Doxorubicin (Liposomal) is a pegylated, liposome-encapsulated formulation of the anthracycline antibiotic doxorubicin. This formulation is designed to enhance drug delivery to tumor sites while reducing systemic exposure and certain toxicities, most notably cardiotoxicity and palmar-plantar erythrodysesthesia (hand-foot syndrome), compared to conventional doxorubicin. It represents a critical chemotherapeutic agent in the Indian oncology landscape.
Adult: Dose is based on body surface area (BSA). **AIDS-KS:** 20 mg/m² IV over 30 minutes every 2-3 weeks. **Ovarian Cancer:** 50 mg/m² IV over 60 minutes every 4 weeks. **Multiple Myeloma:** 30 mg/m² IV over 60 minutes on day 4 following bortezomib (which is given on days 1, 4, 8, & 11 of a 21-day cycle).
Note: FOR INTRAVENOUS INFUSION ONLY. MUST NOT BE GIVEN INTRAMUSCULARLY OR SUBCUTANEOUSLY. Do not mix with other drugs. Dilute in 250 mL of 5% Dextrose Injection (preferred) to minimize aggregation. Do not use saline or any other diluent. Administer using a dedicated IV line at a controlled rate (as per indication) using an infusion pump. Observe for extravasation, which can cause severe local tissue damage.
The liposomal formulation delivers doxorubicin to tumor sites via the Enhanced Permeability and Retention (EPR) effect. Once internalized by tumor cells and doxorubicin is released, it intercalates into DNA base pairs, causing uncoiling of the DNA helix. This inhibits the progression of the enzyme topoisomerase II, which is required for DNA replication and repair, leading to DNA strand breaks and inhibition of nucleic acid synthesis.
Pregnancy: **FDA Pregnancy Category D.** Doxorubicin can cause fetal harm. It is embryotoxic and teratogenic. Not recommended during pregnancy. Effective contraception is required for both males and females during and for at least 6 months after therapy.
Driving: May cause fatigue, dizziness, or malaise. Patients should be cautioned about driving or operating machinery if affected.
| Trastuzumab, Cyclophosphamide | Markedly increased risk of cardiotoxicity (congestive heart failure, decreased LVEF). | Major |
| Other Myelosuppressive Agents (e.g., Paclitaxel, Gemcitabine) | Additive bone marrow suppression. Monitor blood counts closely. | Major |
| Phenobarbital, Phenytoin | Increased hepatic metabolism of doxorubicin, potentially reducing its efficacy. | Moderate |
| Live Vaccines (e.g., MMR, Varicella) | Risk of disseminated infection due to immunosuppression. Avoid. | Major |
| Dexrazoxane | Cardioprotective agent used to reduce the risk of doxorubicin-induced cardiomyopathy. | Beneficial Interaction |