NAME OF DRUG
daunorubicin

CLASSIFICATION

Cytotoxic Agent- vesicant
Antimitotic-Antibiotic

ALTERNATE NAMES

CERUBIDINE, daunomycin

• treatment of numerous leukemias in combination with other drugs

• appears to inhibit DNA synthesis and DNA-dependent RNA synthesis by forming a complex between base pairs of DNA and uncoiling the helix
• may also inhibit polymerase activity, affect regulation of gene expression and be involved in free-radical damage to DNA
• immunosuppressive
• the predominant metabolite of daunorubicin has an average terminal plasma half-life of 26.7 hours
• daunorubicin is extensively metabolized in the liver and other tissues
• daunorubicin and its metabolites are excreted in the urine (14-23% of dose) and the bile (40% of dose)

• ALL cytotoxic agents are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date.  All cytotoxic waste including bags, sets, tubing, gloves, etc. must be properly disposed of in the cytotoxic waste containers on the nursing unit.

• compatible with sterile water for injection, NS, D5S, D5W
• compatible with hydrocortisone
• incompatible with dexamethasone, fluorouracil, heparin, sodium bicarbonate

PERIPHERAL ROUTE

• via syringe using side arm method into the tubing of a free-flowing IV of D5W or NS at a rate of 20 mg every 1-3 minutes (refer to PCG C-396)

CENTRAL ROUTE

• IV intermittent - in 50mL over 10-15 minutes.

A Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO # 45) must be used for prescribing if this cytotoxic agent
is not already on an existing PPO.

G - Cytotoxic Agents - See Drug Table G for specific administration guidelines.
H - Central route: the IV infusion rate must be controlled by an automated infusion control device. 

DOSAGE

Dose and schedule depend on protocol and patient response.

Usual dose

• 30-60 mg/m² daily x 3-6 days (total dose per cycle 90-360 mg/m²)
• maximum total cumulative dose 550 mg/m² with normal cardiac function (lower doses recommended if in combination with thoracic radiotherapy pre-existing heart disease or prior anthracycline therapy)
   
• reduce dose by 50% if serum creatinine > 265 umol/L or > 2 x upper limit of normal
• adjust dosage in hepatic failure as follows:

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• extravasation can cause tissue necrosis (see Appendix VII for extravasation protocol)

IMPORTANT IMPLICATIONS

• bone marrow toxicity occurs 7-10 days after therapy and platelet support is frequently required
• cardiotoxicity (either acute or chronic):  arrhythmias and conduction abnormalities can occur within minutes to hours of the infusion and are usually transient; chronic cardiomyopathy is related to the cumulative dose of the drug; CHF usually occurs with cumulative doses in the range of 550 mg/m² and increases as the total dose increases
• careful monitoring of cardiac function is necessary
• nausea and vomiting may occur a few hours after drug administration and may be alleviated by anti-emetics
• stomatitis may occur within a week of administration of the drug; it usually begins as a burning sensation with erythema of the oral mucosa leading to ulceration in 2-3 days
• alopecia almost always occurs; it is reversible with regrowth usually starting about 5 weeks after stopping therapy
• reduce dosage if radiation or other cytotoxic agents are used concomitantly or in hepatic dysfunction
• daunorubicin imparts red colour to the urine for 1-2 days (not clinically significant)

VGH Site only:
Notify security-84 immediately upon accidental spillage.
DO NOT ATTEMPT CLEAN-UP

• See also Appendix VI

Rev. Nov 2007