Names and pronunciation
(eye-dah-roob′ih-sin) Idamycin PFS
PDF page 674
Loading InternPractice…
Drug reference
(eye-dah-roob′ih-sin) Idamycin PFS
PDF page 674
Func. class.: Antineoplastic, antibiotic
PDF page 674
Chem. class.: Anthracycline glycoside
PDF page 674
Do not confuse: IDArubicin/DOXOrubicin
PDF page 674
ACTION: Non–cell-cycle specific; topoisomerase II inhibitor; vesicant; inter- calating between DNA base pairs, causing shape change, low free radicals
PDF page 674
USES: Used in combination with other antineoplastics for acute myelocytic leu- kemia in adults
PDF page 674
Unlabeled uses: Breast cancer, liquid tumors, non-Hodgkin’s lymphoma, ALL, CML, NHL
PDF page 674
CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity to this product or other anthracyclines/ anthracenediones, severe infection, max- imum cumulative dose of IDArubicin, DOXOrubicin, daunorubicin, epiRUBi- cin, or other anthracenediones
PDF page 674
Black Box Warning: Myelosuppression, bilirubin >5 mg/dL Precautions: Children, gout, bone mar- row depression, preexisting CV disease, dehydration, electrolyte imbalance, infection, vaccination Black Box Warning: Renal/hepatic dis- ease, heart failure Black Box Warning: Renal/hepatic dose: Adult: IV CCr >2.5 mg/dL, reduce dose; bilirubin 2.5-5 mg/dL, reduce dose by 50%; bilirubin >5 mg/dL, do not use Black Box Warning: CBC, differential, platelet count weekly; notify prescriber of results, severe myelosuppression can occur • Renal studies: BUN, serum uric acid, urine CCr; electrolytes before, during therapy • Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hy pocalcemia • I&O ratio; report fall in urine output to <30 mL/hr • Monitor temperature; fever may indi- cate beginning infection Black Box Warning: Hepatic studies be- fore, during therapy: bilirubin, AST, ALT, alk phos prn or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea, do not use if bilirubin >5 mg/dL Black Box Warning: Cardiac toxicity: HF, dysrhythmias, cardiomyopathy; car- diac studies before and periodically dur- ing treatment: ECG, chest x-ray, MUGA; ECG: watch for ST-T wave changes, low QRS and T, possible dysrhythmias (sinus tachycardia, heart block, PVCs) • Bleeding: hematuria, guaiac stools, bruising or petechiae, mucosa or orifices • Effects of alopecia on body image; discuss feelings about body changes • Inflammation of mucosa, breaks in skin • Buccal cavity for dryness, sores, ulcer- ation, white patches, oral pain, bleeding, dysphagia Black Box Warning: Local irritation, pain, burning at inj site; extravasation (vesicant) • GI symptoms: frequency of stools, cramping • Increase fluid intake to 2-3 L/day to prevent urate and calculi formation • Pregnancy/breastfeeding: do not use in pregnancy/breastfeeding
PDF pages 674, 675, 676
SIDE EFFECTS CNS: Fever, chills, headache, seizures CV: Dysrhythmias, HF, pericarditis, myo carditis, 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; thrombo phlebitis and tissue necrosis at inj site; radiation recall SYST: Infection, tumor lysis syndrome, anaphylaxis, infection, shock, myelodys plastic syndrome
PDF page 675
INTERACTIONS Increase: bleeding risk—anticoagulants, salicylates, NSAIDs, thrombolytics; avoid concurrent use Decrease: IDArubicin effect—corticoste- roids Increase: HF, ventricular dysfunction— trastuzumab Increase: ECG changes (QT prolongation, changes in QRS voltage)—class IA/III anti dysrhythmias, some phenothiazines, and other products that increase QT prolongation Increase: cardiotoxicity—cyclophospha mide Increase: toxicity—other antineoplastics or radiation Decrease: antibody response—live virus vaccines Drug/Lab Test Decrease: calcium, platelets, neutrophils Increase: uric acid, phosphate, potas- sium, LFTs I
PDF page 675
DOSAGE AND ROUTES • Adult: IV 8-12 mg/m2/day × 3 days in combination with cytarabine (induction) • Adolescent/child (unlabeled): IV 10- 12 mg/m2/day × 3 days
PDF page 674
Available forms: Inj 1 mg/mL in 5-mL, 10-mL, 20-mL single-use vials
PDF page 674
Administer: • Intermittent ice compress after stop- ping infusion for extravasation (1⁄2 hr immediately, then 1⁄2 hr qid × 3 days), elevate extremity; early wide excision of area may be considered if severe pain persists • Store at room temperature for 3 days after reconstituting or 7 days refriger- ated Intermittent IV INFUSION route • Do not give IM/SUBCUT • Use cytotoxic handling procedures af- ter preparing in biologic cabinet wearing gown, gloves, mask • Antiemetic 30-60 min before product and 6-10 hr after treatment to prevent vomiting • After reconstituting 5-mg vial with 5 mL 0.9% NaCl (1 mg/1 mL), give over 10-15 min through Y-tube or 3-way stopcock of infusion of D5W or NS; discard unused portion; use caution when needle inserted into vial (negative pressure) • Use a free-flowing IV; do not give IM/ SUBCUT • A vesicant, monitor for necrosis Y-site compatibilities: Amifostine, amika- cin, aztreonam, cimetidine, cladribine, cyclophosphamide, cytarabine, diphen- hydrAMINE, droperidol, erythromycin, filgrastim, granisetron, imipenem/CISplatin, magnesium sulfate, mannitol, melphalan, metoclopramide, potassium chloride, ra- NITIdine, sargramostim, thiotepa, vinorelbine
PDF pages 674, 675
Assess:
PDF page 675
Evaluate: • Therapeutic response: decreased liquid tumor, spread of malignancy
PDF page 676
CLINICAL CONSIDERATIONS
PDF page 675
Patient and caregiver information: • To report signs of HF, cardiac toxicity, beginning infection • That hair may be lost during treatment; that wig or hairpiece may make patient feel better; that new hair may be different in color, texture • To avoid foods with citric acid, hot temperature, or rough texture • To avoid crowds, persons with upper respiratory illness • To report any bleeding, white spots, ulcerations in mouth; to examine mouth daily • That urine may be red-orange for 48 hr; that all body fluids will change color • To report if pregnancy is planned or suspected; to use contraception during treatment and for ≥4 mo after treatment
PDF page 676
PHARMACOKINETICS Half-life 22 hr; metabolized by liver; crosses placenta; excreted in bile, urine (primarily as metabolites); 97% protein binding
PDF page 675
• Adolescent/child (unlabeled): IV 10- 12 mg/m2/day × 3 days
PDF page 674