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Daunorubicin

(daw-no-roo-buh-sin)

Trade/other name(s): Cerubidine, Daunomycin, Rubidomycin, DNR

Why would this drug be used?

Daunorubicin is used to treat acute lymphocytic and myelocytic leukemias. It is sometimes used for chronic leukemia and other cancers.

How does this drug work?

Daunorubicin belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It slows or stops cancer cells from growing, causing many of them to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever been treated for cancer with doxorubicin, epirubicin, idarubicin, mitoxantrone, (similar types of chemotherapy), or any other drug that may cause heart damage. Your dose of daunorubicin may need to be adjusted.
  • If you have ever had radiation treatment to the chest. Radiation may cause some damage to the heart, and your doctor may change your daunorubicin dose to reduce the risk of further damage.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If doxorubicin is given with cyclophosphamide, it may raise the risk of bleeding in the bladder. It can also increase the risk of heart muscle damage.

If you are taking other drugs that affect the bone marrow, your doctor may reduce your dose of doxorubicin.

Drugs that can harm the liver, such as high doses of methotrexate, can increase the risk of toxic effects from doxorubicin.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Daunorubicin is given in a vein over about 15 minutes. The dose and how often you get the medicine depends on your size, your blood counts, how well your liver is working, and the type of cancer being treated. You will get medicine to stop any nausea or vomiting before receiving daunorubicin and will get more to take afterward. You will have your blood counts checked before each treatment. If they are too low, your treatment will be delayed. Daunorubicin may be given along with other anti-cancer medicines.

Precautions

Daunorubicin is given into the vein (IV). If the drug leaks out of the vein and under the skin, it could damage the tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV.

This drug can cause allergic reactions. Mild reactions usually consist of fever and chills. More serious reactions are rare. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives (welts), nausea, itching, headache, coughing, shortness of breath, or swelling of the face, eyes, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms as you get the drug.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Daunorubicin causes the urine to turn reddish for 1 to 2 days after each dose is given. This is normal while your body gets rid of the drug, but may stain clothes.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, diarrhea, or bringing up sputum.

Daunorubicin may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Daunorubicin can cause radiation recall. If you have ever had radiation therapy, the skin or tissue damage from prior radiation therapy can become red and appear damaged again after you get this drug. Tell your doctor or nurse if your skin gets red in areas where radiation was given.

Daunorubicin can injure the heart muscle when large total doses of this type of drug are given, and can cause congestive heart failure either during or after your treatment. Your doctor will test your heart before you receive your first treatment, and then during the treatment. This way, any damage can be found early. During and after your treatment with the drug, it is still important to let your doctor know right away if you notice shortness of breath, swollen feet or ankles, or irregular heartbeat. These effects can show up months or even years after you get the drug.

This drug can kill large numbers of cancer cells within the first 24 hours of treatment, spilling the cells' contents into the blood. This can lead to electrolyte imbalances and tumor lysis syndrome, which can result in serious kidney damage and other problems. If your doctor thinks you may be at risk, he or she will give you medicines and/or fluids to help prevent it. If you notice pain in the back or sides of your chest, or blood in your urine, call your doctor right away.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor believes that this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • nausea*
  • vomiting*
  • decreased platelet count with increased risk of bleeding*
  • hair loss*
  • darkened fingernails and toenails

Less common

  • radiation recall skin changes*
  • rash
  • fetal changes if taken while you are pregnant or if you become pregnant while taking this drug
  • anemia (low red blood cell count)

Rare

  • temporary changes in electrocardiogram (EKG)
  • loosening of fingernails
  • fever*
  • chills*
  • abdominal pain
  • high uric acid level in the blood, which can worsen gout
  • tumor lysis syndrome, kidney damage*
  • heart damage with shortness of breath, swollen feet and ankles, which can happen months or years after treatment*
  • irregular heartbeat
  • sores in mouth, throat, or on lips, usually a few days after doxorubicin
  • severe allergic reaction*
  • leukemia or myelodysplastic syndrome, which may happen years after treatment*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1987.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 11/25/2009
Last Revised: 11/25/2009