Classifications: antineoplastic; antibiotic; Therapeutic: antineoplastic
Pregnancy Category: D
5 mg, 10 mg, 20 mg vials; 1 mg/mL injection
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.
Idarubicin exhibits inhibitory effects on DNA and RNA polymerase, thus affecting nuceleic acid and protein syntheses in
rapidly dividing cells.
In combination with other antineoplastic drugs for treatment of AML.
Breast cancer, other solid tumors.
Myelosuppression, hypersensitivity to idarubicin or doxorubicin, children <2 y, pregnancy (category D), lactation.
Impaired renal or hepatic function; patients who have received irradiation or radiotherapy to areas surrounding heart; cardiac
Route & Dosage
|Acute Myelogenous Leukemia (AML)
Adult: IV 12 mg/m2 daily for 3 d injected slowly over 1015 min
Acute Nonlymphocytic Leukemia, Acute Lymphocytic Leukemia
Child: IV 1012 mg/m2/d for 3 d
Creatinine >2 mg/dL: give 75% of dose
Bilirubin 1.55 mg/dL: give 50% of dose; if >5 mg/dL: do not use drug
- 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 1015 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
Nephrotoxicity, hepatotoxicity, alopecia,
cause additive bone marrow
, 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
In liver to idarubicinol, which may be as active as idarubicin. Elimination:
16% in urine; 17% in bile. Half-Life:
Idarubicin 1545 h, idarubicinol 45 h.
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
- 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.