Home Drug Guide Idarubicin Hydrochloride

Drug Guide

Generic Name

Idarubicin Hydrochloride

Brand Names Idamycin, Idamycin Pfs

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Anthracycline antibiotic

FDA Approved Indications

Acute myeloid leukemia (AML)

Mechanism of Action

Intercalates into DNA, inhibiting topoisomerase II, which prevents DNA replication and repair, leading to apoptosis of cancer cells.

Dosage and Administration

Adult: Dose varies; typically 12-14 mg/m² IV daily for 3-6 days, depending on regimen and patient response.

Pediatric: Dose based on body surface area, usually 12 mg/m² IV daily for 3 days.

Geriatric: Dose adjustments may be necessary based on renal and hepatic function.

Renal Impairment: Adjust dose; closely monitor renal function.

Hepatic Impairment: Adjust dose; hepatic impairment may increase toxicity.

Pharmacokinetics

Absorption: Administered IV; not absorbed orally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized hepatically.

Excretion: Excreted primarily in bile and urine.

Half Life: Approx. 24-48 hours, depending on dose and patient factors.

Contraindications

Hypersensitivity to idarubicin or anthracyclines.
Severe myelosuppression.

Precautions

Monitor cardiac function; risk of cardiotoxicity.
Use with caution in hepatic or renal impairment.
Risk of secondary malignancies, including leukemia.

Adverse Reactions - Common

Myelosuppression (Very common)
Nausea and vomiting (Common)
Mucositis (Common)
Alopecia (Common)

Adverse Reactions - Serious

Cardiotoxicity (including cardiomyopathy and arrhythmias) (Serious, risk increases with cumulative dose)
Severe myelosuppression leading to infections or bleeding (Serious)
Secondary malignancies (Rare)

Drug-Drug Interactions

Other myelosuppressive agents, other cardiotoxic drugs (e.g., trastuzumab), CYP3A4 inhibitors and inducers.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts, cardiac function (e.g., echocardiogram), liver and renal function.

Diagnoses:

Risk for infection
Impaired tissue integrity
Risk for decreased cardiac output

Implementation: Administer IV as ordered, monitor labs and cardiac status, provide antiemetics as needed.

Evaluation: Assess for signs of infection, cardiotoxicity, and degree of myelosuppression.

Patient/Family Teaching

Report symptoms of infection, unusual bleeding or bruising.
Avoid pregnancy during treatment and for several months after.
Use effective contraception.
Report new or worsening chest pain, shortness of breath, or palpitations.

Special Considerations

Black Box Warnings:

Myocardial toxicity potentially leading to congestive heart failure.
Myelosuppression that may be severe and life-threatening.

Genetic Factors: CYP3A4 metabolism may vary among individuals.

Lab Test Interference: May cause elevations in serum transaminases, alkaline phosphatase, and bilirubin.

Overdose Management

Signs/Symptoms: Severe myelosuppression, extravasation injuries, cardiotoxicity.

Treatment: Supportive care; cytoprotective agents like dexrazoxane may be used in cases of extravasation or anthracycline cardiotoxicity.

Storage and Handling

Storage: Store in a light-protected container at 2-8°C (refrigeration).

Stability: Stable under recommended storage conditions, use within specified time.