IDARUBICIN

IDARUBICIN (i-da-a-roo'bi-cin) Idamycin PFS Classifications: antineoplastic; antibiotic; Therapeutic: antineoplastic Prototype: Doxorubicin Pregnancy Category: D

Availability

5 mg, 10 mg, 20 mg vials; 1 mg/mL injection

Action

Cytotoxic anthracycline antibiotic. Potency of idarubicin is greater than that of daunorubicin or doxorubicin. It may be less cardiotoxic than other anthracyclines. Idarubicin exhibits inhibitory effects on DNA topoisomerase II, an enzyme responsible for repairing faulty sections of DNA. It results in breaks in the helix of the DNA, and thus it affects RNA and protein synthesis in rapidly dividing cells.

Therapeutic Effect

Idarubicin exhibits inhibitory effects on DNA and RNA polymerase, thus affecting nuceleic acid and protein syntheses in rapidly dividing cells.

Uses

In combination with other antineoplastic drugs for treatment of AML.

Unlabeled Uses

Breast cancer, other solid tumors.

Contraindications

Myelosuppression, hypersensitivity to idarubicin or doxorubicin, children <2 y, pregnancy (category D), lactation.

Cautious Use

Impaired renal or hepatic function; patients who have received irradiation or radiotherapy to areas surrounding heart; cardiac disease.

Route & Dosage

Acute Myelogenous Leukemia (AML) Adult: IV 12 mg/m2 daily for 3 d injected slowly over 10–15 min Acute Nonlymphocytic Leukemia, Acute Lymphocytic Leukemia Child: IV 10–12 mg/m2/d for 3 d Renal Impairment Creatinine >2 mg/dL: give 75% of dose Hepatic Impairment Bilirubin 1.5–5 mg/dL: give 50% of dose; if >5 mg/dL: do not use drug

Administration

Intravenous IV administration to infants, children: Verify correct IV concentration and rate of infusion with physician. PREPARE: IV Infusion: • Reconstitute 5- and 10-mg vials with 5 and 10 mL, respectively, of nonbacteriostatic NS to yield 1 mg/mL.• Vials are under negative pressure, therefore, carefully insert needle into vial to reconstitute.• Wash skin accidentally exposed with soap and water.  ADMINISTER: IV Infusion: Give slowly over 10–15 min into tubing of free flowing IV of NS or D5W.   If extravasation is suspected, immediately stop infusion, elevate the arm, and apply ice pack for ? h then q.i.d. for ? h x 3 d. INCOMPATIBILITIES Solution/additive: alkaline solutions (i.e., sodium bicarbonate), heparin. Y-site: Acyclovir, allopurinol, ampicillin/sulbactam, cefazolin, cefepime, ceftazidime, clindamycin, dexamethasone, etoposide, furosemide, gentamicin, heparin, hydrocortisone, imipenem/cilastatin, lorazepam, meperidine, methotrexate, mezlocillin, piperacillin/tazobactam, sargramostim, sodium bicarbonate, teniposide, vancomycin, vincristine.

• Store reconstituted solutions up to 7 d refrigerated at 2°–8° C (36°–46° F) and 72 h at room temperature 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CV: CHF, atrial fibrillation, chest pain, MI. GI: Nausea, vomiting, diarrhea, abdominal pain, mucositis. Hematologic: Anemia, leukopenia, thrombocytopenia. Other: Nephrotoxicity, hepatotoxicity, alopecia, rash.

Interactions

Drug: immunosuppressants cause additive bone marrow suppression; anticoagulants, nsaids, salicylates, aspirin, thrombolytic agents increase risk of bleeding; idarubicin may blunt the effects of filgrastim, sargramostim.

Pharmacokinetics

Onset: Median time to remission 28 d. Peak: Serum level 4 h. Duration: Serum levels 120 h. Distribution: Concentrates in nucleated blood and bone marrow cells. Metabolism: In liver to idarubicinol, which may be as active as idarubicin. Elimination: 16% in urine; 17% in bile. Half-Life: Idarubicin 15–45 h, idarubicinol 45 h.

Nursing Implications

Assessment & Drug Effects

• Monitor infusion site closely, as extravasation can cause severe local tissue necrosis. Notify physician if pain, erythema, or edema develops at insertion site.
• Lab tests: Monitor hepatic and renal function, CBC with differential and coagulation studies periodically.
• Monitor cardiac status closely, especially in older adult patients or those with preexisting cardiac disease.
• Monitor hematologic status carefully; during the period of myelosuppression, patients are at high risk for bleeding and infection.
• Monitor for development of hyperuricemia secondary to lysis of leukemic cells.

Patient & Family Education

• Learn all potential adverse reactions to idarubicin.
• Anticipate possible hair loss.
• Discuss interventions to minimize nausea, vomiting, diarrhea, and stomatitis with health care providers.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug