Daunorubicin

Indications
 Intravenous
Acute leukaemias
Adult: 30-45 mg/m2 BSA daily on days 1-3 of the induction course and days 1 and 2 for the subsequent courses. Admin as a solution in 0.9% sodium chloride into a fast-running infusion of sodium chloride or glucose. May repeat course 3-6 wk later. Max (total cumulative dose): 550 mg/m2 in patients without risk factors for cardiotoxicity and 400 mg/m2 in patients who have received chest radiotherapy.
Child: For acute lymphoblastic leukaemia: 25 mg/m2 BSA once wkly in combination with other regimens. <2 yr old or BSA <0.5 m2: 1 mg/kg once wkly. Max (total cumulative dose): 300 mg/m2 and in children <2 yr: 10 mg/kg.
Renal impairment: Based on serum-creatinine concentrations: 105-265 micromoles/l: 75% of the usual dose; >265 micromoles/l: 50% of the usual dose.
Hepatic impairment: Based on serum bilirubin concentrations of 12-30 mcg/ml: 75% of the usual dose; >30 mcg/ml: 50% of the usual dose.
Intravenous
AIDS-related Kaposi's sarcoma
Adult: As the liposomal formulation: Initially, 40 mg/m2 once every 2 wk, diluted in glucose 5% to a concentration of 0.2-1 mg/ml and given over 30-60 minutes. May continue for as long as disease control can be maintained.
Renal impairment: Based on serum-creatinine concentrations: 105-265 micromoles/l: 75% of the usual dose; >265 micromoles/l: 50% of the usual dose.
Hepatic impairment: Based on serum bilirubin concentrations of 12-30 mcg/ml: 75% of the usual dose; >30 mcg/ml: 50% of the usual dose.

Incompatibility: Incompatible with heparin sodium and dexamethasone sodium phosphate solution.
Contraindications
 Heart failure. Pregnancy, lactation.
Warnings / Precautions
 Regular blood count and ECG monitoring; elderly, children. Hepatic or renal impairment may increase risk of toxicity. Pre-existing cardiac disease and previous treatment with doxorubicin. Myocardial toxicity leading to potentially fatal congestive heart failure may occur during therapy or mth to yr after therapy cessation. Incidence of myocardial toxicity increases after total cumulative dose exceeds 400-550 mg/m2 in adults, 300 mg/m2 in children >2 yr, or 10 mg/kg in children <2 yr. Risk of severe myelosuppression leading to infection or haemorrhage.
Adverse Reactions
 GI disturbances; stomatitis; alopoecia and dermatological reactions. Extravasation of daunorubicin may cause severe local tissue necrosis damaging surrounding muscles, tendons and nerves. IV infusion, back pain, flushing and chest tightness.
Potentially Fatal: Bone marrow suppression, cardiac toxicity, cardiomyopathy and congestive heart failure.
Overdose Reactions
 Severe myelosupression, cardiotoxicity with or without transient reversible ECG changes leading to CHF. Treatment is supportive and symptomatic.
Drug Interactions
 Increased risk of cardiotoxicity when used with cyclophosphamide. Increased risk of hepatic toxicity when used with hepatotoxic drugs e.g. high-dose methotrexate.
Potentially Fatal: Immunisation with live vaccines is not recommended. Concurrent radiation may lead to increased radiation reaction.
See Below for More daunorubicin Drug Interactions
Mechanism of Actions
 Daunorubicin forms a stable complex with DNA and interferes with the nucleic acid synthesis. It is a cell-cycle nonspecific agent, but its cytotoxic effects are mostly marked in the S-phase. It also has immunosuppressant and antibacterial effects.
Distribution: Body tissues; crosses the placenta; enters breast milk.
Metabolism: Hepatic; converted to daunorubicinol.
Excretion: Urine (as active form). Elimination half-life: 18.5 hr (daunorubicin), 26.7 hr (active metabolite).
Storage Conditions
 Intravenous: Powder for inj: Store at 15-25°C. Solution for inj & liposomal inj: Refrigerate at 2-8°C. Do not freeze.
ATC Classification
 L01DB02 - daunorubicin ; Belongs to the class of cytotoxic antibiotics, anthracyclines and related substances. Used in the treatment of cancer.
Storage
 Intravenous: Powder for inj: Store at 15-25°C. Solution for inj & liposomal inj: Refrigerate at 2-8°C. Do not freeze.
Available As
  • Daunorubicin 20 mg

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