daunorubicin, daunomycin; DNR (Cerubidine, DaunoXome)
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Introduction
Daunorubicin HCl & Daunorubicin citrate (liposomal).
Tradenames:
- DaunoXome. Daunorubicin citrate (liposomal)
- Cerubidine. Daunorubicin HCl
Indications
- used in combination with other agents in the treatment of leukemias
- used for induction therapy in acute myeloid leukemia (AML)
- HIV-associated Kaposi's sarcoma (liposomal)
- Wilm's tumor, neuroblastoma[3]
Contraindications
Dosage
Lyophilized powder for injection: 10, 20, 50, 200 mg.
Monitor
- evaluate cardiac, renal & hepatic function prior to each dose
- CBC prior to each dose, Hold if neutrophil count < 750/mm3
- monitor uric acid
Adverse effects
- common (> 10%)
- alopecia (reversible)
- reddish discoloration of the urine
- stomatitis (3-7 days after administration)
- nausea/vomiting (50%) within 1st 24 hours
- fatigue, headache, abdominal pain, anorexia, neuropathy, cough, dyspnea, rhinitis, infection
- less common (1-10%)
- gastrointestinal
- cardiac toxicity: CHF maximum lifetime dose
- 550 mg/mm2 in adults
- 400 mg/mm2 in patients receiving chest irradiation
- 300 mg/mm2 in children > 2 years of age
- 10 mg/kg in children < 2 years of age
- myelosuppression
- leukopenia more significant than thrombocytopenia
- onset 7 days
- nadir 14 days
- recovery 21-28 days
- hyperuricemia
- hypertension, palpitations, syncope, tachycardia, chest pain, edema, depression, dizziness, insomnia, malaise, pruritus, hot flashes, constipation, tenesmus, arthralgia, myalgia, abnormal vision, sinusitis
- uncommon (< 1%)
- skin rash, myocarditis/pericarditis, pigmentation of nail beds, abnormal liver function tests, chills, fertility impairment
Drug interactions
- incompatible with NaHCO3, 5-fluorouracil, heparin, dexamethasone
- drug interaction(s) of antibiotics with warfarin
- drug interaction(s) of atorvastatin with anthracycline
Mechanism of action
- anthracyclin antibiotic
- inhibits topoisomerase II
- interferes with DNA synthesis