[Jackie07]

A serious but uncommon side effect of Doxil can be interference with the pumping action of the heart. You can receive only up to a certain amount of Doxil during your lifetime. This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs. No "lifetime maximum dose" has been established for Doxil. You may be given Doxil for as long as the disease does not progress and you show no evidence of heart toxicity.
Delayed Effects of Doxil:

There is a slight risk of developing a blood cancer such as leukemia years after taking drugs similar to Doxil. Talk to your doctor about this risk in relation to Doxil.
Not all Doxil side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When To Contact Your Doctor or Health Care Provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.5º F (38º C) or higher or chills (possible signs of infection).

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Mouth sores (painful redness, swelling or ulcers)
• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Fast or irregular heart beats
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Extreme fatigue (unable to carry on self-care activities)
• Constipation
• Swelling of the feet or ankles
• Tingling or burning, redness, swelling or peeling of skin, blisters or small sores on the palms of the hands or soles of feet.

Always inform your health care provider if you experience any unusual symptoms.
Doxil Precautions:

• Before starting Doxil treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). Do not take aspirin or products containing aspirin unless your doctor permits this.
• Do not receive any kind of vaccination without your doctor's approval while taking Doxil.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D Doxil may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Doxil. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant after therapy.
• Do not breast feed while taking Doxil.
• You may be more sensitive to sunlight, take extra care to avoid sun exposure.
• People with congestive heart failure, those who have already had high doses of Doxil or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive Doxil.
• Anyone who has had an allergic reaction to Doxil or any of its components cannot receive it again.

Doxil Self Care Tips:

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor.
• Prevention of hand-foot syndrome. Modification of normal activities of daily living to reduce friction and heat exposure to hands and feet, for about a week after treatment. (For more information see - Managing side effects: hand foot syndrome).
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by Doxil.
• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
• Get plenty of rest.
• Maintain good nutrition.
• In general, drinking alcoholic beverages should be minimized or avoided. You should discuss this with your doctor.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Doxil:

A baseline heart evaluation is recommended before starting treatment, and a heart function test will be done as your doctor prescribes. You will be checked regularly by your health care professional while you are taking Doxil, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.