Trade name: Caelyx™ 10 ml (20 mg) and 25 ml (50 mg) vials Drug class: anthracycline Manufacturer: Essex
Indications: AIDS-associated Kaposi's sarcoma with < 200 CD4 cells/^l and severe mucocutaneous or visceral KS in patients not tolerating chemotherapy with other drugs or with progressive disease despite treatment.
Dose: in adults 20 mg/m2 in 250 ml 5 % glucose solution intravenously over 30 minutes. Repeat after 3 weeks.
Side effects: myelosuppression (only 10-15 %% neutropenia grade III-IV), cardiomyopathy, stomatitis (rarely severe), palmar-plantar erythrodysesthesia (PPE or hand-foot syndrome - erythematous rash which may be very painful. Treatment: cool affected areas). Rare: nausea (mild), diarrhea, alopecia.
Comments/Warnings: liposomal doxorubicin is contraindicated in decompensated cardiomyopathy, severe myelosuppression (neutrophils < 1,000/p.l, platelets < 50,000/^l) and in patients who have previously received maximum cumulative doses of anthracyclines.
Cardiological examination is important (ECG, echocardiography: left ventricular ejection fraction, LVEF) before initiation of treatment and at periodic intervals during treatment. If the cumulative dose of 450 mg/m2 is exceeded, echocardiography is necessary before each further cycle.
It is important to inform patients of PPE (may be induced by sweating, pressure, friction - therefore no tight gloves, no sun, no long warm showers, cool drinks). Do not administer intramuscularly or subcutaneously. This drug is expensive: in Germany, two 20 mg vials cost approximately 1,343 Euro!
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