11% of patients with solid tumors. Withhold doxorubicin (liposomal) for infusion-related reactions and resume at a reduced rate. Discontinue doxorubicin (liposomal) for serious or life-threatening infusion-related reactions.
Liposomal formulations of doxorubicin should NOT be substituted for conventional doxorubicin hydrochloride on a mg-per-mg basis. Medication and equipment to manage infusion reactions should be immediately available during infusion.
AIDS-related Kaposi sarcoma: IV: 20 mg/m2 once every 21 days until disease progression or unacceptable toxicity.
Breast cancer, metastatic (off-label use): IV: 50 mg/m2 every 4 weeks (Ref).
Castleman disease, multicentric, human herpesvirus-8-associated (HHV-8 MCD) (off-label use): IV: 20 mg/m2 once every 3 weeks (in combination with rituximab and antiretroviral therapy); patients received up to 2 cycles beyond HHV-8 MCD symptom resolution and improvement in biochemical abnormalities and then received consolidation therapy (Ref).
Diffuse large B-cell lymphoma (off-label use): IV: 30 mg/m2 on day 1 every 3 weeks (in combination with cyclophosphamide, vincristine, and prednisone) for 6 to 8 cycles (Ref).
Hodgkin lymphoma, salvage treatment (off-label use): GVD regimen: IV: 15 mg/m2 (10 mg/m2 if post transplant) on days 1 and 8 every 3 weeks (in combination with gemcitabine and vinorelbine) for 2 to 6 cycles (Ref).
Multiple myeloma: IV: 30 mg/m2 on day 4 every 21 days (in combination with bortezomib) for 8 cycles or until disease progression or unacceptable toxicity (Ref).
Ovarian cancer, advanced: IV: 50 mg/m2 once every 28 days until disease progression or unacceptable toxicity.
Off-label dosing: IV: 30 mg/m2 on day 1 every 28 days (in combination with bevacizumab and carboplatin) for up to 6 cycles, followed by bevacizumab maintenance; refer to protocol for further information (Ref) or 40 mg/m2 once every 28 days (as a single agent) until disease progression or unacceptable toxicity (Ref) or 30 mg/m2 once every 28 days (in combination with carboplatin) for at least 6 cycles (Ref) or 40 mg/m2 once every 28 days (in combination with bevacizumab) until disease progression or unacceptable toxicity (Ref).
Soft tissue sarcoma, advanced or metastatic (off-label use): IV: 50 mg/m2 every 4 weeks for 6 cycles (Ref).
Uterine leiomyosarcoma, advanced or recurrent (off-label use): IV: 50 mg/m2 every 4 weeks until disease progression or unacceptable toxicity (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling. Dosage adjustment is not likely necessary (Ref).
There are no dosage adjustments provided in the manufacturer's US labeling. However, doxorubicin is predominantly hepatically eliminated and doxorubicin (liposomal) doses should be reduced in patients with serum bilirubin ≥1.2 mg/dL.
The following adjustments have also been recommended:
Krens 2019:
Bilirubin >1.2 to <3 mg/dL: Reduce dose to 75% of the original dose.
Bilirubin 3 to 5 mg/dL: Reduce dose to 50% of the original dose.
Bilirubin >5 mg/dL: Use is not recommended.
Canadian labeling (Caelyx):
Bilirubin 1.2 to 3 mg/dL: For patients with breast and ovarian cancers, reduce initial dose to 75% of normal dose; if tolerated and no increase in bilirubin/hepatic enzymes, may increase to full dose with cycle 2. For patients with AIDS-related Kaposi sarcoma, reduce dose to 50% of normal dose.
Bilirubin >3 mg/dL: For patients with breast and ovarian cancers, reduce initial dose to 50% of normal dose; if tolerated and no increase in bilirubin/hepatic enzymes, may increase dose to 75% of normal dose for cycle 2; if cycle 2 dose tolerated, may increase to full dose for subsequent cycles. For patients with AIDS-related Kaposi sarcoma, reduce dose to 25% of normal dose.
American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2: Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full, weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref).
|
Adverse reactions |
Severity |
Doxorubicin (liposomal)a,b dosage modification |
|---|---|---|
|
a Once a dosage reduction due to toxicity has been implemented, the dose should not be increased at a later time. b Bortezomib may also require dosage modification; refer to Bortezomib monograph. c HFS = hand foot syndrome. | ||
|
HFSc |
Grade 1 (mild erythema, swelling, or desquamation not interfering with daily activities) |
If no prior grade 3 or 4 HFS, no dosage adjustment is necessary. If prior grade 3 or 4 HFS, delay doxorubicin (liposomal) dose up to 2 weeks and then decrease dose by 25%. |
|
Grade 2 (erythema, desquamation, or swelling interfering with, but not precluding normal physical activities; small blisters or ulcerations <2 cm in diameter) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1. If no resolution after 2 weeks, discontinue doxorubicin (liposomal). If resolved to grade 0 or 1 within 2 weeks AND no prior grade 3 or 4 HFS, continue treatment at previous dose. If resolved to grade 0 or 1 within 2 weeks AND prior grade 3 or 4 HFS has occurred, decrease dose by 25%. | |
|
Grade 3 (blistering, ulceration, or swelling interfering with walking or normal daily activities; cannot wear regular clothing) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1, then decrease dose by 25%. If no resolution after 2 weeks, discontinue doxorubicin (liposomal). | |
|
Grade 4 (diffuse or local process causing infectious complications, or a bedridden state or hospitalization) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1, then decrease dose by 25%. If no resolution after 2 weeks, discontinue doxorubicin (liposomal). | |
|
Infusion reaction |
≤ grade 3 |
Temporarily stop doxorubicin (liposomal) infusion until resolution and then resume at a reduced rate. |
|
Serious or life-threatening |
Discontinue doxorubicin (liposomal). | |
|
Stomatitis |
Grade 1 (painless ulcers, erythema, or mild soreness) |
If no prior grade 3 or 4 toxicity, no dosage adjustment is necessary. If prior grade 3 or 4 toxicity, delay doxorubicin (liposomal) dose up to 2 weeks and then decrease dose by 25%. |
|
Grade 2 (painful erythema, edema, or ulcers, but can eat) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1. If no resolution after 2 weeks, discontinue doxorubicin (liposomal). If resolved to grade 0 or 1 within 2 weeks AND no prior grade 3 or 4 stomatitis, continue doxorubicin (liposomal) at previous dose. If resolved to grade 0 or 1 within 2 weeks AND prior grade 3 or 4 stomatitis, decrease doxorubicin (liposomal) dose by 25%. | |
|
Grade 3 (painful erythema, edema, or ulcers, and cannot eat) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1. Decrease dose by 25% and return to original dosing interval. If after 2 weeks there is no resolution, discontinue doxorubicin (liposomal). | |
|
Grade 4 (requires parenteral or enteral support) |
Delay doxorubicin (liposomal) dosing up to 2 weeks or until resolved to grade 0 or 1. Decrease dose by 25% and return to original dosing interval. If after 2 weeks there is no resolution, discontinue doxorubicin (liposomal). | |
|
Hematologic toxicity: neutropenia or thrombocytopenia |
Grade 2 |
Delay doxorubicin (liposomal) until ANC ≥1,500/mm3 and platelets ≥75,000/mm3; resume treatment at previous dose. |
|
Grade 3 |
Delay doxorubicin (liposomal) until ANC ≥1,500/mm3 and platelets ≥75,000/mm3; resume treatment at previous dose. | |
|
Grade 4 |
Delay doxorubicin (liposomal) until ANC ≥1,500/mm3 and platelets ≥75,000/mm3; then resume with a 25% dose reduction or continue at previous dose with granulocyte growth factor support. | |
|
Doxorubicin (liposomal) dosage modification when administered in combination with bortezomibb | ||
|
Hematologic toxicity |
Fever ≥38°C and ANC <1,000/mm3 |
Withhold doxorubicin (liposomal) for this cycle if prior to day 4. Decrease doxorubicin (liposomal) dose by 25% if after day 4 of previous cycle. |
|
On any day of doxorubicin (liposomal) administration after day 1 of each cycle:
|
Withhold doxorubicin (liposomal) for this cycle if prior to day 4. Decrease doxorubicin (liposomal) dose by 25% if after day 4 of previous cycle AND if bortezomib dose is reduced for hematologic toxicity. | |
|
Nonhematologic toxicity |
Neuropathic pain or peripheral neuropathy |
No doxorubicin (liposomal) dose reduction is necessary. Refer to Bortezomib monograph for bortezomib dosing adjustment. |
|
Grade 3 or 4 nonhematologic toxicity |
Delay doxorubicin (liposomal) until recovered to < grade 2, then reduce dose by 25%. | |
|
Adverse reactions |
Severity |
Doxorubicin (liposomal) dosage modification |
|---|---|---|
|
a Refer to Doxorubicin (Liposomal) Dosage Modification for Adverse Reactions table (above) for severity grade descriptions for PPE (see HFS above) and stomatitis. | ||
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b PPE = Palmar-plantar erythrodysesthesia. | ||
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Breast cancer or ovarian cancer | ||
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PPEb |
Grade 1a |
If at weeks 4 and 5 following prior dose, resume dosing unless patient has experienced prior grade 3 or 4 PPE toxicity (if prior grade 3 or 4 PPE, wait an additional week). If at week 6, decrease dose by 25%; return to 4-week interval. |
|
Grade 2a |
If at weeks 4 and 5 following prior dose, wait an additional week. If at week 6, decrease dose by 25%; return to 4-week interval. | |
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Grades 3 or 4a
|
If at weeks 4 and 5 following prior dose, wait an additional week. If at week 6, discontinue doxorubicin (liposomal). | |
|
Stomatitis |
Grade 1a |
If at weeks 4 and 5 following prior dose, resume dosing unless patient has experienced prior grade 3 or 4 stomatitis (if prior grade 3 or 4 stomatitis, wait an additional week). If at week 6, decrease dose by 25%; return to 4-week interval or discontinue doxorubicin (liposomal), based on assessment. |
|
Grade 2a |
If at weeks 4 and 5 following prior dose, wait an additional week. If at week 6, decrease dose by 25%; return to 4-week interval or discontinue doxorubicin (liposomal), based on assessment. | |
|
Grades 3 or 4a
|
If at weeks 4 and 5 following prior dose, wait an additional week. If at week 6, discontinue doxorubicin (liposomal). | |
|
Hematologic toxicity: neutropenia or thrombocytopenia |
Grades 2 or 3 |
Delay doxorubicin (liposomal) until ANC ≥1,500/mm3 and platelets ≥75,000/mm3; resume treatment at previous dose. |
|
Grade 4 |
Delay doxorubicin (liposomal) until ANC ≥1,500/mm3 and platelets ≥75,000/mm3; then resume with a 25% dose reduction or continue at previous dose with granulocyte growth factor support. | |
|
AIDS-related Kaposi sarcoma | ||
|
PPE |
Grade 1a |
If at week 3 following prior dose, resume unless prior grade 3 or 4 PPE toxicity (if prior grade 3 or 4 PPE, wait an additional week). If at week 4 following prior dose, decrease dose by 25% and return to 3-week interval. |
|
Grade 2a |
If at week 3 following prior dose, wait an additional week. If at week 4 following prior dose, decrease dose by 50% and return to 3-week interval | |
|
Grades 3 or 4a |
If at week 3 following prior dose, wait an additional week. If at week 4, discontinue doxorubicin (liposomal). | |
|
Stomatitis |
Grade 2a |
Wait 1 week and if symptoms improve, resume at 100% dose. |
|
Grade 3a |
Wait 1 week and if symptoms improve, resume with a 25% dose reduction. | |
|
Grade 4a |
Wait 1 week and if symptoms improve, resume with a 50% dose reduction. | |
|
Hematologic toxicity: neutropenia or thrombocytopenia |
Grade 3 |
Delay doxorubicin (liposomal) until ANC ≥1,000/mm3 and/or platelets ≥50,000/mm3 and then resume with a 25% dose reduction. |
|
Grade 4 |
Delay doxorubicin (liposomal) until ANC ≥1,000/mm3 and/or platelets ≥50,000/mm3 and then resume with a 50% dose reduction. | |
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Cardiomyopathy (≤11%)
Central nervous system: Fatigue (>20%), headache (1% to 11%)
Dermatologic: Palmar-plantar erythrodysesthesia (ovarian cancer: 51%), skin rash (ovarian cancer: 29%, Kaposi sarcoma: 1% to 5%), alopecia (ovarian cancer: 19%; Kaposi sarcoma: 9%)
Gastrointestinal: Nausea (ovarian cancer: 46%; Kaposi sarcoma: 17%), stomatitis (ovarian cancer: 41%; ovarian cancer, grades 3/4: 8%: Kaposi sarcoma: 7%), vomiting (ovarian cancer: 33%; Kaposi sarcoma: 8%), diarrhea (ovarian cancer: 21%; Kaposi sarcoma: 8%), constipation (>20%), anorexia (20%; Kaposi sarcoma: 1% to 5%), mucous membrane disease (ovarian cancer: 14%), dyspepsia (ovarian cancer: 12%)
Hematologic & oncologic: Thrombocytopenia (Kaposi sarcoma: grade 3: 61%, grade 4: 4%; ovarian cancer: grade 3: 1%), anemia (Kaposi sarcoma: grade 3: 55%, grade 4: 18%; grade 3: 5%, grade 4: <1%), neutropenia (Kaposi sarcoma: grade 3: 49%, grade 4: 13%; ovarian cancer: grade 3: 8%, grade 4: 4%)
Infection: Infection (1% to 12%)
Neuromuscular & skeletal: Asthenia (ovarian cancer: 40%; Kaposi sarcoma: 10%), back pain (1% to 12%)
Respiratory: Pharyngitis (ovarian cancer: 16%; Kaposi sarcoma: <1%), dyspnea (ovarian cancer: 15%; Kaposi sarcoma: 1% to 5%)
Miscellaneous: Fever (ovarian cancer: 21%; Kaposi sarcoma: 9%), infusion related reaction (7% to 11%)
1% to 10%:
Cardiovascular: Deep vein thrombosis (ovarian cancer: 1% to 10%), hypotension (1% to 10%), tachycardia (1% to 10%), vasodilation (ovarian cancer: 1% to 10%), chest pain (1% to 5%), peripheral edema (ovarian cancer: 1% to 5%)
Central nervous system: Depression (ovarian cancer: 1% to 10%), dizziness (1% to 10%), drowsiness (1% to 10%), anxiety (ovarian cancer: 1% to 5%), chills (1% to 5%), emotional lability (Kaposi sarcoma: 1% to 5%), insomnia (ovarian cancer: 1% to 5%), malaise (ovarian cancer: 1% to 5%)
Dermatologic: Acne vulgaris (ovarian cancer: 1% to 10%), ecchymoses (ovarian cancer: 1% to 10%), exfoliative dermatitis (ovarian cancer: 1% to 10%), fungal dermatitis (ovarian cancer: 1% to 10%), furunculosis (ovarian cancer: 1% to 10%), herpes simplex dermatitis (1% to 10%), maculopapular rash (ovarian cancer: 1% to 10%; Kaposi sarcoma: <1%), pruritus (1% to 10%), skin discoloration (ovarian cancer: 1% to 10%), vesiculobullous dermatitis (ovarian cancer: 1% to 10%), xeroderma (ovarian cancer: 1% to 10%), diaphoresis (ovarian cancer: 1% to 5%)
Endocrine & metabolic: Dehydration (ovarian cancer: 1% to 10%; Kaposi sarcoma: <1%), hypercalcemia (ovarian cancer: 1% to 10%), hypokalemia (ovarian cancer: 1% to 10%), hyponatremia (ovarian cancer: 1% to 10%), weight loss (1% to 10%), albuminuria (Kaposi sarcoma: 1% to 5%), hyperglycemia (Kaposi sarcoma: 1% to 5%), hypocalcemia (Kaposi sarcoma: 1% to 5%)
Gastrointestinal: Dysgeusia (ovarian cancer: 1% to 10%; Kaposi sarcoma: <1%), dysphagia (1% to 10%), esophagitis (ovarian cancer: 1% to 10%), intestinal obstruction (ovarian cancer: 1% to 10%), oral candidiasis (1% to 10%), oral mucosa ulcer (1% to 10%), abdominal pain (Kaposi sarcoma: 1% to 5%), aphthous stomatitis (Kaposi sarcoma: 1% to 5%), enlargement of abdomen (ovarian cancer 1% to 5%), glossitis (Kaposi sarcoma: 1% to 5%)
Genitourinary: Hematuria (ovarian cancer: 1% to 10%), urinary tract infection (ovarian cancer: 1% to 10%), vulvovaginal candidiasis (ovarian cancer: 1% to 10%)
Hematologic & oncologic: Rectal hemorrhage (ovarian cancer: 1% to 10%), hypochromic anemia (Kaposi sarcoma: ≥5%), hemolysis (Kaposi sarcoma: 1% to 5%), prolonged prothrombin time (Kaposi sarcoma: 1% to 5%)
Hepatic: Hyperbilirubinemia (1% to 10%), increased serum alkaline phosphatase (Kaposi sarcoma: 8%), increased serum alanine aminotransferase (Kaposi sarcoma: 1% to 5%)
Hypersensitivity: Hypersensitivity reaction (1% to 5%)
Infection: Herpes zoster infection (ovarian cancer: 1% to 10%; Kaposi sarcoma: <1%), paresthesia (5%), myalgia (ovarian cancer: 1% to 5%)
Ophthalmic: Conjunctivitis (ovarian cancer: 1% to 10%; Kaposi sarcoma: <1%), dry eye syndrome (ovarian cancer: 1% to 10%), retinitis (Kaposi sarcoma 1% to 5%)
Respiratory: Increased cough (ovarian cancer: 10%; Kaposi sarcoma: <1%), epistaxis (ovarian cancer: 1% to 10%), pneumonia (1% to 10%), rhinitis (ovarian cancer: 1% to 10%), sinusitis (ovarian cancer: 1% to 10%)
<1%: Bundle branch block, candidiasis, cardiac failure, cryptococcosis, hepatitis, palpitations, sepsis, thrombophlebitis, thrombosis, ventricular arrhythmia
Frequency not defined:
Hematologic & oncologic: Bone marrow depression, progression of cancer
Infection: Toxoplasmosis
Ophthalmic: Optic neuritis
Postmarketing: Erythema multiforme, lichenoid eruption (keratosis), muscle spasm, pulmonary embolism, secondary acute myelocytic leukemia, squamous cell carcinoma, Stevens-Johnson syndrome, toxic epidermal necrolysis
History of severe hypersensitivity (including anaphylaxis) to doxorubicin (liposomal), conventional doxorubicin, or any component of the formulation.
Canadian labeling: Additional contraindications (not in the US labeling): Breastfeeding.
Concerns related to adverse effects:
• Bone marrow suppression: Neutropenia, anemia, and thrombocytopenia may occur. Hematologic toxicity may occur at a higher frequency and severity with combination chemotherapy.
• Cardiomyopathy: Doxorubicin (liposomal) can cause myocardial damage, including acute left ventricular failure. The risk of cardiomyopathy was 11% when the cumulative anthracycline dose was between 450 and 550 mg/m2. Cardiomyopathy is defined as a >20% decrease in resting left ventricular ejection fraction (LVEF) from baseline (if LVEF remained in the normal range) or a >10% decrease from baseline (where LVEF was less than the institutional lower limit of normal). Some patients developed signs/symptoms of heart failure without documented evidence of cardiomyopathy. The risk of cardiomyopathy with doxorubicin is generally proportional to the cumulative exposure; include prior use of other anthracyclines or anthracenediones in the calculations of the cumulative dose. The risk of cardiomyopathy may be increased at lower cumulative doses in patients with prior mediastinal irradiation. Use in patients with a history of cardiovascular disease only if potential benefits outweigh cardiovascular risk.
• Infusion-related reactions: Serious, life-threatening, and fatal infusion-related reactions can occur with doxorubicin (liposomal). Acute infusion-related reactions occurred in 11% of patients with solid tumors. Infusion reactions may include flushing, shortness of breath, facial swelling, headache, chills, back pain, tightness in the chest or throat, fever, hypotension, chest pain, pruritus, rash, cyanosis, syncope, tachycardia, bronchospasm, asthma, and apnea. Most reactions occurred during the first infusion. Some reactions have resulted in dose interruption.
• Palmar-plantar erythrodysesthesia (hand-foot syndrome): Hand-foot syndrome has been reported in patients receiving doxorubicin (liposomal), including grade 3 or 4 cases. It is usually seen after 2 to 3 treatment cycles, although may also occur earlier.
• Secondary malignancy: Cases of secondary oral cancers (primarily squamous cell carcinoma) have been reported with long-term (>1 year) doxorubicin (liposomal) exposure; these secondary oral malignancies have occurred during treatment and up to 6 years after treatment. The development of oral ulceration or discomfort should be monitored and further evaluated in patients with past or present use of doxorubicin (liposomal). Tissue distribution of the liposomal doxorubicin compared to free doxorubicin may play a role in the development of oral secondary malignancies associated with long-term use.
Dosage form specific issues:
• Liposomal vs conventional formulation dosing: Liposomal formulations of doxorubicin should NOT be substituted for conventional doxorubicin hydrochloride on a mg-per-mg basis.
Doxil, generic doxorubicin HCl liposomal (Sun Pharma), and Caelyx (Canadian product) are pegylated liposomal formulations of doxorubicin hydrochloride.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intravenous, as hydrochloride:
Doxil: 2 mg/mL (10 mL, 25 mL)
Generic: 2 mg/mL (10 mL, 25 mL)
Injectable, Intravenous, as hydrochloride [preservative free]:
Generic: 2 mg/mL (10 mL, 25 mL)
Yes
Injection (Doxil Intravenous)
2 mg/mL (per mL): $79.56
Injection (DOXOrubicin HCl Liposomal Intravenous)
2 mg/mL (per mL): $54.00 - $116.28
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intravenous, as hydrochloride:
Caelyx: 2 mg/mL (10 mL) [contains phosphatidylcholine, soy]
Generic: 2 mg/mL (10 mL, 25 mL)
IV: For IV infusion only; do not administer IV push. If contact with skin/mucosa occurs, wash immediately with soap and water. Monitor for infusion reaction. Medication and equipment to manage infusion reactions should be immediately available during infusion.
Administer IVPB over 60 minutes; the manufacturer recommends infusing the first dose at initial rate of 1 mg/minute to minimize risk of infusion reactions; if no infusion-related reactions are observed, then increase the infusion rate for completion over 1 hour. Do NOT administer undiluted. Do NOT infuse with in-line filters. Do not mix with other medications. Monitor for local erythematous streaking along vein and/or facial flushing (may indicate rapid infusion rate).
For multiple myeloma, administer doxorubicin (liposomal) after bortezomib on day 4 of each cycle.
Irritant (Ref); monitor infusion site; avoid extravasation. Assure proper needle or catheter position prior to administration.
Extravasation management: If extravasation, infiltration, or burning/stinging sensation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity (Ref). Do not apply pressure to the site. Apply ice to the site for 15 minutes 4 times a day for 3 days.
Hazardous agent (NIOSH 2016 [group 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).
AIDS-related Kaposi sarcoma: Treatment of AIDS-related Kaposi sarcoma after failure of or intolerance to prior systemic therapy.
Multiple myeloma: Treatment of multiple myeloma (in combination with bortezomib) in patients who have not previously received bortezomib and have received at least 1 prior therapy.
Ovarian cancer, advanced: Treatment of ovarian cancer after progression or recurrence on platinum-based chemotherapy.
Breast cancer, metastatic; Castleman disease, multicentric (human herpesvirus-8-associated); Cutaneous T-cell lymphomas (mycosis fungoides and Sézary syndrome), recurrent or refractory; Diffuse large B-cell lymphoma; Hodgkin lymphoma (salvage treatment); Soft tissue sarcomas, advanced or metastatic; Uterine leiomyosarcoma, advanced or recurrent
Liposomal formulation (Doxil) may be confused with the conventional formulation (Adriamycin)
DOXOrubicin liposomal may be confused with DACTINomycin, DAUNOrubicin, DAUNOrubicin liposomal, daunorubicin/cytarabine (liposomal), doxapram, doxazosin, DOXOrubicin (conventional), epiRUBicin, IDArubicin, valrubicin
Doxil may be confused with Doxy 100, Paxil
This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Use caution when selecting product for preparation and dispensing; indications, dosages, rate of administration, and adverse event profiles differ between conventional DOXOrubicin hydrochloride solution and DOXOrubicin liposomal. Both formulations are the same concentration. As a result, serious errors have occurred. Liposomal formulation of doxorubicin should NOT be substituted for doxorubicin hydrochloride on a mg-per-mg basis.
Caelyx [Canada] may be confused with Myocet [Canada]; product formulations and indications differ
Doxil [US, Israel] may be confused with Doxal brand name for doxepin [Finland] and pyridoxine/thiamine [Brazil]
Substrate of CYP2D6 (minor), CYP3A4 (minor), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Ado-Trastuzumab Emtansine: May enhance the cardiotoxic effect of Anthracyclines. Management: When possible, patients treated with ado-trastuzumab emtansine should avoid anthracycline-based therapy for up to 7 months after stopping ado-trastuzumab emtansine. Monitor closely for cardiac dysfunction in patients receiving this combination. Risk D: Consider therapy modification
Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy
Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination
Bevacizumab: May enhance the cardiotoxic effect of Anthracyclines. Risk X: Avoid combination
Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy
Brivudine: May enhance the adverse/toxic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Chikungunya Vaccine (Live). Risk X: Avoid combination
Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy
Chloramphenicol (Systemic): Myelosuppressive Agents may enhance the myelosuppressive effect of Chloramphenicol (Systemic). Risk X: Avoid combination
Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination
Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification
COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy
COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy
COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy
CycloPHOSphamide: May enhance the cardiotoxic effect of Anthracyclines. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination
Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification
Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination
Etrasimod: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Fam-Trastuzumab Deruxtecan: May enhance the cardiotoxic effect of Anthracyclines. Management: When possible, patients treated with fam-trastuzumab deruxtecan should avoid anthracycline-based therapy for up to 7 months after stopping fam-trastuzumab deruxtecan. Monitor closely for cardiac dysfunction in patients receiving this combination. Risk D: Consider therapy modification
Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination
Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy
Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification
Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Margetuximab: Anthracyclines may enhance the adverse/toxic effect of Margetuximab. Specifically, the risk of cardiac dysfunction may be increased. Management: Avoid anthracycline-based therapy for up to 4 months after discontinuing margetuximab due to an increased risk of cardiac dysfunction. If anthracyclines must be used with margetuximab monitor cardiac function closely. Risk D: Consider therapy modification
Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination
Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination
Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy
Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy
Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy
Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification
Pegloticase: May diminish the therapeutic effect of PEGylated Drug Products. Risk C: Monitor therapy
Pegvaliase: PEGylated Drug Products may enhance the adverse/toxic effect of Pegvaliase. Specifically, the risk of anaphylaxis or hypersensitivity reactions may be increased. Risk C: Monitor therapy
P-glycoprotein/ABCB1 Inhibitors: May increase the serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor therapy
Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy
Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination
Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification
Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification
Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination
Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification
Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification
Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy
Stavudine: DOXOrubicin (Liposomal) may diminish the therapeutic effect of Stavudine. Risk C: Monitor therapy
Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination
Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination
Taxane Derivatives: May enhance the adverse/toxic effect of Anthracyclines. Taxane Derivatives may increase the serum concentration of Anthracyclines. Taxane Derivatives may also increase the formation of toxic anthracycline metabolites in heart tissue. Management: Consider separating doxorubicin and paclitaxel administration by as much time as possible, using liposomal doxorubicin or epirubicin instead of doxorubicin, or using docetaxel instead of paclitaxel. Monitor closely for cardiovascular and other toxicities. Risk D: Consider therapy modification
Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination
Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination
Trastuzumab: May enhance the cardiotoxic effect of Anthracyclines. Management: When possible, patients treated with trastuzumab should avoid anthracycline-based therapy for up to 7 months after stopping trastuzumab. Monitor closely for cardiac dysfunction in patients receiving anthracyclines with trastuzumab. Risk D: Consider therapy modification
Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination
Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy
Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination
Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Vinflunine: DOXOrubicin (Liposomal) may enhance the adverse/toxic effect of Vinflunine. Specifically, the risk for hematologic toxicities may be increased. DOXOrubicin (Liposomal) may increase the serum concentration of Vinflunine. Vinflunine may decrease the serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor therapy
Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination
Zidovudine: DOXOrubicin (Liposomal) may enhance the adverse/toxic effect of Zidovudine. DOXOrubicin (Liposomal) may diminish the therapeutic effect of Zidovudine. Management: Avoid concomitant use of doxorubicin and zidovudine. Reduced efficacy of zidovudine is possible based on in vitro data. Also, increased myelosuppressive effects are possible with combined administration. Risk D: Consider therapy modification
Verify pregnancy status prior to use in patients who could become pregnant. Patients who could become pregnant and patients with partners who could become pregnant should use effective contraception during therapy and for 6 months after doxorubicin (liposomal) treatment.
Doxorubicin (liposomal) may impair fertility. Doxorubicin (liposomal) may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities; may also result in oligospermia, azoospermia, and permanent loss of fertility (sperm counts have been reported to return to normal levels in some patients, occurring several years after the end of therapy). Doxorubicin (liposomal) may cause amenorrhea and infertility. Premature menopause can occur; return of menses and ovulation may be related to age at treatment.
In placental perfusion studies, doxorubicin (liposomal) crossed the placenta similar to conventional doxorubicin (Soininen 2015). Based on the mechanism of action and data from animal reproduction studies, in utero exposure to doxorubicin (liposomal) may cause fetal harm. Doxorubicin (liposomal) use during the first trimester should be avoided.
The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy; the guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). In general, if chemotherapy is indicated, it should be avoided in the first trimester and there should be a 3-week time period between the last chemotherapy dose and anticipated delivery, and chemotherapy should not be administered beyond week 33 of gestation (ESMO [Peccatori 2013]).
A long-term observational research study is collecting information about the diagnosis and treatment of cancer during pregnancy. For additional information about the pregnancy and cancer registry, or to become a participant, contact Cooper Health (1-877-635-4499).
It is not known if doxorubicin (liposomal) is present in breast milk.
Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding should be discontinued during doxorubicin (liposomal) treatment.
CBC with differential and platelet count, liver function tests (ALT/AST, bilirubin, alkaline phosphatase). Assess left ventricular function with ECG or multigated acquisition scan prior to and during treatment to detect acute changes; monitor after treatment to detect delayed cardiotoxicity. Verify pregnancy status prior to treatment initiation (in patients who could become pregnant). Monitor infusion site. Monitor for infusion reactions, hand-foot syndrome, stomatitis, and oral ulceration/discomfort suggestive of secondary oral malignancy.
The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.
Doxorubicin inhibits DNA and RNA synthesis by intercalating between DNA base pairs causing steric obstruction and inhibits topoisomerase-II at the point of DNA cleavage. Doxorubicin is also a powerful iron chelator. The iron-doxorubicin complex can bind DNA and cell membranes, producing free hydroxyl (OH) radicals that cleave DNA and cell membranes. Doxorubicin (liposomal) is a pegylated formulation which protects the liposomes, and thereby increases blood circulation time.
Distribution: Vdss: ~2.7 to 2.8 L/m2; largely confined to vascular fluid
Protein binding, plasma: Unknown; nonliposomal (conventional) doxorubicin: ~70%
Half-life elimination: Terminal: Distribution: ~4.7 to 5.2 hours, Elimination: ~52 to 55 hours
Metabolism: Hepatic and in plasma to doxorubicinol and the sulfate and glucuronide conjugates of 4-demethyl,7-deoxyaglycones
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