Adverse Reaction Management

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Proactive communication with your patients during DOXIL® therapy may help with the management of adverse reactions—such as hand-foot syndrome (HFS), stomatitis, and anemia.

The information in the tabs below provides important talking points you can review with your patients prior to DOXIL® treatment.

  • HFS
  • Stomatitis¹
  • Neutropenia
  • Anemia
  • Thrombocytopenia
  • Nausea/Vomiting

Teach Your Patients to Proactively Monitor for These Common Signs and Symptoms of HFS

  • Tingling, burning, itching, or numbness
  • Redness
  • Pain or tenderness
  • Flaking or peeling of the skin
  • Swelling
  • Rash
  • Small blisters or small sores on the palms of the hands or soles of the feet
  • Before each dose of DOXIL®, ask your patient if he or she has experienced numbness or tingling or symptoms of HFS anywhere on his or her body since the last dose
    • This may help you assess for HFS
  • Intervention at the first appearance of symptoms can minimize the extent, severity, and degree of HFS
  • It’s important that patients be taught to take action right away if HFS symptoms arise. Helpful interventions include
    • Gently patting—not rubbing—the skin with a soft towel after bathing
    • Examining between the folds of the skin for redness or irritation
    • Hydrating the skin with plain, mild moisturizers¹
    • Soaking the affected area with cool or tepid water
  • Advise your patients to follow the suggestions below, at least 24 hours before and 3 to 5 days after DOXIL® administration
    • Wear comfortable shoes
    • Don’t wear tight or restrictive clothing or accessories—such as belts, jewelry, undergarments, knee-highs, spandex, bras, socks, and pantyhose
    • Use sun block
    • Stay away from direct sunlight, including sunny windows
    • Avoid activities that put pressure on the skin, like gardening, kneeling for long periods of time, carrying heavy objects (grocery bags), aerobics, and power walking
    • Avoid friction-causing activities like typing, lawn mowing, vacuuming, sweeping, dusting, and mopping
    • Avoid steam, hot baths and showers, and whirlpool baths
    • Use mild soaps when bathing

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing HFS.

  • Make sure your patients know that they need to report symptoms like redness, swelling, or sores in the mouth
  • Assess your patient’s current oral hygiene and emphasize the importance of maintaining good oral hygiene during DOXIL® treatment
  • Advise your patients to avoid
    • Hot or spicy foods
    • Hard or crunchy foods
    • Alcoholic beverages
    • Hot beverages
    • Citrus fruits or juices
    • Tobacco use

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing stomatitis.

DOXIL®, like other chemotherapy treatments, can lower white blood cell counts. In patients treated with DOXIL®, changes in white blood cell counts were generally moderate and able to be reversed in patients with recurrent ovarian cancer. In some patients, white blood cell counts may be severely lowered and result in neutropenia.

If your patient develops neutropenia, adjust the dose of DOXIL®. (See dose modification guidelines for recurrent ovarian cancer patients or multiple myeloma patients.)

Here Are Some Ways to Help Your Patients Avoid Infections:

  • Explain that they need be vigilant about hygiene
    • Patients should bathe daily and wash their hands often throughout the day, especially before eating and after using the bathroom
    • Any cuts or scrapes should be cleaned immediately with soap, warm water, and an antiseptic
  • Warn patients to avoid cuts or breaks in the skin by
    • Taking care with sharp objects
    • Using an extra-soft toothbrush
    • Not cutting, tearing or biting nails or cuticles
    • Not squeezing or scratching pimples
    • Using lotion or oil to help soften and heal dry or cracked skin
  • Let patients know that they should avoid situations that increase the risk of infection by
    • Staying away from places where there may be large crowds
    • Minimizing contact with anyone who has an infectious disease
    • Wearing protective gloves when gardening or cleaning up after animals or other people
  • Tell patients to seek your advice about health-related activities that may increase their risk of infection, such as
    • Flossing their teeth, vaccinations, or the use of enemas or suppositories

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing neutropenia.

DOXIL®, like other chemotherapy treatments, can lower red blood cell counts. In patients treated with DOXIL®, changes in red blood cell counts are generally moderate and able to be reversed in patients with recurrent ovarian cancer. In some patients, red blood cell counts may be severely lowered and result in anemia.

Let Your Patients Know That Anemia May Make Them Feel Weak and Tired. Offer Them These Tips for Feeling More Energetic:

  • Patients should get a lot of rest and do only those activities that are most important. In addition
    • Daily naps—or just periods of relaxation—are essential and should be part of the daily routine
    • 8 hours of sleep every night is ideal
    • Ask your patients to tell you if they are having trouble sleeping
  • Let your patients know if an exercise program is appropriate for them at this time
  • Counsel patients about their diet
    • Remind them to eat a well-balanced diet and drink plenty of liquids
    • Let patients know whether they should eat more protein or foods with iron
  • Encourage patients to ask friends, family, and even neighbors, for help
  • Warn patients to stand up slowly after sitting or lying down in order to prevent dizziness

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing anemia symptoms.

DOXIL®, like other chemotherapy treatments, can lower platelet counts. In patients treated with DOXIL®, changes in platelet counts are generally moderate and able to be reversed. However, in some patients, platelet counts may be severely lowered and result in thrombocytopenia.

If your patient develops thrombocytopenia, adjust the dose of DOXIL®. (See dose modification guidelines for recurrent ovarian cancer patients or multiple myeloma patients.)

Let Patients Know That Thrombocytopenia May Cause Bleeding to Last Longer.

  • Encourage your patients to avoid situations that may cause bleeding. For example, during this time they should be extra careful
    • With scissors, knives, pins, tools, and any other objects that could cause a cut or break in the skin
    • When working with anything hot—like an iron—to avoid burns
    • With their diets, to avoid constipation
    • When shaving—an electric shaver is preferable to a razor
    • When bending over—the head should remain above the level of the heart
    • When wiping or blowing the nose—it should be done gently with a soft tissue
    • To avoid contact sports or other activities that could cause injury
    • With non-prescription medicines, some of which can make bleeding problems worse
    • Alcoholic beverages—generally, it is better to avoid alcohol
    • When brushing and flossing—an extra-soft toothbrush is preferable

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing thrombocytopenia symptoms.

Like other chemotherapies, DOXIL® may cause nausea and vomiting. In patients treated with DOXIL®, nausea and vomiting were usually mild and in most cases were managed with medications. Ask your patients to tell you if they experience either of these adverse reactions.

You Can Also Offer Them These Tips for Controlling Nausea and Vomiting:

  • Eat frequent small meals throughout the day instead of a few big meals
  • Avoid fried, fatty, and sweet foods
  • Drink liquids at least 1 hour before or after meals instead of with them
  • Eat foods that are cold or at room temperature to avoid strong smells
  • Dry foods like toast, crackers, or cereal can mitigate morning nausea if eaten before getting out of bed
  • Drinking clear, cool liquids like apple juice, iced tea, or flat ginger ale and sucking on ice cubes or mints can help to combat nausea
  • Eat and drink slowly and chew food well
  • Do not lay down immediately after eating; wait at least 2 hours
  • Avoid tight-fitting clothes and strong smells from cooking, perfume or smoke

If patients still feel nauseous, suggest that they try:

  • Stress-relieving techniques, such as breathing slowly and deeply, meditation, or relaxation CDs
  • Distracting activities like watching TV or movies, talking with friends or family, or listening to music

Visit the recurrent ovarian cancer or multiple myeloma patient and caregiver sections of this Web site to review specific tips for managing nausea and vomiting.