Parenteral Manual

IDArubicin (NON-FORMULARY)

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): 
IDAMYCIN
Classification: 
Antineoplastic antibiotic (anthracycline) - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • 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.

Reconstitution and Stability: 
  • 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
  • Reconstituted solution stable 72 hours room temperature and 7 days in the fridge.
  • Infusions are stable for 72 hours at room temperature
  • Stable in syringe for 24 hours at room temperature, 7 days in the fridge
  • Protect from light
Compatibility: 

- 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

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, certified nurses only; central line preferred
Infusion time: over 15 minutes into the tubing of a freely running IV

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
Usual dilution: dilute in 500-1,000 mL D5W or NS           

Infusion time: 24 hours

Dosage: 

(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
Potential hazards of parenteral administration: 

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 extravasated, first sign is usually pain.  Refer to policy for administration of vesicant chemotherapy before giving: follow Preventiona and Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

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

Notes: 
  • 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

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