- Relapsed or refractory acute leukemias in children
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.
- Refrigerate vials. Supplied in 5 and 10 mg vials of powder.
- Reconstitute with equal amount (in mL) of preservative free Sterile Water for Injection to yield a 1 mg/mL solution that is clear and red-orange in colour
- Diluted solution stable 48 hours room temperature and 14 days in the fridge
- Protect from light
- Solutions Compatible: D5W, NS, and combinations
- Y-site Compatible: diphenhydramine, cyclophosphamide, cytarabine, magnesium sulfate, metoclopramide, KCl, ranitidine
Incompatible: acyclovir, alkaline solutions (contact will degrade idarubicin), allopurinol, ampicillin, cefazolin, ceftazidime, clindamycin, dexamethasone, etoposide, furosemide, gentamicin, heparin, hydrocortisone, lorazepam, meperidine, methotrexate, sodium bicarbonate, vancomycin, vincristine
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
YES, certified nurses only; central line preferred |
| IV Intermittent Infusion | YES, central line preferred Usual dilution: undiluted or dilute in 50 mL NS or D5W Infusion time: 15-30 minutes |
| IV Continuous Infusion |
YES, CENTRAL LINE MANDATORY Infusion time: 24 hours |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- 10-12 mg/m2/day x 3-5 days Q 3 weeks
- Use ideal body weight for dose calculations
- Children <0.5 m2 should be dosed on a mg/kg basis. To obtain mg/kg dose, divide mg/m2 by 30
** Dosage may differ according to protocol
Dose adjustment in renal/hepatic impairment:
- serum bilirubin 40-85 micromol/L; give 50% of usual dose
- serum bilirubin > 85 micromol/L; omit
- serum creatinine > 200 micromol/L; give 50% of usual dose
Immediate (within a few minutes to hours):
- Cardiac toxicity, transient arrhythmias, hypotension
- Nausea and vomiting (moderately-high emetogenic potential)
- Red discoloration or urine for 1-2 days (this is not hematuria)
- Fever, chills, rarely anaphylaxis (no precautions necessary)
- Streaks along vein of injection (is likely a flare reaction, not extravasation, may respond to antihistamines or slowing of infusion rate)
- Facial flushing with rapid injection
- Photosensitivity
- VESICANT: extravasation will lead to tissue damage and necrosis. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
Delayed (within a few days to weeks):
- Bone marrow suppression (nadir 7-14 days)
- Alopecia
- Mucositis (may be severe)
- Transient elevation of bilirubin and liver enzymes
- Cardiotoxicity (see notes section below)
- Treatment for unusual side effects available through the study chair identified on the front page of the protocol and/or pharmacy
- Verify whether cardiac function studies are needed prior to administration
- Cardiotoxicity is related to total lifetime cumulative dose (including other anthracyclines). When calculating total cumulative dose of anthracycline, multiply idarubicin dose by 3 to add to cumulative dose (Maximum lifetime dose is 137.5 mg/m2 equivalent to 450 mg/m2 doxorubicin)
- Contraindicated in impaired cardiac function, caution administering if patient has had prior radiation to the field of the heart
- Avoid contact with skin, wash thoroughly with water
- Recall dermatitis may occur in previously irradiated areas