• 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 increased 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 decrease 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 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 to 5 mL of blood to remove some of the drug. Remove the infusion needle. Treatment of extravasation includes rest and 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 DMSO or dexrazoxane to treat extravasation. For DMSO: Apply dimethyl sulfoxide (DMSO) 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 hours for 7 days. Do not cover the area with dressing. For dexrazoxane: administer first infusion as soon as possible within 6 hrs of extravasation. Remove ice packs for at least 15 minutes prior to and during dexrazoxane administration. Recommended dose of dexrazoxane for day 1 is 1,000 mg/m² (up to 2,000 mg), the dose for day 2 is 1,000 mg/m² (up to 2,000 mg), and the dose for day 3 is 500 mg/m² (up to 1,000 mg). Dexrazoxane is administered as an IV infusion over 1 to 2 hours. Concurrent treatment with topical dimethyl sulfoxide application should not be used in with dexrazoxane, and if administered, 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.