Daunomycin

Generic Name: Daunorubicin

(daw-noe-ROO-bi-sin)

Trade Name: Cerubidine®

Other Names: daunorubicin hydrochloride; daunomycin; rubidomycin hydrochloride

Daunorubicin is the generic name for the trade name drug Cerubidine®. Daunorubicin hydochloride and daunomycin are other names for daunorubicin. In some cases, health care professionals may use the trade name Cerubidine® or other names; such as daunorubicin hydrochloride, daunomycin or rubidomycin when referring to the generic drug name daunorubicin.

Drug Type: Daunorubicin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "anthracycline antitumor antibiotic." (For more detail, see "How this drug works" section below).

What This Drug Is Used For:

• Treatment of acute myelogenous leukemia (AML)
• Treatment of acute lymphoblastic leukemia (ALL)
• Treatment of acute promyelocytic leukemia (APL)

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How This Drug Is Given:

• Daunorubicin is given by intravenous injection (IV). The syringe needle is placed directly into the tubing of a freely flowing IV solution into a vein or central line and the drug is given over several minutes.
• There is no pill form of daunorubicin.

The amount of daunorubicin you will receive depends of many factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dose and schedule.

Side Effects:

Things to remember about the side effects of daunorubicin:

• Most people do not experience all of the daunorubicin side effects listed.
• Daunorubicin side effects are often predictable in terms of their onset and duration.
• Daunorubicin side effects can be reversible and may go away after treatment is complete.
• Daunorubicin aide effects will improve after therapy is complete.
• Daunorubicin side effects may be quite manageable. There are many options to minimize or prevent the side effects of daunorubicin.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking daunorubicin:

• Pain along the site where the medication was given.
• Urine may appear red, red-brown, orange or pink from the color of the medication for one to two days after you receive a dose.
• Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
• Nausea or vomiting (usually mild, occurs within 1-2 hours of treatment).
• Mouth sores (in the first week after therapy).
• Hair loss on the scalp or elsewhere on the body (called alopecia). Most patients do lose some or all of their hair during their treatment. But your hair will grow back after treatment is completed.

The following side effects are less common (occurring in 10-29%) for patients taking daunorubicin:

• Diarrhea (within the first week of therapy)
• Problems with fertility - ability to bear children (this should be discussed with your doctor prior to therapy).
• Darkening of skin at the site of previous radiation therapy. (radiation recall - see skin reactions).
• Darkening, discoloration of nail beds (see skin reactions).

A serious but uncommon side effect of daunorubicin can be interference with the pumping action of the heart. You can receive only up to a certain amount of daunorubicin during your lifetime. This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs. Your doctor will check your heart function before you may take any daunorubicin and will monitor your heart closely during your treatment. Dose-related heart problems can occur as late as 7 or 8 years after treatments have ended.

Another serious side effect of daunorubicin is that it may lower your body's ability to make blood cells that your body needs. This can lead to the need for a blood transfusion, which can further cause bleeding complications and infections. Your doctor will check to make sure your body is making the blood cells it needs, but be sure to tell your doctor right away if you have any signs of infection or bleeding, such as: fever, chills, sore throat, bruising, abnormal bleeding, and feeling weak or tired.

• Although uncommon, daunorubicin may leak out of the line that is administering the drug into your body, causing damage to the muscle and skin in which it is in contact with (the administration site). If this occurs, you will feel a sharp, burning sensation run through your arm as well as blistering and or discoloration around the area it is being administered. Daunorubicin is a vesicant. A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein. The nurse or doctor who gives this drug must be carefully trained. If you notice redness or swelling at the IV site while you are receiving daunorubicin, alert your health care professional immediately.

Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher or chills (possible signs of infection).
• Blistering at the IV site.
• Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling or facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

• Mouth sores (painful redness, swelling or ulcers)
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Fast or irregular heart beats
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine. Extreme fatigue (unable to carry on self-care activities).
• Swelling of the feet or ankles
• Yellowing of the eyes or skin

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting daunorubicin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
• People with congestive heart failure, those who have already had high doses or this drug or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive this drug.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking daunorubicin.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (daunorubicin may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking daunorubicin. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.
• You may be more sensitive to sunlight, take extra care to avoid sun exposure.

Self-Care Tips:

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

A baseline heart evaluation is recommended before starting treatment, and a heart function test will be done as your doctor prescribes. You will be checked regularly by your doctor while you are taking daunorubicin, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How This Drug Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Daunorubicin is classified as an antitumor antibiotic. Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces. These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.