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Liposomal doxorubicin (Caelyx, Myocet, Doxil)

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This page tells you about the chemotherapy drug liposomal doxorubicin and its possible side effects. You can read about

 

What liposomal doxorubicin is

Liposomal doxorubicin is the chemical name for the chemotherapy drug. It is also called by the brand names Caelyx, Myocet or Doxil. Doctors use it to treat some types of cancer, including breast cancer, ovarian cancer, multiple myeloma and a type of sarcoma called Kaposi’s sarcoma.

This drug contains the chemotherapy drug doxorubicin (Adriamycin) wrapped up in a fatty covering called a liposome. This allows the doxorubicin to stay in the bloodstream longer, so that more of the drug reaches the cancer cells. It has fewer side effects on healthy cells than regular doxorubicin, because the fatty covering acts as a barrier.

 

How you have liposomal doxorubicin

Liposomal doxorubicin is a light red liquid that you have through a drip (infusion) into your bloodstream.

You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

Each treatment usually takes between 30 to 90 minutes. You usually have liposomal doxorubicin as a course of several cycles of treatment. Your treatment plan will depend on which type of cancer you have. There is detailed information about how doctors plan chemotherapy in the chemotherapy section.

The side effects that liposomal doxorubicin may cause are listed below. Use the links to find out more about each side effect or go to the cancer drug side effects section.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. Contact your doctor or nurse if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Feeling or being sick, which is usually well controlled with anti sickness medicines but it is important to tell your nurse if you still feel sick
  • A sore mouth or mouth ulcers in up to 1 in 3 people
  • Soreness, redness and peeling on the palms of the hands and soles of the feet (palmar – plantar syndrome) which may cause tingling, numbness, pain and dryness
  • Red or orange urine within 1 or 2 days of treatment – this is the colour of the drug and won't harm you
  • Loss of appetite
  • Temporary hair loss or hair thinning may begin 2 to 5 weeks after treatment starts
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if it becomes severe or lasts for more than a couple of days as you could get dehydrated
  • Constipation can occur in some people – if you get constipated, try to drink plenty of liquids, eat fruit and vegetables and ask your doctor or nurse for a laxative
  • Watery eyes and blurred vision
  • Heart muscle damage, which may change the rhythm of the heartbeat or make your heart work less well – your doctor or nurse will check your heart before you start treatment and in many people the changes go back to normal after treatment finishes
  • Numbness or tingling in the fingers and toes happens to nearly everyone having oxaliplatin and is usually worse if you are cold – you may have trouble with fiddly tasks such as doing up buttons. This can start a few days or weeks after treatment and usually goes away within a few months of the treatment ending
  • Sensitivity to the sun during treatment and for several months afterwards – cover up and stay in the shade during this time but if you must go in the sun, use a high factor sun cream (SPF 30 or higher)
  • An allergic reaction occurs in up to 1 in 10 people (10%) while they are having the drug, causing flushing, breathlessness, swelling of the face, chills, back pain, a headache, or chest tightness – tell your nurse immediately if you have any of these
  • An itchy skin rash over most of your body
  • Indigestion
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
  • Black or brown discoloration in skin creases is particularly likely in children (although this drug is not often given to children)
  • Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment, Talk to your doctor before starting treatment if you plan to have a baby in the future
  • Changes in your liver that are mild and unlikely to cause any symptoms – the changes usually go back to normal once the treatment ends
 

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

Liposomal doxorubicin may have a harmful effect on a developing baby. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant. You need to use reliable contraception during treatment and for 6 months afterwards.

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about liposomal doxorubicin

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 21 May 2013