Home Drug Guide Daunorubicin Hydrochloride

Drug Guide

Generic Name

Daunorubicin Hydrochloride

Brand Names Cerubidine

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/A

Drug-Herb Interactions

N/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.