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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › ANTINEOPLASTIC AGENTS › CYTOTOXIC ANTIBIOTICS AND RELATED SUBSTANCES › Anthracyclines and related substances
daunorubicin
L01DB02
Forms & Strengths
- Solution for injection: 5 mg/mL (as base)
- Liposomal injection: 2 mg/mL
Adult Dosing
- Acute myeloid leukemia (AML): 45 mg/m²/day IV for 3 days per course in combination
- Acute lymphoblastic leukemia (ALL): 45 mg/m²/day IV on days 1, 2, and 3 in combination
- Liposomal formulation: 40 mg/m² IV once every 2 weeks
Pediatric Dosing
- AML/ALL (age ≥ 2 years): 25 to 45 mg/m²/day IV for 3 days, depending on protocol
- Infants < 2 years or BSA < 0.5 m²: Dose calculated on weight basis (1 mg/kg/day)
Indications
- Remission induction in acute myeloid leukemia (AML)
- Remission induction in acute lymphoblastic leukemia (ALL)
- First-line treatment of HIV-related Kaposi sarcoma (liposomal formulation)
Mechanism of Action
- Intercalates between DNA base pairs, inhibiting DNA and RNA synthesis
- Inhibits topoisomerase II, causing DNA strand scission
- Generates cytotoxic free radicals that damage cellular membranes, DNA, and proteins
Contraindications
- Hypersensitivity to daunorubicin or other anthracyclines
- Pre-existing severe myocardial insufficiency or recent myocardial infarction
- Severe baseline myelosuppression
Adverse Reactions
- Cardiotoxicity (acute arrhythmias, chronic dose-dependent cardiomyopathy and heart failure)
- Severe myelosuppression (neutropenia, thrombocytopenia, anemia)
- Mucositis, stomatitis, and gastrointestinal ulceration
- Alopecia and severe local tissue necrosis upon extravasation
Drug Interactions
- Cardiotoxic agents (trastuzumab, other anthracyclines): increases risk of congestive heart failure
- Myelosuppressive drugs: additive bone marrow suppression
- Inhibitors of CYP3A4: may alter metabolism and increase toxicity
- Live vaccines: risk of systemic infection due to immunosuppression
Curated Content: Needs Vetting Before Put to Clinical Use