1. Understanding the Formulation:
• Doxil is the liposomal formulation of doxorubicin. The encapsulation in liposomes alters its pharmacokinetics, reducing the rate of clearance and enabling a more targeted delivery to tumor tissues. This can lead to lower systemic toxicity compared to conventional doxorubicin.

2. Cardiotoxicity:
• Although Doxil is less cardiotoxic than conventional doxorubicin, there is still a risk, particularly with cumulative doses. Monitoring of cardiac function is essential, and consider baseline and periodic cardiac evaluations during treatment.

3. Infusion-Related Reactions:
• Doxil may cause severe infusion-related reactions. Pre-medicate patients with antihistamines, antipyretics, and corticosteroids to reduce the risk. The first infusion should be given at a slow rate (over 90 minutes), and patients must be monitored during administration.

4. PPE and Handling Instructions:
• Doxil is cytotoxic, requiring appropriate Personal Protective Equipment (PPE) during preparation and administration to prevent skin exposure. Guidelines recommend double-gloving, goggles, and protective gowns.

5. Mucositis:
• Mucositis is a common side effect of Doxil, which can vary from mild oral soreness to severe ulceration. Proactive management with good oral hygiene, protective agents, and pain management is critical.

6. Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia):
• This distinctive side effect involves redness, swelling, and pain on the palms of the hands and soles of the feet. It can be managed with dose adjustments, cooling measures, and pain relief creams. Encouraging patients to cool their hands and feet during infusion may help reduce symptom onset.

7. Dose Modifications for Toxicity:
• It's crucial to adjust Doxil dosing in the presence of toxicity, particularly regarding hepatic function. Doxil clearance is decreased in patients with impaired hepatic function, and dose adjustments must reflect hepatic status.

8. Secondary Malignancies:
• Long-term use of Doxil can increase the risk of secondary malignancies, such as acute myeloid leukemia (AML). Continuous monitoring of blood counts and patient history should be maintained to manage and identify these risks early.

9. Drug Interactions:
• Be wary of interactions with other drugs, especially those metabolized by the same cytochrome P450 enzymes. Interaction with drugs like ritonavir may increase doxorubicin plasma concentrations.

10. Usage in Special Populations:
• Careful consideration should be given when administering Doxil to special populations such as the elderly, patients with renal impairments, or compromised liver function, due to the increased risk of adverse reactions in these groups.