Daunorubicin; Uses, Dosage, Side Effects, Interactions

Mechanism of Action of Daunorubicin

Contra-Indications of Daunorubicin

• Severe? infection?
• Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
• Decreased function of bone marrow?
• Anemia?
• Decreased Blood Platelets
• Decreased Neutrophils a Type of White Blood Cell
• heart attack? within the last 30 days
• Disease of the Muscle of the Heart with Enlargement
• Atrioventricular Heart Block
• Bundle Branch Block
• Abnormal heart rhythm
• Heart Failure?
• Inflammation? of the Middle Tissue Heart Muscle?
• liver problems
• High Amount of Bilirubin? in the Blood
• Tingling?
• Pain?
• Redness and Edema? of Hands and Feet
• Pregnancy
• A mother who is producing milk and breastfeeding
• Dysfunction of Left Ventricle? of Heart Without Symptoms?
• Anemia from Pyruvate Kinase and G6PD Deficiencies
• Allergies to Anthracyclines

Dosage? of Daunorubicin

Strengths: 20 mg; 5 mg/mL; 50 mg

Acute Nonlymphocytic Leukemia

• Under 60 years of age: 45 mg/m2 IV over 2 to 5 minutes once a day on days 1, 2, and 3 for the first course and on days 1 and 2 for subsequent courses) with cytosine arabinoside (ara-C) intravenously once a day (usually for 7 days for the first course and 5 days for subsequent courses) as remission induction therapy.

Acute Lymphocytic Leukemia

For Remission Induction:

• 45 mg/m2/day IV on days 1, 2, and 3 (along with vincristine, prednisone, and L-asparginase therapy)

Acute Nonlymphocytic Leukemia

• Greater than or equal to 60 years of age: 30 mg/m2 IV over 2-5 minutes once a day on days 1, 2, and 3 for the first course and on days 1 and 2 for subsequent courses) with cytosine arabinoside (ara-C) intravenously once a day (usually for 7 days for the first course and 5 days for subsequent courses) as remission induction therapy.

Pediatric Dose for Acute Myeloid Leukemia

As a part of combination therapy: Induction

• 30 to 60 mg/m2/day by continuous IV infusion on days 1 to 3 of cycle
  or
• 20 mg/m2/day for 4 days every 14 days

Side Effects of Daunorubicin

Most Common

• Pain, redness, swelling? at the place of injection
• Painful swallowing?
• Signs of anemia (e.g., feeling weak, dizzy, or short of breath)
• Signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, cuts that don’t stop bleeding)
• Signs of a blood clot in blood vessels, such as sudden vision change or dizziness, chest pain, pain and swelling in one leg muscle
• Signs of an infection (e.g., fever over 38°C, chills or sweating, sore throat, coughing, redness or swelling around a cut, wound or catheter site, painful or difficult urination, unusual vaginal itching or discharge)

More Common

• Hair loss, thinning of hair
• Nausea and vomiting
• Sores in the mouth and on the lips
• Darkening of the soles, palms, or nails
• Diarrhea
• Fast or irregular heartbeat
• Shortness of breath
• Swelling of the feet and lower legs

Less Common

• Cough or hoarseness accompanied by fever or chills
• Darkening or redness of the skin (if you recently had radiation treatment)
• Fast or irregular heartbeat
• Fever or chills
• Joint pain
• Lower back or side pain accompanied by fever or chills
• Pain at the injection site
• Painful or difficult urination accompanied by fever or chills
• Red streaks along the injected vein

Drug Interactions of Daunorubicin

Daunorubicin may interact with following drugs, supplements & may change the efficacy of drugs

• antipsychotics (e.g., chlorpromazine, clozapine)
• atorvastatin
• “azole” antifungals (e.g., fluconazole, itraconazole, voriconazole)
• bevacizumab
• bupropion
• calcium channel blockers (e.g., diltiazem, verapamil)
• carbamazepine
• carvedilol
• celecoxib
• ciprofloxacin
• cyclosporine
• dasatinib
• desipramine
• dexamethasone
• hydrocortisone
• loperamide
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• mercaptopurine
• metronidazole
• non-drowsy” antihistamines (e.g., cetirizine, desloratadine, loratadine)
• norfloxacin
• other anthracyclinecancer medications (e.g., daunorubicin, idarubicin)
• other cancer medications (e.g., cyclophosphamide, doxetaxel, irinotecan, paclitaxel)
• oxcarbazepine
• pentobarbital
• phenobarbital
• phenytoin
• prazosin
• primidone
• progesterone
• propranolol
• protease inhibitors (e.g., lopinavir, ritonavir, stavudine)
• selegiline
• SSRI antidepressants (e.g., fluoxetine, paroxetine, sertraline)
• St. John’s wort
• tacrolimus
• tamoxifen
• tetracycline

Pregnancy Category

FDA Pregnancy Category: D

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

This medication passes into breast milk. If you are a breastfeeding mother and are taking doxorubicin, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding. Children who receive doxorubicin are at an increased risk of developing leukemia. Children may also be more susceptible to the effects of this medication on the heart.

References