Doxil Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

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Doxorubicin induces dose-related myelosuppression, primarily affecting leukocytes. Therapy with doxorubicin should be withheld in patients whose bone marrow function is severely depressed by prior irradiation or chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. If the need outweighs the risk, extreme caution should be exercised in administering doxorubicin and the dosage should be reduced. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitory of hematopoietic function is recommended. Doxorubicin is contraindicated in patients with severe persistent drug-induced myelosuppression

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Precautions and monitoring of patients administered doxorubicin liposomal are the same as those noted for conventional doxorubicin. Doxorubicin can cause myocardial toxicity leading to congestive heart failure. The incidence of drug-induced congestive heart failure in adults is increased when the total cumulative dose of doxorubicin exceeds 550 mg/m2. Patients with preexisting-existing heart disease, prior irradiation, or previous therapy with doxorubicin or related compounds such as daunorubicin, idarubicin or mitoxantrone are at increased risk of cardiotoxicity at a lower cumulative dose. An electrocardiogram, determination of left ventricular ejection fraction, and/or echocardiogram prior to therapy with doxorubicin, at 400 mg/m2 cumulative dose, and periodically thereafter are recommended.

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The pharmacokinetics of doxorubicin liposomal has not been adequately evaluated in patients with hepatic impairment. Doxorubicin is eliminated in large part by the liver. Reduce doxorubicin liposomal injection for serum bilirubin of 1.2 mg/dL or higher.

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