Daunorubicin

Indications

Cancer

Daunobin is given together with other approved anticancer medicines to induce remission in acute nonlymphocytic leukaemia (myelogenous, monocytic or erythroid types) in adults, and to induce remission in acute lymphocytic leukaemia in both children and adults.

⚠️ Always consult a registered physician before taking any medicine.

Pharmacology

Daunorubicin has antimitotic and cytotoxic activity, and several mechanisms have been proposed for how it works. It forms complexes with DNA by intercalation between base pairs. It also inhibits topoisomerase II activity by stabilizing the DNA-topoisomerase II complex, which prevents the religation part of the ligation-religation reaction that topoisomerase II catalyzes. The result is single-strand and double-strand DNA breaks. It may also inhibit polymerase activity, affect the regulation of gene expression, and cause free radical damage to DNA. Against a wide spectrum of animal tumors, whether grafted or spontaneous, it has shown an antitumor effect.

Distribution

Daunorubicin is distributed quickly and widely in the tissues. The highest levels are found in the spleen, kidneys, liver, lungs and heart. The drug binds to many cellular components, particularly nucleic acids. There is no evidence that it crosses the blood-brain barrier, but it apparently does cross the placenta.

Metabolism and Elimination

Daunorubicin is extensively metabolized in the liver and other tissues, mainly by cytoplasmic aldo-keto reductases. This produces daunorubicinol, the major metabolite, which has antineoplastic activity. After a dose of Daunorubicin, about 40% of the drug in the plasma is present as daunorubicinol within 30 minutes, and 60% within 4 hours. Further metabolism has been demonstrated through reduction cleavage of the glycosidic bond, 4-O demethylation, and conjugation with both sulfate and glucuronide. Simple glycosidic cleavage of Daunorubicin or daunorubicinol is not a significant metabolic pathway in man. Twenty-five percent of an administered dose is eliminated in an active form by urinary excretion, and an estimated 40% by biliary excretion.

Pregnancy & Breastfeeding

Pregnancy Category D. It isn't known whether Daunorubicin passes into breast milk, but since many medicines do and this drug carries a risk of serious harm to a nursing infant, mothers should be advised to stop breastfeeding while receiving Daunorubicin treatment.

⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

Dosage Reference

⚠️ Reference ranges from official sources only. Consult your doctor for personalized dosing.

Adults: Check all parenteral products visually for particulate matter before giving them. Representative dose schedules and combination for the approved indication of remission induction in adult acute nonlymphocytic leukemia, in combination: for patients under 60 years of age, Daunorubicin 45 mg/m2/day IV on days 1, 2 and 3 of the first course and on days 1 and 2 of later courses, together with cytosine arabinoside 100 mg/m2/day by IV infusion daily for 7 days in the first course and for 5 days in later courses. For patients aged 60 years and above, Daunorubicin 30 mg/m2/day IV on days 1, 2 and 3 of the first course and on days 1 and 2 of later courses, together with cytosine arabinoside 100 mg/m2/day by IV infusion daily for 7 days in the first course and for 5 days in later courses. This reduction in the Daunorubicin dose is based on a single study and may not be appropriate where optimal supportive care is available. Representative dose schedule and combination for the approved indication of remission induction in pediatric acute lymphocytic leukemia, in combination: Daunorubicin 25 mg/m2 IV on day 1 every week, Vincristine 1.5 mg/m2 IV on day 1 every week, and prednisone 40 mg/m2 by mouth daily. A complete remission is generally achieved within four such courses of therapy. If the patient is only in partial remission after four courses, one further course, or two if necessary, may be given in an effort to achieve complete remission. In children under 2 years of age or with a body surface area below 0.5 m2, it is recommended that the Daunorubicin dose be calculated by weight (1 mg/kg) rather than by body surface area. Representative dose schedules and combination for the approved indication of remission induction in adult acute lymphocytic leukemia, in combination: Daunorubicin 45 mg/m2/day IV on days 1, 2 and 3, and Vincristine 2 mg IV on days 1, 8 and 15; prednisone 40 mg/m2/day by mouth on days 1 through 22, then tapered between days 22 and 29; L-asparaginase 500 IU/kg/day IV for 10 days on days 22 through 32. Or, as directed by the registered physician.

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Indications

Pharmacology

Pregnancy & Breastfeeding

Dosage Reference

Side Effects & Interactions

Side Effects

Key Interactions