daunorubicin hydrochloride

Contraindicated in:

Hypersensitivity to daunorubicin or any other components in the formulation;
Symptomatic HF or arrhythmias;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Active infections or decreased bone marrow reserve;
Previous radiation therapy (may reactivate skin lesions);
Renal impairment (↓ dose)
;
Hepatic impairment (↓ dose)
;
Previous anthracycline therapy or underlying cardiovascular disease (↑ risk of cardiotoxicity);
Rep: Women of reproductive potential;
Geri: ↓dose recommended for patients ≥60 yr.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, CARDIOTOXICITY

Derm: alopecia

EENT: rhinitis, abnormal vision, sinusitis

GI: nausea, vomiting, esophagitis, hepatoxicity, stomatitis

GU: red urine, gonadal suppression

Hemat:

anemia

leukopenia

thrombocytopenia

Local: phlebitis at IV site

Metab: hyperuricemia

Misc: chills, fever

Interactions ⬆ ⬇

Drug-drug:

Additive myelosuppression with other antineoplastics.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
Cyclophosphamide and trastuzumab may ↑ risk of cardiotoxicity; avoid use of daunorubicin for up to 7 mo after discontinuing trastuzumab.
May ↑ risk of hepatotoxicity with other hepatotoxic agents.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 5 mg/mL

Route/Dosage ⬆ ⬇

In adults, cumulative dose should not exceed 550 mg/m² (450 mg/m² if previous chest radiation).
IV (Adults <60 yr): 45 mg/m²/day for 3 days in 1st course, then for 2 days of 2nd course (as part of combination regimen).
IV (Adults ≥60 yr): 30 mg/m²/day for 3 days in 1st course, then for 2 days of 2nd course (as part of combination regimen).
IV (Children >2 yr): 25 mg/m² once weekly (as part of combination regimen). In children <2 yr or BSA <0.5 m², dose should be determined on a mg/kg basis.

Renal Impairment

IV (Adults ):
CCr 30–50 mL/min: Administer 75% of normal dose; CCr <30 mL/min or hemodialysis: Administer 50% of normal dose.

Hepatic Impairment

IV (Adults ):
Serum bilirubin 1.2–3 mg/dL: Administer 75% of normal dose; Serum bilirubin >3 mg/dL: Administer 50% of normal dose.

Action ⬆ ⬇

Forms a complex with DNA, which subsequently inhibits DNA and RNA synthesis (cell-cycle phase-nonspecific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: anthracyclines

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Extensively metabolized by the liver. Converted partially to a compound that also has antineoplastic activity (daunorubicinol); 40% eliminated by biliary excretion.

Half-Life: Daunorubicin: 18.5 hr. Daunorubicinol: 26.7 hr.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	7–10 days	10–14 days	21 days

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications, especially products containing aspirin or NSAIDs.
Instruct patient to notify health care provider if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patient should be cautioned not to drink alcoholic beverages.
Instruct patient to inspect oral mucosa for erythema and ulceration. If ulceration occurs, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Stomatitis pain may require management with opioid analgesics. Period of highest risk is 3–7 days after administration of dose.
Instruct patient to notify health care provider immediately if irregular heartbeat, shortness of breath, or swelling of lower extremities occurs.
Discuss possibility of hair loss with patient. Explore methods of coping. Regrowth of hair usually begins within 5 wk after discontinuing therapy.
Inform patient that medication may turn urine reddish color for 1–2 days after administration.
Instruct patient not to receive any vaccinations without advice of health care provider.
Emphasize the need for periodic lab tests to monitor for side effects.
Rep: May cause fetal harm. Advise women of reproductive potential and men with female partners of reproductive potential to use effective contraception during therapy and for >4 mo after last dose Advise women to avoid breastfeeding during therapy. May impair fertility.

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Indications ⬇

Contraind./Precautions ⬆ ⬇