Caelyx (liposomal adriamycin)

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Your doctor has prescribed for you a treatment which includes the chemotherapy drug Caelyx. The active component of this drug is adriamycin (doxorubicin) but it is contained in a lipid capsule which reduces the cardiac risk.

Caelyx is given via a drip over 60-120 minutes. This treatment is repeated every 3-4 weeks. Before each course of chemotherapy you will see a doctor and have a blood test. If your blood count is low then chemotherapy may be delayed a few days.

We have outlined side-effects that you may experience during treatment. It is important that you feel free to ask questions so that you understand what to expect and what to do. Occasionally people have rare side-effects which are not expected or mentioned on this sheet. If in doubt please ask!

Side effects  

Immediate allergic reactions; Some people have hot flushes when the drug is being given. Fevers and chills: back pain, shortness of breath, headaches and swelling of the face may occur during the time the drug is being given. Your doctor may prescribe a drug that can help to reduce these side effects and, if necessary, we can give you this before your next treatment.

Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. Some self help tips may also be useful.

If your blood counts falls you may experience the following:

Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.

Contact to chicken pox; If you can't remember whether you've had Chicken Pox as a child and you come in contact with a person who as it or shingles you should contact your oncology team. They will arrange a blood test to find out if you are immune to chicken pox (the varcella virus). If not a series of injections can be administered to offer you temporary immunity

Fatigue; All chemotherapy can cause fatigue. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help.  Fatigue and malaise may last up to 2-3 months (or longer) after the end of chemotherapy. 

Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.

Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.

Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help. 

A change in your skin is one of the most common side effects of Caelyx. Your skin may darken because of an excess production of pigment. This usually returns to normal a few months after the treatment has finished. You may also develop red palms and soles of the feet. known as hand foot syndrome or Palmer-Planter Syndrome. Occasionally your skin may flake and crack. Again, this is temporary and improves when the treatment is finished. We can prescribe tablets and creams to help you. Your doctor may change the interval between doses or reduce the dose to help.

Some chemotherapy can make your skin more sensitive to the sun than usual. Sit in the shade, avoid too much sun and use a sunblock cream.

Hair loss; You may lose a little hair with this treatment but hair loss requiring a wig is rare. It usually starts 3-4 weeks after the first course and may be lost completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow after treatment, although it may at first be a different texture, very like a baby's hair. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately 55 for an acrylic wig, 140 for half real hair wig and  205 for a full real hair wig).  

Fertility may be affected by chemotherapy, in both men and women.  It is important to discuss fertility with your doctor before starting treatment. For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent causing menopausal symptoms.   You should not become pregnant during chemotherapy, as chemotherapy will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant. Men must also use a barrier contraceptive whilst receiving chemotherapy as sperm is damaged by chemotherapy.

Constipation: Some patients experience constipation which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP. 

Steroids; This chemotherapy is given with steroids (e.g. Dexamethasone) to help prevent sickness. Steroids have some side effects, including fluid retention, weight gain, wakefulness and sometimes agitation. If you suffer from  indigestion you may be given tablets to prevent this. If patients are prone to "spots" or acne this can be made worse. Likewise they can temporarily upset diabetes or high blood pressure.

Your veins Three types of damage can occur, listed in order of seriousness:

Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy. 

Alcohol is best avoided for 48 hours after completing the course of treatment.  

Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team. 

Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally.


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