Parenteral Manual

DAUNOrubicin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
DAUNOMYCIN, CERUBIDINE
Classification: 
Antineoplastic, antibiotic (anthracycline) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
October 2024
Indications: 
  • Acute lymphoblastic leukemias (ALL)
  • Acute non-lymphoblastic leukemias (ANLL)
  • Non-Hodgkin?s lymphoma (NHL)

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as solution for injection (5 mg daunorubicin base/mL).  Each vial contains 20mg/4mL
  • Stable in 0.9% NaCl for 30 hours at room temperature of 9 days refrigerated
  • Color change to blue/purple indicates decomposition - discard solution
  • Protect from light
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: cytarabine, filgrastim, hydrocortisone sodium succinate, methotrexate, ondansetron, KCl, sodium bicarbonate

- Incompatible: allopurinol, dexamethasone, heparin, piperacillin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES
Usual dilution: 100 mg/mL
Infusion rate: do not exceed 500 mg/minute in adults
IV Intermittent Infusion YES, central line preferred
Doses up to 30 mg/m2 over 15 minutes into the tubing of a freely running IV
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 45 mg/m2  x 2 up to 100 mg/m2 Q 3 weeks
  • Use ideal body weight for dosage calculations (if patient is obese, or ascites is present)
  • Total cumulative lifetime dose should not usually exceed 450 mg/m2 or 350 mg/m2 with concomitant use of mediastinal or cardiac radiation, 300 mg/m2 in children > 2 years of age and < 12 years, and 10 mg/kg in children < 2 years of age

- Dosage may differ according to protocol

Dosage adjustment in renal/hepatic impairment:

  • Reduce dose in severe renal impairment
  • Reduce dose in hepatic impairment (see below)
Serum Bilirubin Dose

25-50 micromol/L

50% of usual dose

51-85 micromol/L

25% of usual dose

>85 micromol/L

Contraindicated
  • Children <0.5 m2 or <2 years of age should be dosed on a mg/kg basis (to obtain mg/kg from mg/m2, divide by 30, i.e: 1 m2 = 30 kg)
Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Transient arrhythmias, hypotension
  • Nausea, vomiting (moderately high emetogenic potential), anorexia, abdominal pain
  • Streaks along vein of injection (likely a flare reaction, not extravasation - may respond to antihistamines)
  • Facial flushing with rapid injection
  • VESICANT: will cause tissue necrosis if extravasated.  If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Delayed (within a few days to weeks):

  • Alopecia
  • Myelosuppression, nadir 10 - 14 days
  • Cardiotoxicity (related to cumulative life-time dose), congestive heart failure, cardiomyopathy
  • Oral mucositis, diarrhea
  • Red coloration of urine, 1 - 2 days post administration

 - Treatment for unusual side effects are available through the study chair identified on the front page

Notes: 
  • Monitor hematological status, liver function
  • ECG and echocardiogram recommended before treatment started and follow cardiac function regularly with subsequent doses; cumulative dose must be recorded, consult protocol for specific intervals
  • Contraindicated in patients with myocardial lesions
  • Use with caution in liver impairment
  • Use with caution in patients who have had thoracic radiation and do not use at the same time as radiation therapy

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