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Lyphidox uses


Lyphidox hydrochloride, USP is an anthracycline topoisomerase II inhibitor indicated:

1.1 Adjuvant Breast Cancer

Lyphidox hydrochloride, USP is indicated as a component of multi-agent adjuvant chemotherapy for treatment of women with axillary lymph node involvement following resection of primary breast cancer .

1.2 Other Cancers

Lyphidox hydrochloride, USP is indicated for the treatment of



2.1 Recommended Dose

Adjuvant Breast Cancer

The recommended dose of Lyphidox hydrochloride, USP is 60 mg/m2 administered as an intravenous bolus on day 1 of each 21-day treatment cycle, in combination with cyclophosphamide, for a total of four cycles .

Metastatic Disease, Leukemia, or Lymphoma

2.2 Dose Modifications

Cardiac Impairment

Discontinue Lyphidox in patients who develop signs or symptoms of cardiomyopathy.

Hepatic Impairment

Lyphidox hydrochloride, USP is contraindicated in patients with severe hepatic impairment .

Decrease the dose of Lyphidox hydrochloride, USP in patients with elevated serum total bilirubin concentrations as follows:

Serum bilirubin concentration

Doxorubicin hydrochloride, USP Dose reduction

1.2 to 3 mg/dL

50 %

3.1 to 5 mg/dL

75 %

greater than 5 mg/dL

Do not initiate doxorubicin hydrochloride, USP

Discontinue doxorubicin hydrochloride, USP

2.3 Preparation and Administration

Preparation of Lyphidox Hydrochloride for injection, USP

Reconstitute Lyphidox hydrochloride for injection, USP with 0.9% Sodium Chloride Injection, USP to obtain a final concentration of 2 mg per mL as follows:

Gently shake vial until the contents have dissolved.

Protect reconstituted solution from light.


Visually inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. Discard if the solution is discolored, cloudy, or contains particulate matter.

Storage of vials of Lyphidox hydrochloride for injection, USP following reconstitution under refrigerated conditions can result in the formation of a gelled product. Place gelled product at room temperature [150 to 300 C ] for 2 to 4 hours to return the product to a slightly viscous, mobile solution.

Administration by Intravenous Injection:

Administration by Continuous Intravenous Infusion:

Infuse only through a central catheter. Decrease the rate of Lyphidox hydrochloride, USP administration if erythematous streaking along the vein proximal to the site of infusion or facial flushing occur.

Protect from light from preparation for infusion until completion of infusion.

Management of Suspected Extravasation

Discontinue Lyphidox hydrochloride, USP for burning or stinging sensation or other evidence indicating peri venous infiltration or extravasation. Manage confirmed or suspected extravasation as follows:

Incompatibility with Other Drugs

Do not admix Lyphidox hydrochloride, USP with other drugs. If Lyphidox hydrochloride, USP is mixed with heparin or fluorouracil a precipitate may form. Avoid contact with alkaline solutions which can lead to hydrolysis of Lyphidox hydrochloride, USP.

2.4 Procedures for Proper Handling and Disposal

Handle and dispose of Lyphidox hydrochloride, USP consistent with recommendations for the handling and disposal of hazardous drugs.1

Treat accidental contact with the skin or eyes immediately by copious lavage with water, or soap and water, or sodium bicarbonate solution. Do not abrade the skin by using a scrub brush. Seek medical attention.



Lyphidox hydrochloride for injection, USP: Vials contain 10 mg and 50 mg Lyphidox hydrochloride as a red-orange lyophilized powder.


Lyphidox hydrochloride is contraindicated in patients with:



5.1 Cardiomyopathy and Arrhythmias


Lyphidox hydrochloride can result in myocardial damage, including acute left ventricular failure. The risk of cardiomyopathy is generally proportional to the cumulative exposure. Include prior doses of other anthracyclines or anthracenediones in calculations of total cumulative dosage for Lyphidox hydrochloride. Cardiomyopathy may develop during treatment or up to several years after completion of treatment and can include decrease in LVEF and signs and symptoms of congestive heart failure. The probability of developing cardiomyopathy is estimated to be 1 to 2% at a total cumulative dose of 300 mg/m2 of Lyphidox hydrochloride, 3 to 5% at a dose of 400 mg/m2, 5 to 8% at a dose of 450 mg/m2, and 6 to 20% at a dose of 500 mg/m2, when Lyphidox hydrochloride is administered every 3 weeks. There is an additive or potentially synergistic increase in the risk of cardiomyopathy in patients who have received radiotherapy to the mediastinum or concomitant therapy with other known cardiotoxic agents such as cyclophosphamide and trastuzumab.

Pericarditis and myocarditis have also been reported during or following Lyphidox hydrochloride treatment.

Assess left ventricular cardiac function (e.g., MUGA or echocardiogram) prior to initiation of Lyphidox hydrochloride, during treatment to detect acute changes, and after treatment to detect delayed cardiotoxicity. Increase the frequency of assessments as the cumulative dose exceeds 300 mg/m2. Use the same method of assessment of LVEF at all time points .

Consider the use of dexrazoxane to reduce the incidence and severity of cardiomyopathy due to Lyphidox hydrochloride administration in patients who have received a cumulative Lyphidox hydrochloride dose of 300 mg/m2 and who will continue to receive Lyphidox hydrochloride.


Lyphidox hydrochloride can result in arrhythmias, including life-threatening arrhythmias, during or within a few hours after Lyphidox hydrochloride administration and at any time point during treatment. Tachyarrhythmias, including sinus tachycardia, premature ventricular contractions, and ventricular tachycardia, as well as bradycardia may occur. Electrocardiographic changes including non-specific ST-T wave changes, atrioventricular and bundle-branch block can also occur. These electrocardiographic changes may be transient and self-limited and may not require dose-modifications of Lyphidox hydrochloride.

5.2 Secondary Malignancies

The risk of developing secondary acute myelogenous leukemia and myelodysplastic syndrome (MDS) is increased following treatment with Lyphidox hydrochloride. Cumulative incidences ranged from 0.2% at five years to 1.5% at 10 years in two separate trials involving the adjuvant treatment of women with breast cancer. These leukemias generally occur within 1 to 3 years of treatment.

5.3 Extravasation and Tissue Necrosis

Extravasation of doxorubicin hydrochloride can result in severe local tissue injury manifesting as blistering, ulceration, and necrosis requiring wide excision of the affected area and skin grafting. When given via a peripheral venous line, infuse Lyphidox over 10 minutes or less to minimize the risk of thrombosis or perivenous extravasation. If signs or symptoms of extravasation occur, immediately terminate the injection or infusion . Extravasation may be present in patients who do not experience a stinging or burning sensation or when blood return is present on aspiration of the infusion needle. If extravasation is suspected, apply ice to the site intermittently for 15 minutes, 4 times a day for 3 days. If appropriate, administer dexrazoxane at the site of extravasation as soon as possible and within the first 6 hours after extravasation.

5.4 Severe Myelosuppression

Lyphidox hydrochloride can cause myelosuppression. In Study 1, the incidence of severe myelosuppression was: grade 4 leukopenia, grade 3 leukopenia (3%), and grade 4 thrombocytopenia (0.1%). A dose-dependent, reversible neutropenia is the predominant manifestation of hematologic toxicity from Lyphidox hydrochloride. When Lyphidox hydrochloride is administered every 21 days, the neutrophil count reaches its nadir 10 to 14 days after administration with recovery usually occurring by the 21st day.

Obtain baseline assessment of blood counts and carefully monitor patients during treatment for possible clinical complications due to myelosuppression.

5.5 Use in Patients with Hepatic Impairment

The clearance of Lyphidox is decreased in patients with elevated serum bilirubin with an increased risk of toxicity . Reduce the dose of Lyphidox hydrochloride in patients with serum bilirubin levels of 1.2 to 5 mg/dL . Lyphidox is contraindicated in patients with severe hepatic impairment (defined as Child Pugh Class C or serum bilirubin level greater than 5 mg/dL) . Obtain liver tests including SGOT, SGPT, alkaline phosphatase, and bilirubin prior to and during Lyphidox hydrochloride therapy.

5.6 Tumor Lysis Syndrome

Lyphidox hydrochloride may induce tumor lysis syndrome in patients with rapidly growing tumors. Evaluate blood uric acid levels, potassium, calcium, phosphate, and creatinine after initial treatment. Hydration, urine alkalinization, and prophylaxis with allopurinol to prevent hyperuricemia may minimize potential complications of tumor lysis syndrome.

5.7 Radiation Sensitization and Radiation Recall

Lyphidox hydrochloride can increase radiation-induced toxicity to the myocardium, mucosa, skin, and liver. Radiation recall, including but not limited to cutaneous and pulmonary toxicity, can occur in patients who receive Lyphidox hydrochloride after prior radiation therapy.

5.8 Embryofetal Toxicity

Lyphidox hydrochloride can cause fetal harm when administered to a pregnant woman. Lyphidox hydrochloride was teratogenic and embryotoxic in rats and rabbits at doses lower than the recommended human dose.

If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patient of the potential hazard to a fetus .

Advise female patients of reproductive potential to use highly effective contraception during treatment with Lyphidox hydrochloride and for 6 months after treatment. Advise patients to contact their healthcare provider if they become pregnant, or if pregnancy is suspected, while taking Lyphidox hydrochloride .



The most common adverse drug reactions are alopecia, nausea and vomiting (6.1).

To report SUSPECTED ADVERSE REACTIONS, contact Mylan Pharmaceuticals Inc. at 1-877-446-3679 (1-877-4-INFO-RX) or FDA at 1-800-FDA-1088 or

The following adverse reactions are discussed in more detail in other sections of the labeling.

6.1 Clinical Trial Experience in Breast Cancer

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The safety data below were collected from 1492 women who received Lyphidox hydrochloride at a dose of 60 mg/m2 and cyclophosphamide at a dose of 600 mg/m2 (AC) every 3 weeks for 4 cycles for the adjuvant treatment of axillary lymph node positive breast cancer. The median number of cycles received was 4. Selected adverse reactions reported in this study are provided in Table 1. No treatment-related deaths were reported in patients on either arm of the study.

*Includes pooled data from patients who received either AC alone for 4 cycles, or who were treated with AC for 4 cycles followed by 3 cycles of CMF






Adverse reactions, % of patients


Grade 3 (1,000 to 1,999 /mm3)



Grade 4 (<1000 /mm3)




Grade 3 (25,000 to 49,999 /mm3)



Grade 4 (<25,000 /mm3)



Shock, sepsis



Systemic infection




Vomiting ≤12 hours



Vomiting >12 hours









Cardiac dysfunction










6.2 Postmarketing Experience

The following adverse reactions have been identified during post-approval use of Lyphidox hydrochloride. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Cardiac-cardiogenic shock

Cutaneous-Skin and nail hyperpigmentation, oncolysis, rash, itching, photosensitivity, urticaria, acral erythema, palmar plantar erythrodysesthesia

Gastrointestinal-Nausea, mucositis, stomatitis, necrotizing colitis, typhlitis, gastric erosions, gastrointestinal tract bleeding, hematochezia, esophagitis, anorexia, abdominal pain, dehydration, diarrhea, hyperpigmentation of the oral mucosa


Laboratory Abnormalities-Increased alanine aminotransferase, increased aspartate aminotransferase

Neurological-Peripheral sensory and motor neuropathy, seizures, coma

Ocular-Conjunctivitis, keratitis, lacrimation

Vascular-Phlebosclerosis, phlebitis/thrombophlebitis, hot flashes, thromboembolism

Other-Malaise/asthenia, fever, chills, weight gain


7.1 Effect of CYP3A4 Inhibitors, Inducers and P-gp

Lyphidox is a major substrate of cytochrome P450 CYP3A4 and CYP2D6, and P-glycoprotein (P-gp). Clinically significant interactions have been reported with inhibitors of CYP3A4, CYP2D6, and/or P-gp (e.g., verapamil), resulting in increased concentration and clinical effect of Lyphidox. Inducers of CYP3A4 (e.g., phenobarbital, phenytoin, St. John's Wort) and P-gp inducers may decrease the concentration of Lyphidox. Avoid concurrent use of Lyphidox hydrochloride with inhibitors and inducers of CYP3A4, CYP2D6, or P-gp.

7.2 Trastuzumab

Concurrent use of trastuzumab and Lyphidox hydrochloride results in an increased risk of cardiac dysfunction. Avoid concurrent administration of Lyphidox and trastuzumab. The appropriate interval for administering Lyphidox following trastuzumab therapy has not been determined .

7.3 Paclitaxel

Paclitaxel, when given prior to Lyphidox hydrochloride, increases the plasma-concentrations of Lyphidox and its metabolites. Administer Lyphidox hydrochloride prior to paclitaxel if used concomitantly.

7.4 Dexrazoxane

Do not administer dexrazoxane as a cardioprotectant at the initiation of Lyphidox hydrochloride containing chemotherapy regimens. In a randomized trial in women with metastatic breast cancer, initiation of dexrazoxane with Lyphidox hydrochloride-based chemotherapy resulted in a significantly lower tumor response rate and shorter time to progression than in women who received Lyphidox hydrochloride-based chemotherapy alone.

7.5 6-Mercaptopurine

Lyphidox hydrochloride may potentiate 6-mercaptopurine-induced hepatotoxicity. In 11 patients with refractory leukemia treated with 6-mercaptopurine (500 mg/m2 intravenously daily for 5 days per cycle every 2-3 weeks) and Lyphidox hydrochloride (50 mg/m2 intravenous once per cycle every 2-3 weeks) alone or with vincristine and prednisone, all developed hepatic dysfunction manifested by elevations of total serum bilirubin, alkaline phosphatase and aspartate aminotransferase.


8.1 Pregnancy

Pregnancy Category D

Risk Summary

Lyphidox hydrochloride can cause fetal harm when administered to a pregnant woman. Lyphidox hydrochloride was teratogenic and embryotoxic in rats and rabbits at doses approximately 0.07 times the recommended human dose of 60 mg/m2. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patient of the potential hazard to a fetus.

Animal Data

Lyphidox hydrochloride was teratogenic and embryotoxic at doses of 0.8 mg/kg/day (about 0.07 times the recommended human dose based on body surface area) when administered during the period of organogenesis in rats. Teratogenicity and embryotoxicity were also seen using discrete periods of treatment. The most susceptible was the 6- to 9-day gestation period at doses of 1.25 mg/kg/day and greater. Characteristic malformations included esophageal and intestinal atresia, tracheo-esophageal fistula, hypoplasia of the urinary bladder, and cardiovascular anomalies. Lyphidox hydrochloride was embryotoxic (increase in embryofetal deaths) and abortifacient at 0.4 mg/kg/day (about 0.07 times the recommended human dose based on body surface area) in rabbits when administered during the period of organogenesis.

8.3 Nursing Mothers

Lyphidox has been detected in the milk of at least one lactating patient . Because of the potential for serious adverse reactions in nursing infants from Lyphidox hydrochloride, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

8.4 Pediatric Use

Based on postmarketing reports, pediatric patients treated with Lyphidox hydrochloride are at risk for developing late cardiovascular dysfunction. Risk factors include young age at treatment (especially < 5 years), high cumulative doses and receipt of combined modality therapy. Long-term periodic cardiovascular monitoring is recommended for all pediatric patients who have received Lyphidox hydrochloride. Lyphidox hydrochloride, as a component of intensive chemotherapy regimens administered to pediatric patients, may contribute to prepubertal growth failure and may also contribute to gonadal impairment, which is usually temporary.

There are no recommended dose adjustments based on age. Lyphidox clearance was increased in patients aged 2 years to 20 years as compared to adults, while Lyphidox clearance was similar in children less than 2 years as compared to adults .

8.5 Geriatric Use

Clinical experience in patients who were 65 years of age and older who received Lyphidox hydrochloride-based chemotherapy regimens for metastatic breast cancer showed no overall differences in safety and effectiveness compared with younger patients.

8.6 Females and Males of Reproductive Potential



Lyphidox hydrochloride can cause fetal harm when administered during pregnancy. Advise female patients of reproductive potential to use highly effective contraception during treatment with Lyphidox hydrochloride and for 6 months after treatment. Advise patients to contact their healthcare provider if they become pregnant, or if pregnancy is suspected, while taking Lyphidox hydrochloride .


Lyphidox hydrochloride may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Males with female sexual partners of reproductive potential should use effective contraception during and for 6 months after treatment .



In females of reproductive potential, Lyphidox hydrochloride may cause infertility and result in amenorrhea. Premature menopause can occur. Recovery of menses and ovulation is related to age at treatment .


Lyphidox hydrochloride may result in oligospermia, azoospermia, and permanent loss of fertility. Sperm counts have been reported to return to normal levels in some men. This may occur several years after the end of therapy.

8.7 Hepatic Impairment

The clearance of Lyphidox was reduced in patients with elevated serum bilirubin levels. Reduce the dose of Lyphidox hydrochloride in patients with serum bilirubin levels greater than 1.2 mg/dL . Lyphidox hydrochloride is contraindicated in patients with severe hepatic impairment (defined as Child Pugh Class C or serum bilirubin levels greater than 5 mg/dL) .


Few cases of overdose have been described. A 58-year-old man with acute lymphoblastic leukemia received 10-fold overdose of Lyphidox hydrochloride (300 mg/m2) in one day. He was treated with charcoal filtration, hemopoietic growth factor (G-CSF), proton pump inhibitor and antimicrobial prophylaxis. The patient suffered sinus tachycardia, grade 4 neutropenia and thrombocytopenia for 11 days, severe mucositis and sepsis. The patient recovered completely 26 days after the overdose. A 17-year-old girl with osteogenic sarcoma received 150 mg of Lyphidox hydrochloride daily for 2 days (intended dose was 50 mg per day for 3 days). The patient developed severe mucositis on days 4-7 after the overdose and chills and pyrexia on day 7. The patient was treated with antibiotics and platelets and recovered 18 days after overdose.


Lyphidox hydrochloride, USP is a cytotoxic, anthracycline, topoisomerase II inhibitor isolated from cultures of Streptomyces peucetius var. caesius. Chemically, Lyphidox hydrochloride, USP is: 5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-α-L-lyxo-hexopyranosyl)oxy]-7,8,9,10 tetrahydro-6,8,11-trihydroxy-8-(hydroxylacetyl)-1-methoxy-, hydrochloride (8S-cis)-. The chemical structure of Lyphidox hydrochloride is:

Lyphidox Hydrochloride for Injection, USP is a sterile red-orange lyophilized powder, provided in single dose vial containing 10 mg, 50 mg Lyphidox HCl, USP.

Lyphidox Hydrochloride for Injection, USP

Each 10 mg lyophilized vial contains 10 mg of Lyphidox Hydrochloride, USP and 50 mg of Lactose Monohydrate, NF.

Each 50 mg lyophilized vial contains 50 mg of Lyphidox Hydrochloride, USP and 250 mg of Lactose Monohydrate, NF.



12.1 Mechanism of Action

The cytotoxic effect of Lyphidox hydrochloride on malignant cells and its toxic effects on various organs are thought to be related to nucleotide base intercalation and cell membrane lipid binding activities of Lyphidox. Intercalation inhibits nucleotide replication and action of DNA and RNA polymerases. The interaction of Lyphidox with topoisomerase II to form DNA-cleavable complexes appears to be an important mechanism of Lyphidox hydrochloride cytocidal activity.

12.3 Pharmacokinetics

Pharmacokinetic studies conducted in patients with various types of tumors have shown that Lyphidox follows multiphasic disposition after intravenous injection. The distribution half-life is approximately 5 minutes, while the terminal half-life is 20 to 48 hours. In four patients, Lyphidox demonstrated dose-independent pharmacokinetics across a dose range of 30 to 70 mg/m2.


Steady-state distribution volume ranges from 809 to 1214 L/m2. Binding of Lyphidox and its major metabolite, doxorubicinol, to plasma proteins is about 75% and is independent of plasma concentration of Lyphidox up to 1.1 mcg/mL.

Lyphidox was measured in the milk of one lactating patient after therapy with 70 mg/m2 of Lyphidox hydrochloride given as a 15-minute intravenous infusion. The peak milk concentration at 24 hours after treatment was 4.4-fold greater than the corresponding plasma concentration. Lyphidox was detectable in the milk up to 72 hours.

Lyphidox does not cross the blood brain barrier.


Enzymatic reduction at the 7 position and cleavage of the daunosamine sugar yields aglycones which are accompanied by free radical formation, the local production of which may contribute to the cardiotoxic activity of Lyphidox hydrochloride. Disposition of doxorubicinol in patients is formation rate limited, with the terminal half-life of doxorubicinol being similar to Lyphidox. The relative exposure of doxorubicinol, i.e., the ratio between the AUC of doxorubicinol and the AUC of Lyphidox is approximately 0.5.


Plasma clearance is in the range 324 to 809 mL/min/m2 and is predominately by metabolism and biliary excretion. Approximately 40% of the dose appears in the bile in 5 days, while only 5 to 12% of the drug and its metabolites appear in the urine during the same time period. In urine, <3% of the dose was recovered as doxorubicinol over 7 days.

Systemic clearance of Lyphidox is significantly reduced in obese women with ideal body weight greater than 130%. There was a significant reduction in clearance without any change in volume of distribution in obese patients when compared with normal patients with less than 115% ideal body weight.

Pediatric patients

Following administration of doses ranging from 10 to 75 mg/m2 of Lyphidox hydrochloride to 60 children and adolescents ranging from 2 months to 20 years of age, Lyphidox clearance averaged 1443 ± 114 mL/min/m2. Further analysis demonstrated that clearance in 52 children greater than 2 years of age was increased compared with adults. However, clearance in infants younger than 2 years of age (813 mL/min/m2) was decreased compared with older children and approached the range of clearance values determined in adults .

Patient Gender

There is no recommended dose adjustment based on gender. A published clinical study involving 6 men and 21 women with no prior anthracycline therapy reported a significantly higher median Lyphidox clearance in men compared to women (1088 mL/min/m2 versus 433 mL/min/m2). However, the terminal half-life of Lyphidox was longer in men compared to women (54 versus 35 hours).

Patients with hepatic impairment

The clearance of Lyphidox and doxorubicinol was reduced in patients with elevation in serum bilirubin .


13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Lyphidox hydrochloride treatment results in an increased risk of secondary malignancies based on postmarketing reports . Lyphidox hydrochloride was mutagenic in the in vitro Ames assay, and clastogenic in multiple in vitro assays (CHO cell, V79 hamster cell, human lymphoblast, and SCE assays) and the in vivo mouse micronucleus assay.

Lyphidox hydrochloride decreased fertility in female rats at the doses of 0.05 and 0.2 mg/kg/day (approximately 0.005 and 0.02 times the recommended human dose, based on body surface area).

A single intravenous dose of 0.1 mg/kg Lyphidox hydrochloride (approximately 0.01 times the recommended human dose based on body surface area) was toxic to male reproductive organs in animal studies, producing testicular atrophy, diffuse degeneration of the seminiferous tubules, and oligospermia/hypospermia in rats. Lyphidox hydrochloride induces DNA damage in rabbit spermatozoa and dominant lethal mutations in mice.


The clinical efficacy of Lyphidox hydrochloride-containing regimens for the post-operative, adjuvant treatment of surgically resected breast cancer was evaluated in a meta-analysis conducted by the Early Breast Cancer Trialists Collaborative Group (EBCTCG). The EBCTCG meta-analyses compared cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) to no chemotherapy (19 trials including 7523 patients) and Lyphidox hydrochloride-containing regimens with CMF as an active control (6 trials including 3510 patients). Data from the meta-analysis of trials comparing CMF to no therapy were used to establish the historical treatment effect size for CMF regimens. The major efficacy outcome measures were disease-free survival (DFS) and overall survival (OS).

Of the 3510 women (2157 received Lyphidox hydrochloride-containing regimens and 1353 received CMF treatment) with early breast cancer involving axillary lymph nodes included in the six trials from the meta-analyses, approximately 70% were premenopausal and 30% were postmenopausal. At the time of the meta-analysis, 1745 first recurrences and 1348 deaths had occurred. The analyses demonstrated that Lyphidox hydrochloride-containing regimens retained at least 75% of the historical CMF adjuvant effect on DFS with a hazard ratio (HR) of 0.91 (95% CI, 0.82 to 1.01) and on OS with a HR of 0.91 (95% CI, 0.81 to 1.03). Results of these analyses for both DFS and OS are provided in Table 2 and Figures 1 and 2.

Abbreviations: DFS = disease free survival; OS = overall survival; AC = Lyphidox hydrochloride, cyclophosphamide; AVbCMF = Lyphidox hydrochloride, vinblastine, cyclophosphamide, methotrexate, 5-fluorouracil; CMF = cyclophosphamide, methotrexate, 5-fluorouracil; CMFVA = cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, Lyphidox hydrochloride; FAC = 5-fluorouracil, Lyphidox hydrochloride, cyclophosphamide; FACV = 5-fluorouracil, Lyphidox hydrochloride, cyclophosphamide, vincristine; HR = hazard ratio; CI = confidence interval

* Includes pooled data from patients who received either AC alone for 4 cycles, or who were treated with AC for 4 cycles followed by 3 cycles of CMF.

** a hazard ratio of less than 1 indicates that the treatment with Lyphidox hydrochloride-containing regimens is associated with lower risk of disease recurrences or death compared to the treatment with CMF.

† Patients received alternating cycles of AVb and CMF.


(starting year)


No. of Cycles

No. of Patients

Doxorubicin -Containing

Regimens vs. CMF HR**

(95% CI)








0.93 (0.82 to 1.06)

0.97 (0.83 to 1.12)









0.86 (0.66 to 1.13)

0.93 (0.69 to 1.26)









0.71 (0.49 to 1.03)

0.65 (0.44 to 0.96)




SE Sweden BCG A





0.59 (0.22 to 1.61)

0.53 (0.21 to 1.37)




NSABC Israel Br0283






0.91 (0.53 to 1.57)

0.88 (0.47 to 1.63)




Austrian BCSG 3





1.07(0.73 to 1.55)

0.93 (0.64 to 1.35)




Combined Studies

Doxorubicin -Regimens CMF



0.91 (0.82 to 1.01)

0.91 (0.81 to 1.03)


Figure 1. Meta-analysis of Disease-Free Survival

Figure 2. Meta-analysis of Overall Survival

fig-1 fig-2



Lyphidox Hydrochloride for Injection, USP is supplied as a sterile red-orange lyophilized powder for intravenous use only, is available in single dose flip-top vials in the following package strengths:

NDC 67457-478-10: 10 mg vial; individually boxed.

NDC 67457-436-50: 50 mg vial; individually boxed.

Store unreconstituted vial at controlled room temperature, between 20°C to 25°C (68°F to 77°F). Protect vials from light. Retain in carton until time of use. Discard unused portion.

Reconstituted Solution Stability

After adding the diluent, the vial should be shaken and the contents allowed to dissolve. The reconstituted solution is stable for 7 days at room temperature and under normal room light (100 foot-candles) and 15 days under refrigeration (2° to 8°C). It should be protected from exposure to sunlight. Discard any unused solution from the 10 mg and 50 mg single dose vials.

Handling and Disposal

Handle and dispose of Lyphidox Hydrochloride for Injection, USP consistent with recommendations for the handling and disposal of hazardous drugs.1


See FDA-Approved Patient Labeling (Patient Information).

Inform patients of the following:

Lyphidox hydrochloride can cause their urine to appear red for 1 to 2 days after administration.

Manufactured for:

Mylan Institutional LLC

Rockford, IL 61103 U.S.A.

Made in India

JULY 2016

Patient Information

Lyphidox (dok-suh-roo-buh-sin) HYDROCHLORIDE For Injection, for intravenous use

What is the most important information I should know about Lyphidox?

Lyphidox may cause serious side effects including:

Tell your doctor if you get any of these symptoms of heart failure during or after treatment with Lyphidox:

Your doctor will do tests to check the strength of your heart muscle before, during, and after your treatment with Lyphidox.

What is Lyphidox?

Lyphidox is a prescription medicine used to treat certain types of cancers. Lyphidox may be used alone or along with other anti-cancer medicines.

Who should not receive Lyphidox?

Do not receive Lyphidox if:

What should I tell my doctor before receiving Lyphidox?

Before you receive Lyphidox, tell your doctor if you:

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Lyphidox can interact with other medicines. Do not start any new medicine before you talk with the doctor that prescribed Lyphidox.

Know the medicines you take. Keep a list to show your doctor and pharmacist each time you get a new medicine.

How will I receive Lyphidox?

Lyphidox will be given to you into your vein.

What are the possible side effects of Lyphidox? Lyphidox may cause serious side effects, including:

See "What is the most important information I should know about Lyphidox?"

Lyphidox may cause lower sperm counts and sperm problems in men.

This could affect your ability to father a child and cause birth defects. Talk to your healthcare provider if this is a concern for you. Talk to your healthcare provider about family planning options that might be right for you.

Irreversible amenorrhea or early menopause. Your periods (menstrual cycle) may completely stop when you receive Lyphidox. Your periods may or may not return following treatment. Talk to your healthcare provider about family planning options that might be right for you.

The most common side effects of Lyphidox include:

Other side effects:

Call your doctor if you have severe symptoms that prevent you from eating or drinking, such as:

Tell your doctor or nurse if you have any side effect that bothers you or that does not go away.

These are not all of the possible side effects of Lyphidox.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Lyphidox.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet.

You can ask your pharmacist or doctor for information about Lyphidox that is written for health professionals.

For more information, call Mylan Pharmaceuticals Inc. at 1-877-446-3679 (1-877-4-INFO-RX).

What are the ingredients of Lyphidox?

Active ingredient: Lyphidox hydrochloride, USP

Inactive ingredients for Lyphidox hydrochloride For Injection: Lactose Monohydrate

This Patient Information has been approved by the U.S. Food and Drug Administration.

Manufactured for:

Mylan Institutional LLC

Rockford, IL 61103 U.S.A.

Made in India

JULY 2016

NDC 67457-478-10

Lyphidox Hydrochloride for Injection, USP

10 mg/vial



For IV use only


Rx only

Single-Dose Vial

10 mg carton

NDC 67457-436-50

Lyphidox Hydrochloride for Injection, USP

50 mg/vial



For IV use only


Rx only

Single-Dose Vial

50 mg carton

Lyphidox pharmaceutical active ingredients containing related brand and generic drugs:

Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.

Lyphidox available forms, composition, doses:

Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.

Lyphidox destination | category:

Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.

Lyphidox Anatomical Therapeutic Chemical codes:

A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.

Lyphidox pharmaceutical companies:

Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.



  2. Dailymed."DOXORUBICIN HYDROCHLORIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". (accessed August 28, 2018).
  3. "doxorubicin". (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Lyphidox?

Depending on the reaction of the Lyphidox after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Lyphidox not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Lyphidox addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.


Review conducted a study on Lyphidox, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Lyphidox consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Rachana Salvi, MD Pharmacology

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