IDArubicin (Rx)
Generic: IDArubicin
Brand: Idamycin PFS
(eye-da-roo'bi-sin)
Pharmacological Action
Not cell cycle specific; topoisomerase II inhibitor, a vesicant; intercalating between DNA base pairs, causing shape change, low free radicals
Therapeutic outcome: Prevention of rapidly growing malignant cells
Uses
Used in combination with other antineoplastics for acute myelocytic leukemia in adults Unlabeled uses: Breast cancer, liquid tumors
Contraindications
Pregnancy D, breastfeeding, hypersensitivity
BLACK BOX WARNING: Myelosuppression, bilirubin >5 mg/dl
Precautions: Children, gout, bone marrow depression, preexisting CV disease
BLACK BOX WARNING: Renal/hepatic disease, heart failure
Dosage & Routes
Adult: IV 8-12 mg/m2/day × 3 days in combination with cytarabine (induction) Renal/hepatic dose
Adult: IV if bilirubin is 2.5-5 mg/dl, give 50% of dose; if bilirubin >5 mg/dl, do not use; if CCr >2.5 mg/dl, reduce dose
Available forms: Inj 1 mg/ml
Implementation - Store at room temp for 3 days after reconstituting or for 7 days refrigerated IV route - Avoid contact with skin; very irritating; wash completely to remove - Administer antiemetic 30-60 min before giving product and prn to prevent vomiting; administer antibiotics for prophylaxis of infection Intermittent IV infusion route - Product should be prepared by experienced personnel using proper precautions (biological cabinet, wearing gown, gloves, mask) - Do not give IM/subcut - Give after reconstituting 5-mg vial with 5 ml of 0.9% NaCl (1 mg/1 ml); give over 10-15 min through Y-tube or 3-way stopcock of inf of D5 or 0.9% NaCl; discard unused portion - Apply ice compress after stopping infusion (extravasation)
Adverse Effects
CNS: Fever, chills, headache, seizures
CV: Dysrhythmias, CHF, pericarditis, myocarditis, peripheral edema, angina, MI, myocardial toxicity
GI: Nausea, vomiting, abdominal pain, mucositis, diarrhea, hepatotoxicity
GU: Nephrotoxicity, red urine
HEMA: Thrombocytopenia, leukopenia, anemia
INTEG: Rash, extravasation, dermatitis, reversible alopecia, urticaria, thrombophlebitis, tissue necrosis at inj site, radiation recall
SYST: Infection, tumor lysis syndrome
Pharmacokinetics
Absorption: Complete bioavailability
Distribution: Rapidly distributed, protein binding 97%
Metabolism: Liver, extensively
Excretion: Bile
Half-life: 22 hr
Pharmacodynamics
Unknown
Interactions
Individual drugs
Cyclophosphamide: increased cardiotoxicity
Radiation: increased toxicity
Trastuzumab: increased CHF, ventricular dysfunction
Drug classifications Anticoagulants, salicylates, NSAIDs, thrombolytics: increased bleeding risk, avoid concurrent use
Antineoplastics: increased toxicity Class IA/III, some phenothiazines, other products that increase QT prolongation: increased ECG changes (QT prolongation, changes in QRS voltage)
Corticosteroids: decreased IDArubicin effect Live virus vaccines: decreased antibody response
Drug/lab test
Increased: uric acid, phosphate, potassium
Decreased: calcium, platelets, neutrophils
Nursing Considerations
Assessment - Assess for tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia - Assess symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing; product should be discontinued - Assess for tachypnea, dyspnea, edema, fatigue
BLACK BOX WARNING: Assess for cardiac toxicity: CHF, dysrhythmias, cardiomyopathy; cardiac studies should be done before and periodically during treatment; ECG, chest x-ray, MUGA
BLACK BOX WARNING: Monitor CBC, differential, platelet count weekly; severe myelosuppression can occur - Monitor renal function studies: BUN, uric acid, urine CCr, electrolytes, before, during therapy - Monitor temp (may indicate beginning of infection)
BLACK BOX WARNING: Monitor liver function tests before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly; note jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea; hepatotoxicity can be severe - Assess for bleeding: hematuria, stool guaiac, bruising or petechiae, mucosa or orifices, assess for inflammation of mucosa, breaks in skin - Identify effects of alopecia on body image; discuss feelings about body changes
BLACK BOX WARNING: Assess for local irritation, pain, burning at injection site, extravasation, a vesicant
Patient/family education - Teach patient to avoid use of products containing aspirin or ibuprofen, razors, commercial mouthwash, since bleeding may occur; to report symptoms of bleeding (hematuria, tarry stools) - Instruct patient to report signs of anemia (fatigue, headache, irritability, faintness, shortness of breath) - Advise patient that hair may be lost during treatment; a wig or hairpiece may make patient feel better; new hair may be different in color, texture - Teach patient to rinse mouth tid-qid with water, club soda; brush teeth bid-qid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss - Tell patient not to have any vaccinations without the advice of the prescriber; serious reactions can occur - Teach patient to report if pregnancy is planned or suspected, pregnancy (D) - Advise patient that contraception is needed during treatment and for several mo after the completion of therapy - Teach patient to report signs of CHF, cardiac toxicity, beginning infection - Advise patient to avoid crowds, those with upper respiratory illness - Advise that all body fluids change color
Evaluation
Positive therapeutic outcome: Prevention of rapid division of malignant cells
Reference
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