Daunorubicin

Key Terms: DNA.

Definition

Daunorubicin is an anti-cancer drug that kills cancer cells. The brand names are DaunoXome for the liposomal formulation and Cerubidine for the daunorubicin hydrochloride formulation.

Purpose

Daunorubicin is available in two different formulations, the daunorubicin hydrochloride and daunorubicin citrate liposome. The liposomal daunorubicin formulation places the drug in lipid molecules. This formulation is able to penetrate cancer cells more effectively because of its smaller size, and it remains in the body longer when compared to the daunorubicin hydrochloride formulation. The daunorubicin hydrochloride is approved by the Food and Drug Administration (FDA) to treat acute myelocytic leukemia (AML) and acute lymphocytic leukemia (ALL). It is also sometimes used to treat chronic myelogenous leukemia (CML), non-Hodgkin's lymphoma, and psoriasis. The liposomal formulation of daunorubicin is used to treat advanced HIV-associated Kaposi's sarcoma.

Description

Daunorubicin interferes with the cells' production of DNA and RNA by inserting itself between the molecules that make up DNA and RNA. It also works by inhibiting the enzyme responsible for repairing of DNA (topoisomerase II enzyme). The structure of daunorubicin is very similar to that of doxorubicin, and both drugs function in the same way.

Recommended Dosage

In the treatment of acute myelocytic leukemia (AML), the dose is 30 to 60 mg of daunorubicin per square meter of body surface area given for three to five days, and the dose is repeated every three to four weeks.

In acute lymphocytic leukemia (ALL), 25 to 45 mg per square meter of body surface area of daunorubicin may be given on day one every week for four cycles, or alternatively may be given at a dose of 30 to 45 mg per square meter of body surface area for three days. The dose for patients receiving daunorubicin citrate liposome is 20 to 40 mg per square meter of body surface area every two weeks, or 100 mg per square meter of body surface area every three weeks.

Patients with decreased liver or kidney function may receive lower doses of the medication than other patients. This medication is usually administered directly into the vein (intravenous, or IV) over the course of three to five minutes. It may also be diluted in a solution to be given over fifteen minutes to one hour.

Precautions

A major problem with the use of daunorubicin is that it may cause a serious heart problem known as heart failure. Some authorities suggest that giving any individual patient more than 900 to 1000 mg of daunorubicin per square meter over the course of their entire life may increase risk of heart injury. Other authorities recommend that the total lifetime cumulative dose not exceed 550 milligrams per square meter. The patient's baseline heart function is obtained prior to starting therapy and is monitored every few cycles of chemotherapy. If the heart function is significantly decreased from baseline, the drug is discontinued.

Side Effects

There is a risk that heart rhythm problems will occur during daunorubicin therapy. Later, patients may develop heart failure. However, patients receiving daunorubicin are, in fact, less likely to develop such problems than are patients receiving doxorubicin.

In addition, the activity of the bone marrow in producing white blood cells to fight infections, platelets to control bleeding, and red blood cells for oxygenation may be impaired by the drug. This and the development of heart problems are the major side effects that may cause doctors to lower the dose of daunorubicin.

Other side effects associated with daunorubicin therapy are nausea, vomiting, ulcerations of the mouth, diarrhea, and hair loss. In addition, the medication has a harmless side effect about which patients should be forewarned; urine and tears may take on a red color.

Patients receiving daunorubicin in conjunction with certain other anticancer drugs may (very rarely) develop a certain type of leukemia. The drug is also an irritant to the skin and tissues of the body. Patients who notice burning or pain with infusion of the drug should notify the nurse immediately to assess if the drug has leaked from the vein into the surrounding tissue. If this occurs, the drug infusion is stopped immediately and appropriate actions are taken to minimize side effects due to tissue damage.

—Bob Kirsch

Brand names: Cerubidine®

Chemical formula:

Español:
• Clorhidrato de daunorrubicina, Solución para inyección

Daunorubicin Hydrochloride Solution for injection

What is this medicine?

DAUNORUBICIN is a chemotherapy drug. This medicine is used to treat acute leukemias.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• blood disorders
• heart disease
• infection (especially a virus infection such as chickenpox, cold sores, or herpes)
• kidney disease
• liver disease
• recent or ongoing radiation therapy
• an unusual or allergic reaction to daunorubicin, other chemotherapy agents, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional. If you have pain, swelling, burning or any unusual feeling around the site of your injection, tell your health care professional right away.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it a soon as you can. If it is almost time for your next dose, consult your prescriber or health care professional. You may need to miss a dose or take a double dose, depending on your condition and treatment. Do not take double or extra doses without advice.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
• chloroquine
• cisapride
• droperidol
• halofantrine
• pimozide

This medicine may also interact with the following medications:
• chlorpromazine
• clarithromycin
• cyclophosphamide
• cyclosporine
• erythromycin
• medicines for depression, anxiety, or psychotic disturbances
• medicines for irregular heart beat like amiodarone, bepridil, dofetilide, encainide, flecainide, propafenone, quinidine
• medicines for nausea, vomiting like dolasetron, ondansetron, palonosetron
• medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim
• methadone
• methotrexate
• pentamidine
• vaccines

Talk to your doctor or health care professional before taking any of these medicines:
• acetaminophen
• aspirin
• ibuprofen
• ketoprofen
• naproxen

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine. You will need important blood work done while you are taking this medicine.

This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

You urine may turn red for a few days after your dose. This is not blood. If your urine is dark or brown, call your doctor.

In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.

Men may have a lower sperm count while taking this medicine. Talk to your doctor if you plan to father a child.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• low blood counts - this medicine may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding.
• signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine
• signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, blood in the urine
• signs of decreased red blood cells - unusually weak or tired, fainting spells, lightheadedness
• breathing problems
• chest pain
• gout pain
• fast, irregular heartbeat
• mouth sores
• pain, swelling, redness at site where injected
• swelling of ankles, feet, or hands
• unusual bleeding or bruising

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
• diarrhea
• hair loss
• loss of appetite
• nausea, vomiting
• red colored urine
• stomach upset

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

An anthracycline antibiotic produced by a strain of Streptomyces coeruleorubidus that is closely related to doxorubicin and has antimitotic, cytotoxic and immunosuppressive effects.

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