idarubicin

ROUTE	ONSET	PEAK	DURATION
IV	Unknown	10–14 days	21 days

Contraindicated in:

Lactation: Lactation.

Use Cautiously in:

Active infection;
↓bone marrow reserve;
Other chronic debilitating illnesses;
Hepatic impairment (dose ↓ may be required; avoid if bilirubin ≥5 mg/dL);
Renal impairment;
Pre-existing cardiac disease;
Previous daunorubicin or doxorubicin therapy;
OB: Another anthracycline is preferred for induction treatment in AML; use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: incidence of adverse reactions in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARRHYTHMIAS, HF

Derm: alopecia, photosensitivity, rash

Endo: gonadal suppression

GI: abdominal cramps, diarrhea, mucositis, nausea, vomiting

Hemat: anemia, leukopenia, thrombocytopenia, BLEEDING

Local: phlebitis at IV site

Metab: hyperuricemia

Neuro: headache, mental status changes, peripheral neuropathy

Resp: pulmonary toxicity, pulmonary allergic reactions

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

↑myelosuppression with other antineoplastics or radiation therapy.
Paclitaxel, trastuzumab, or cyclophosphamide may ↑ risk of cardiotoxicity; avoid use of idarubicin for up to 7 mo after discontinuing trastuzumab.
May ↓ antibody response to and increase risk of adverse reactions from live-virus vaccines.

Route/Dosage ⬆ ⬇

IV (Adults ): 12 mg/m² once daily for 3 days.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL

Assessment ⬆ ⬇

Monitor BP, pulse, respiratory rate, and temperature frequently during administration. Report significant changes.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Monitor intake and output ratios. Report significant discrepancies. Encourage fluid intake of 2000–3000 mL/day. Allopurinol and alkalinization of the urine may be used to ↓ serum uric acid levels and to help prevent urate stone formation.
Severe and protracted nausea and vomiting may occur as early as 1 hr after therapy and may last 24 hr. Parenteral antiemetics should be administered 30–45 min prior to therapy and routinely around the clock for the next 24 hr as indicated. Monitor amount of emesis; report emesis exceeding guidelines to prevent dehydration.
Monitor for development of signs of myocardial toxicity manifested by life-threatening arrhythmias, cardiomyopathy, and HF (peripheral edema, dyspnea, rales/crackles, weight gain). Chest x-ray, ECG, echocardiography, and radionuclide angiography determinations of left ventricular ejection fraction should be monitored prior to and periodically during therapy.
Assess injection site frequently for redness, irritation, or inflammation. May infiltrate painlessly. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to SUBQ tissue. If possible, withdraw 3–5 mL of blood to remove some of the drug. Remove the infusion needle. Treatment of extravasation includes rest, elevation of the extremity, and application of intermittent ice packs (apply for 30 min immediately and 30 min 4 times/day for 3 days). May also use dimethyl sulfoxide or dexrazoxane to treat extravasation. For dimethyl sulfoxide:Apply dimethyl sulfoxide 50% by saturating a gauze pad and painting on an area twice the size of the extravasation. Allow site to air-dry and repeat application every 8 hr for 7 days. Do not cover the area with dressing. For dexrazoxane: Administer first infusion as soon as possible within 6 hr of extravasation. Remove ice packs for at least 15 min prior to and during dexrazoxane administration. Recommended dose of dexrazoxane for Day 1 is 1000 mg/m² (max = 2000 mg), the dose for Day 2 is 1000 mg/m² (max = 2000 mg), and the dose for Day 3 is 500 mg/m² (max = 1000 mg). Dexrazoxane is administered as an IV infusion over 1–2 hr. Concurrent treatment with topical dimethyl sulfoxide application should not be used with dexrazoxane, because the combination may worsen extravasation-induced tissue injury. If pain, erythema, or vesication persists longer than 48 hr, immediate plastic surgery may be warranted.

Lab Test Considerations:

Monitor CBC, differential, and platelet count prior to and frequently during therapy. Nadirs of leukopenia and thrombocytopenia are 10–14 days, with recovery occurring 21 days after a dose.
- Monitor renal and hepatic function prior to and periodically during therapy. Idarubicin may cause hyperuricemia. May also cause transient ↑ in AST, ALT, LDH, serum alkaline phosphatase, and bilirubin. Do not administer if serum bilirubin level >5 mg/dL.

Implementation ⬆ ⬇

Do not confuse idarubicin with daunorubicin, doxorubicin, or idarucizumab.
- Do not administer SUBQ or IM and avoid extravasation; may cause severe tissue necrosis.

IV Administration:

Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard IV equipment in specially designated containers.
Administer undiluted.
Rate: Administer each dose slowly over 10–15 min through a free-flowing infusion of 0.9% NaCl or D5W. Attach tubing to a butterfly needle and inject into a large vein.

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional promptly if fever; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in stools, urine, or emesis; ↑ fatigue; dyspnea; or orthostatic hypotension occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs, as these may precipitate gastric bleeding.
Instruct patient to report pain at injection site immediately.
Instruct patient to inspect oral mucosa for erythema and ulceration. If ulceration occurs, advise patient to use sponge brush, rinse mouth with water after eating and drinking, and confer with health care professional if mouth pain interferes with eating. Further courses of idarubicin should be withheld until recovery from mucositis, and subsequent doses should be ↓ by 25%. Stomatitis pain may require treatment with opioid analgesics.
Instruct patient to notify health care professional immediately if irregular heartbeat, shortness of breath, or swelling of lower extremities occurs.
Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
Discuss with patient the possibility of hair loss. Explore methods of coping.
Instruct patient not to receive any vaccinations without advice of health care professional.
Inform patient that urine may turn a reddish color.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for at least 6.5 mo after last dose and to avoid breastfeeding during and for 14 days after last dose of therapy. Advise males with female partners of reproductive potential to use effective contraception during therapy and for 3.5 mo after last dose. May impair fertility; advise both men and women to seek advice for fertility preservation before therapy and/or seek genetic counseling after treatment.
Emphasize the need for periodic lab tests to monitor for side effects.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇