Nurses Compass
Drug Guide
Daunorubicin Hydrochloride
Classification
Therapeutic: Antineoplastic (anticancer) agent
Pharmacological: Anthracycline antibiotic
FDA Approved Indications
- Acute myeloid leukemia (AML)
Mechanism of Action
Interferes with DNA replication by intercalating between DNA base pairs and inhibiting topoisomerase II, leading to apoptosis of cancer cells.
Dosage and Administration
Adult: Dose varies based on treatment protocol; typically 45-60 mg/m² IV every 21 days.
Pediatric: Dosing based on body surface area, usually 20-30 mg/m² IV every 21 days.
Geriatric: Adjust dose considering renal and hepatic function, comorbidities, and tolerability.
Renal Impairment: May require dose adjustments; monitor renal function.
Hepatic Impairment: Use with caution; hepatic function impacts clearance.
Pharmacokinetics
Absorption: Administered IV, so absorption is complete.
Distribution: Widely distributes into tissues, crosses the placenta, and is found in breast milk.
Metabolism: Metabolized in the liver to produce active and inactive metabolites.
Excretion: Primarily excreted in the bile and urine.
Half Life: Approximately 20-48 hours.
Contraindications
- Hypersensitivity to daunorubicin or anthracyclines.
- Significant myelosuppression.
Precautions
- Use cautiously in patients with prior cardiac disease, liver impairment, or concurrent radiation therapy.
Adverse Reactions - Common
- Myelosuppression (Very common)
- Nausea and vomiting (Common)
- Alopecia (Common)
Adverse Reactions - Serious
- Cardiotoxicity (myocardial damage) (Serious and dose-dependent)
- Extravasation leading to tissue necrosis (Serious)
- Secondary malignancies (e.g., leukemia) (Rare)
Drug-Drug Interactions
- Other cardiotoxic agents, other myelosuppressive drugs, live vaccines.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor cardiac function (echocardiograms), complete blood counts, hepatic and renal function.
Diagnoses:
- Risk of infection due to myelosuppression.
- Risk of cardiotoxicity.
Implementation: Administer IV infusion as prescribed, monitor for extravasation, monitor blood counts, cardiac status, and signs of toxicity.
Evaluation: Assess blood counts, cardiac function, and the patient’s overall response to therapy.
Patient/Family Teaching
- Report symptoms of heart failure (shortness of breath, swelling).
- Report signs of infection (fever, sore throat).
- Use effective contraception during and for some months after therapy.
Special Considerations
Black Box Warnings:
- Cardiotoxicity (may be irreversible and cumulative).
- Secondary malignancies.
- Myelosuppression leading to infection.
Genetic Factors: Patients with certain genetic polymorphisms may be at increased risk for toxicity.
Lab Test Interference: Can cause false-positive serum aminotransferase and bilirubin levels.
Overdose Management
Signs/Symptoms: Severe myelosuppression, mucositis, cardiotoxicity, extravasation injury.
Treatment: Supportive care, symptomatic treatment, and possibly administration of dexrazoxane as a cardioprotective agent in overdose cases.
Storage and Handling
Storage: Store vials refrigerated at 2-8°C, protected from light.
Stability: Stable until expiration date when stored properly.