Idarubicin

Indications
 Oral
Refractory breast cancer
Adult: 45 mg/m2 as a single dose or divided over 3 consecutive days; may be repeated every 3-4 wk depending on haematological recovery.
Renal impairment: Reduce dose.
Hepatic impairment: Reduce dose.
Oral
Acute myeloid leukaemia
Adult: 30 mg/m2 daily for 3 days as single agent or 15-30 mg/m2 daily for 3 days in combination with other drugs.
Renal impairment: Reduce dose.
Hepatic impairment: Bilirubin 12-20 mcg/ml: Administer 50% of normal dose.
Intravenous
Acute lymphoblastic leukaemia
Adult: 12 mg/m2 by inj daily for 3 days as single agent.
Child: 10 mg/m2 daily for 3 days as single agent.
Renal impairment: Reduce dose.
Hepatic impairment: Bilirubin 12-20 mcg/ml: Administer 50% of normal dose.
Intravenous
Acute myeloid leukaemia
Adult: Induction: 12 mg/m2 daily for 3 days, in combination with cytarabine. Dose to be given as slow inj (over 10-15 minutes). Cytarabine may be given as 100 mg/m2 daily for 7 days via continuous infusion or 25 mg/m2 via bolus inj followed by cytarabine 200 mg/m2 daily for 5 days via continuous infusion. A 2nd course may be used in patients with evidence of leukaemia after the 1st induction course; delay admin of the 2nd course if patient develops severe mucositis, until recovery has occurred, dose reduction of 25% is recommended.
Renal impairment: Reduce dose.
Hepatic impairment: Bilirubin 12-20 mcg/ml: Administer 50% of normal dose.

Special Populations: Dose reduction in renal and hepatic impairment. Patients who developed severe mucositis during the 1st course of therapy: Reduce the 2nd course dose to 25%.

Incompatibility: Heparin. Solutions with alkaline pH.
Contraindications
 Severe myelosuppression, uncontrolled infection. Pregnancy and lactation. Hypersensitivity.
Warnings / Precautions
 Elderly. Prevent hyperuricaemia. Systemic infections. Previous anthracyclines therapy. Preexisting cardiac disease. Monitor bilirubin levels and withhold if bilirubin >20 mcg/ml. Monitor CBC regularly. Monitor cardiac function. Renal and hepatic impairment.
Adverse Reactions
 Severe myelosuppression, leucopenia, thrombocytopenia, cardiotoxicity, hyperuricaemia, reversible alopecia; nausea and vomiting, mucositis, diarrhoea; fever, rash; local tissue necrosis upon extravasation; increased bilirubin and transaminases; headache, peripheral neuropathy, mental status changes.
Overdose Reactions
 Symptoms: Severe myelosuppression, acute cardiac toxicity, increased GI toxicity. Management: Supportive e.g. platelet tranfusions, anti-infectives. No known antidote; unlikely to be removed by peritoneal dialysis or haemodialysis.
Drug Interactions
 May impair immune response to vaccines; possible infection with live vaccines.
See Below for More idarubicin Drug Interactions
Mechanism of Actions
 Idarubicin works by intercalating between DNA base pairs, thus inhibiting nucleic acid (DNA and RNA) synthesis.
Absorption: Oral admin: Variable (4-77%).
Distribution: Volume of distribution: 64 L/kg. Extensive tissue binding. Protein binding: 94-97%.
Metabolism: Hepatically to idarubicinol which is active.
Excretion: Urine and hepatic. Elimination half-life: 14-35 hr (oral); 12-27 hr (IV).
Administration
 May be taken with or without food. (May be taken w/ a light meal.)
Storage Conditions
 Intravenous: Store intact vials under refrigeration (2-8°C/36-46°F).
ATC Classification
 L01DB06 - idarubicin ; Belongs to the class of cytotoxic antibiotics, anthracyclines and related substances. Used in the treatment of cancer.
Storage
 Intravenous: Store intact vials under refrigeration (2-8°C/36-46°F).
Available As
  • Idarubicin 10 mg
  • Idarubicin 25 mg
  • Idarubicin 5 mg

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